Ministry of Health releases guidelines on disclosing confidential information for medical practitioners

Following the High Court’s move to overturn a psychiatrist’s conviction for breaching one of his patient’s confidential information, the Ministry of Health (MOH) sent out a circular on Wednesday (22 October) to medical practitioners on guidelines on how to communicate medical information over the phone. In the beginning of this year, Dr Soo Shuenn Chiang, a psychiatrist at the National University Hospital (NUH) was fined S$50,000 by the Singapore Medical Council’s (SMC) tribunal after he pleaded guilty for failing to verify the identity of a caller claiming to be the patient’s husband, writing a memo containing the patient’s confidential medical information, and failing to take appropriate steps to ensure that such information was not accessible to unauthorized persons. The Ministry stated that their decision to come up with these guidelines came after a review began in March this year, where opinions were gathered from public healthcare institutions, polyclinics and private hospitals. Below are the seven “key guiding principles” that was formed by MOH when it comes to communicating medical information over the phone:

• When a request for medical information comes in, balance the need to act in a patient’s best interest with the need to respect the patient’s confidentiality
• The right processes and avenues must be taken, and it can only be changed if there is “legitimate urgent need” to do so
• Both caller (if he is medical professional) and receiver must make proper documentation, which include the reasons why the medical information is urgently needed, the kind of information requested and released, and the identities of individuals involved in the call.
• When it comes to identifying the individual who is requesting for information, reasonable effort should be made. For example: medical institutions could find out the caller’s relationship with the patient, three patient identifiers or return the call through the assigned next-of-kin’s number as written in the patient’s records
• Ensure only necessary information that is requested is shared.
• Healthcare providers must find appropriate methods to divulge the confidential information to make sure it reaches the right person
• Healthcare institutions should consistently look at the requests and release of confidential medical information

Patients have the right to expect that their medical information in terms of clinical care will be secured as private and confidential, based on SMC’s ethical code and guidelines. However, their information will be released only if a patient gives an approval for specific disclosure to other parties. If that’s not all, it is also stated under the Private Hospitals and Medical Clinics Regulations that proper safeguards must be done by healthcare institutions to protect medical records against unlawful and accidental loss, destruction or modification, or disclosure, unauthorized access, copying, use or modification.

Dr Soo’s case

The affected patient of Dr Soo was admitted to NUH in January 2015 due to a drug overdose. On 20th March 2015, Dr Soo received a call from the patient’s brother claiming to be the patient’s husband at that time, and was informed that the patient was suicidal. Acting on this information, Dr Soo wrote a memo referring the patient to the Institute of Mental Health for a suicide assessment risk, which was addressed to “Ambulance staff / Police-in-charge”. He also left instructions for his clinic staff for the memo “to be passed to the patient’s husband who had called earlier that same day”. It turned out that the memo reached the patient’s brother’s hands and he used it to obtain a Personal Protection Order against the patient. The patient then made a complaint against Dr Soo for failing to verify the identity of the caller. After having been granted an extension of time to appeal by the High Court in March, the SMC also recorded new statements from the patient’s brother and ex-husband, and sought to have them admitted before the appeal court, to which Dr Soo had no objections. During the hearing, it was revealed that the brother stated that he did not misrepresent himself to Dr Soo that he was the patient’s husband; instead, he did clarify at that time that he was “calling on behalf of the patient’s husband”. This appeared contradictory to Dr Soo’s clinical notes stating that the patient’s husband had called; even the patient herself was disputing the truthfulness of the account of events in the new statements. After Dr Soo was fined S$50,000 by the SMC’s tribunal, it resulted to a furore among doctors. In fact, two petitions emerged – one supporting the psychiatrist and the other one pushes the SMC to look at the ruling’s impact on medical practice. Following that, on 14 March 2019, the SMC noted that it would be requesting for the fine to be reduced. Just two months later, the council said that it would seek to overturn the conviction, as new information came to known and it had raised doubt on the “circumstances surrounding the incident”. In March this year, Dr Soo was fined S$50,000 by the SMC’s tribunal. This sparked an outcry among doctors and two petitions emerged, one in support of the psychiatrist and the other urging the SMC to consider the ruling’s impact on medical practice. The High Court then quashed the psychiatrist’s conviction on 18 October.