Today’s correspondent has a
… question re privacy and confidentiality. At a mine site the Paramedic office is placed in a team office where four offices are able to overhear conversations in each room.
1) Open door policy: This would breach privacy and confidentiality would it not? Assessing and treating a patient where anyone can hear and see.
2) Paper thin walls allow personal information to be heard by others. Is this a breach of privacy/confidentiality?
How is this situation best approached in a diplomatic way. I believe a number of mine sites have paramedic offices within the same office space as the safety team whereas for others the paramedic’s office is far removed for privacy reasons.
I’m not sure what is meant by an ‘open door policy’ – usually that means that managers or colleagues are available to consult, eg when I was a young barrister we were told that the bar had an open door policy which meant that we could in fact knock on anyone’s door (form our junior colleague to the most senior QC) and ask for advice or guidance. Not that their door would be physically open or that we could ask at any time – if they were busy there were busy. I find it hard to believe that there is a policy that insists office doors are open at all times.
However we can put aside the details as the issue is clear – what is the obligation when conversations can be heard and treatment seen.
The starting place is the AHPRA Code of Conduct adopted by the Paramedicine Board. The Code says, at [3.3] (emphasis added):
3.3 Confidentiality and privacy
You have ethical and legal obligations to protect the privacy of patients. Patients have a right to expect that you will hold information about them in confidence, unless the release of information is required or authorised by law, or is required to facilitate emergency care.
To protect privacy and confidentiality, good practice includes that you:
b) provide surroundings to enable private and confidential consultations and discussions, particularly when working with multiple people at the same time, or in a shared space…
The NSW Health Privacy Manual (2015) says (at [9.2.8], emphasis added) “It is important to ensure that patient information is not discussed in public areas such as corridors or lifts or anywhere where it is likely to be overheard”.
It is an expectation that you will not treat patients where they can be seen or your consultation overheard (which again causes me to ask ‘How are reality ambulance shows legal? (October 9, 2018)).
In short, treating people in circumstances where “anyone can hear and see” and “personal information [can] be heard by others” is a breach of privacy/confidentiality and contrary to professional expectations. It is not for me to answer ‘How is this situation best approached in a diplomatic way’ because that depends on the employer and your relationship with them; but it should be raised and reference should be made to the Code and the expectations that apply to a paramedic because they are a paramedic, not because they are an employee of a particular company.
This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.
Check your state legislation with regards to treatment areas and first aid rooms
Mark, I’m not sure what legislation you have in mind so if you could point to specific legislation that would help. Old legislation like the Occupational Health and Safety Regulation 2001 (NSW) used to have detailed instructions on first aid facilities and rooms, including a requirement that a first aid room ‘is not used for any purpose other than for first aid or occupational health purposes’ (cl 20) but that regulation is no longer in force and that sort of detail is not contained in the Work Health and Safety Act 2011 and its regulations. Today the Code of Conduct for First Aid in the Workplace says “A risk assessment will help determine the type of first aid facilities needed. For example, a clean, quiet area within the workplace that affords privacy to an injured or ill person may be suitable and practicable for some workplaces”. That does reinforce the need for privacy when providing first aid but consistent with the trend in modern legislation there are not specific guides rather it is up to the PCBU to determine taking into account the needs of the workplace.