- © 2007 Canadian Medical Association or its licensors
Registered nurse
My physician recently told me that he had audited the charts of his patients with diabetes. I casually asked who had done the audit for him. He replied, “My daughter.” My heart dropped; his daughter is a student nurse in the program in which I teach.
In a later conversation I asked if all identifying information had been removed before the audit took place. It soon became clear that the physician's daughter had had full access to my medical file.
I feel that during the conduct of this audit there was a failure to adhere to several ethical standards. First, patient privacy and confidentiality were violated. Second, informed consent was not obtained, as required by the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans.1 Third, the CMA Code of Ethics was breached, particularly some of the guidelines itemized in the sections entitled “Fundamental Responsibilities” and “Responsibilities to the Patient.”2 In addition, student nurses need to be aware that they must adhere to the Canadian Nurses Association's Code of Ethics3 under all circumstances, regardless of whether or not a physician has asked them to do something.
I am writing this letter not to complain, but to ask physicians to stop and think about the methods they are using to evaluate their practices. I urge the colleges of physicians to review protocols for chart audits to ensure that patient confidentiality is safeguarded and to give serious consideration to insisting that written informed consent be obtained before any information collected during such audits is disclosed to third parties. I appreciate my own physician's professionalism in listening to my concerns.
Footnotes
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Editor's note: This letter writer's name and affiliation have been withheld at our request and with the letter writer's consent to protect the privacy of all concerned.