National Pathology Accreditation Advisory

Question:

Answer:

Introducation

Informed consent is the permission a patient grants a treating practitioner to perform a pathology test after the practitioner has explained the possible consequences of the procedure. The level of consent needed by the treating practitioner relates to the kind of procedure being undertaken or the kind of information needed. The types of consent associated with pathology are implied consent, verbal consent and written consent (1). Implied consent happens when an individual willingly cooperates in a procedure without discussion. Verbal consent happens when an individual willingly states their consent to a pathology test. Finally, written consent happens when an individual willingly signs a consent form affirming the test and its linked implications have been explained and understood (1). Confidentiality is the obligation of the treating practitioner to protect a patient against improper disclosure of pathology test results.

Informed consent and confidentiality are governed by the National Pathology Accreditation Advisory Council (NPAAC). Under NPAAC, informed consent is guaranteed in S1.4 (2). This section notes that consent is needed for an autopsy, which can be gotten from the next of kin. However, exclusion is allowed when the Coroner directs an autopsy. In some instances, the patient might grant consent antemortem. Consent might be needed for retention of a particular specimen or body part for research in laboratory and quality activities. In pathology tests, consent also includes informed financial consent. Financial consent happens when all the costs for a procedure are elucidated before the pathology test starts. The final account involving pathology test might be unknown before the pathology test begins. According to S1.5 of the NCAAP, the confidentiality and privacy of a patient should be observed at all times (2).

The Privacy Act 1988 also governs informed consent and confidentiality in medical research. Based on the Privacy Act, researchers should seek patient’s consent before commencing their research activities (3). Also, they should protect the person’s health information from unexpected or inappropriate use. Informed consent and confidentiality should also be observed in genetic testing. A treating practitioner should seek consent before commencing a genetic testing procedure in an accredited laboratory. The genetic results should be treated as confidential and should not be given to another healthcare provider or family member without the patient's consent (4). Another legislation that propagates confidentiality is Health Administration Act 1982. This Act specifically protects a person’s HIV test results. The Act notes that it is an offence for a pathology laboratory to share or disclose a patient’s HV status results without written consent (5).

How does your workplace manage the consequences of not obtaining informed consent? How is professional confidentiality maintained?

My workplace is rmit university histopathology laboratory. Since rmit is teaching laboratory, we do not have consequences of not obtaining informed consent. The workplace acknowledges that consent to any pathology test should be sought from a patient. Further, the testing practitioners understand that failure to obtain consent could lead to legal actions. Evidently, failure to obtain consent might result in civil liability for adverse outcomes, even if the particular treatment was not negligent (6). Such a case might be classified as gross negligence, unauthorised practice or malpractice. However, my workplace is shielded from legal actions because of it’s a teaching centre.

Professional confidentiality in the workplace is maintained in various ways. Firstly, there is a confidentiality agreement in the workplace. The confidentiality agreement is a legal document that particularises what information can be shared outside the laboratory. All new practitioners are required to sign the confidentiality agreement during orientation. Secondly, there are guidelines for collecting and handling patient information. Practitioners are required to de-identify the collected data to ensure it is stored anonymously. Codes are used on data documents instead of registering identifying information. Besides, practitioners are advised to keep separate documents that link the code to subject’s identifying information. Several other elements that govern the handling of information are the removal of face sheets with identifiers, proper disposal of data, limited access to discernible information and securely storage of data documents. Fourthly, professional confidentiality in the workplace is enhanced through the provision of training regularly. Training in the rmit pathology laboratory is meant to make sure that all testing practitioners understand the principles of professional confidentiality. Occasionally, training opportunities are provided to the practitioners to learn about privacy issues and the methods that can enhance confidentiality in the workplace. Lastly, professional confidentiality in the workplace extends to medical information as well as daily routines.

References

Department of Health. Pathology - The Facts. Consent - What you need to know. [Online].; 2013 [cited 2017 10 3. Available from: https://www.health.gov.au/internet/publications/publishing.nsf/Content/qupp-benefits-and-risks-for-consumers-of-pathology-testing~qupp-consent

Australian Government Department of Health. Requirements for medical pathology services. Canberra : National Pathology Accreditation Advisory Council (NPAAC), Department of Health; 2013. Report No.: NPAAC Tier 2 Document.

OAIC. Health information and medical research. [Online].; 2017 [cited 2017 10 3. Available from: https://www.oaic.gov.au/privacy-law/privacy-act/health-and-medical-research#medical-research.

Royal College of Pathologist of Australia (RCPA). Pathology: The Facts. [Online].; n.d. [cited 2017 10 3. Available from: https://www.rcpa.edu.au/Library/Fact-Sheets/Pathology-The-Facts/Docs/Path-Fcts-Bookl

HIV Legal. Privacy and Confidentiality. [Online].; 2013 [cited 2017 10 3. Available from: https://hivlegal.ashm.org.au/index.php/guide-to-australian-hiv-laws-and-policies-for-healthcare-professionals/privacy-and-confidentialit

Australia Law Reform Commission (ALRC). Informed consent to medical treatment. [Online].; 2017 [cited 2017 10 3. Available from: https://www.alrc.gov.au/publications/10-review-state-and-territory-legislation/informed-consent-medical-treatment#_ftn36