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By Pharm. Stephen Daniel Davou
The quotes, “Health is wealth” and “a healthy nation is a wealthy nation” have become universal that many users do not know that their origins were the American philosopher, Ralph Waldo Emerson, and Nduka, respectively.
These two great statements I can describe to be Siamese twins, as a look at the health indices and economic values of nations have solidified the assertion. “Health” is defined as a state of wellness of an individual. An individual is comprised of the body and the mind, and any or both of these components could become faulty, and would need care to restore it to a good state.
Goal 3 of the United Nations Sustainable Development Goals (SDGs) desires health and well-being for all. Based on this desire – and even before it – healthy citizens are encouraged to maintain their states of health, while sick citizens need healthcare. Indeed, responsible governments see healthcare as a right of their citizens.
Government at all levels – local, state, and federal – provide healthcare to citizens with the Primary Healthcare Centres, Secondary Health Facilities, or Tertiary Healthcare Centres. Private individuals and organisations, including religious bodies and other non-governmental organisations, also provide humanitarian social service at different levels.
Healthcare has been defined as the preservation of mental and physical health by preventing or treating illness through services offered by the health profession.4&5 In other words, healthcare is offered by professionals and the care could be in either preventive or curative, or both.
Approaches to healthcare
There are many approaches to healthcare, summarised as traditional and orthodox. In either of the approaches, there is always a provider and a recipient (client or beneficiary). Other parties that have emerged in healthcare include the regulator, patient relations, third-party-payer (for people on insurance), and patient groups.
In modern orthodox healthcare provision, no single professional can claim sole responsibility for successes or failures. Services are offered by teams, and a team of healthcare providers could be made of technicians, doctors, medical laboratory scientists, journalists, medical records officers, drivers, sanitary officers, pharmacists, dieticians, medical imaging scientists, security personnel, and so on.
The number and types of professionals in any team depend on many factors, such as category of health facility, types of services offered in the facility, specialisation(s) of the team, etc.
Some organisations have moved on to integrate traditional and orthodox medical practices. Typical examples of integrated healthcare providers are Alexandria Hospital (a government-owned health facility) and Radcliffe Hospital (a private health facility), all in Singapore.
Some other examples of integrations in healthcare are informal referrals from the Jos University Teaching Hospital (a government-owned tertiary healthcare facility and orthodox practitioner) on the Jos Plateau to Dantoros House (a private healthcare facility and traditional bone-setter) in Vom Plateau state.
Reverend Dachung, a traditional bone-setter sent his clients to get drugs, especially analgesics, bandages, antibiotics, antioxidants and haematinics from Dachny Pharmacy and store. There are many more examples of integrations of the traditional and orthodox healthcare practices in nearly all communities.
Necessity of information-sharing
For effective healthcare delivery, information is shared at least between the provider and the recipient – and in some cases with any or some of the other parties. This information needs to be treated with every sense of respect and care, in order to protect the privacy of the client and for confidence to be built amongst parties, especially the recipient and the provider. Any leakage or passage of information to the wrong party could jeopardise the process of healthcare, and might invite legal action, or even heads to roll, as witnessed during the outbreak of COVID-19 on the Plateau.
Many tools are employed in management and/or provision of healthcare.7-10 The list of tools is endless, as every organisation or community has different tools for same or different forms of healthcare. The tools employed in the provision of healthcare range from simple devices as pens, files/folders, papers and books, to stethoscopes and sphygmomanometers, to cars and lorries, helicopters/airplanes/jets, computers, CT scan machines, x-ray machines, MRI machines, drugs and other medical consumables, as well as to nonphysical tools as counselling, confidentiality, teaching, teamwork, etc.,. For the purpose of this work, kindly permit me to propose that the tools can simply be grouped as palpable and impalpable tools.
Place of confidentiality
Confidentiality is as an impalpable tool, and has been defined as the state of being kept secret or private. This can raise many other questions in healthcare delivery, as another quote says, “There is no secret between two persons.”
One may ask, should there be secrets in healthcare? Celine Dion brought another concept, “If walls could talk.”11 Looking at all the listed quotes and concepts it becomes difficult to pin-point who and where confidence is broken in healthcare, due to leakage of information.
Information collected for the purpose of use in healthcare needs to be a secret between the giver and the user(s) of the information. Some of the pieces of information in healthcare are not given, and may even be unknown to the client/patient; but the information generated/discovered in the course of providing healthcare services must be held in confidence. For instance, evidences of pregnancies, rapes, HIV status, etc. of clients MUST be held in confidence.
Vital considerations
It must be noted that confidentiality in healthcare is complex, as receivers of information may have collected such information for the use of another or other persons in the “team”; hence the information must be revealed or disclosed, or shared with others. For instance, a folder may need to be marked “reacts to sulphonamides” for all other members in a healthcare team to know that the client being attended to should in no way be administered any sulphonamide-containing medication.
It is common knowledge that some clients infected with the Human Immunodeficiency Virus (HIV) got stigmatised when their statuses were disclosed to persons that had little or no knowledge of the disease. Some of such patients get depressed and their health status deteriorates, even when the HIV disease has not developed into the Acquired Immune Deficiency Syndrome (AIDS).
The duty to maintain confidentiality of patient information is not explicit; instead, it is implied by the nature of the relationship.12 For example, a receptionist or medical records officer collects information from a client for use of many others in the team, who may or may not meet with the recipient later in the course of service provision. Also, a pharmacist may need to share the information of a client with other pharmacies to enable him or her get medications for his or her client from any of the pharmacies. However, irrespective of who gets access to a client’s information, there must be confidentiality.
We need to also note that the client/recipient of healthcare has a right to access his or her information, when the need arises. This beneficiary of the information that needs to be treated with every confidence also has the right to disclose/share the information to whoever he or she wants. In this scenario it becomes difficult to employ confidentiality in healthcare.
Where then is the place of “freedom of expression,” as enshrined in the Nigerian Constitution?13&14 This question can be a subject of another discussion.
Conclusion
There are diverse ways in which information can/must be shared in healthcare. However, whatever the reason for sharing information, confidentiality is a watchword to protect the client(s). The simple nature of information sharing through the internet has made sharing and leakage of information simple; hence the concept of confidentiality in healthcare can be revisited to accommodate the invention of Internet.
(davoustephen@yahoo.com , 08036819758, WhatsApp: 08170925112)
References:
Advanced English Dictionary Offline
Oxford Advanced Learners Dictionary, New 8th Edition
Editorial: A Healthy Nation is a Wealthy Nation, African Newspage
Guidelines For Donations of Medicines And Health Care Equipment In Nigeria
Federal Republic of Nigeria Essential Drugs List, Fourth Revision 2003
Nigeria Supply Chain Policy for Pharmaceuticals and Other Healthcare Products, February 2016
Nigeria Centre For Disease Control Participants’ Manual For Logistics And Supply Chain Management
Celine Dion – If Walls Could Talk from the Album All the Way … A Decade of Song, 1999
1999 Constitution of the Federal Republic of Nigeria And Fundamental Rights(Enforcement Procedure) Rules With Amendments 2011
Freedom of Information Act 2011, Laws of the Federation of Nigeria
