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Patient Confidentiality
Patient Confidentiality
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A Debate on Patient Confidentiality
Patient confidentiality is a set of rules that protects the information regarding a patient and to ensure the information remains between the patient and the practitioner. Confidentiality in the medical field is a core value for the health practitioners and the HIPAA regulations. It is in the code of ethics for healthcare and all practitioners are bound to follow it failure to which legal actions may be taken against the facility or the practitioner. It helps build trust between the patient and the practitioner. This is important because it will enable a patient to open up about their health problems and in turn receive proper medical attention. However, there are some instances that allow the disclosure of a patient’s information. These exceptions include when a patient gives consent to the disclosure, an order from a court of law or when the information will put either the patient or people around him or her in danger. The purpose of this paper is to debate on the patient confidentiality, whether a patient’s information should remain confidential or it should be disclosed.
Patient confidentiality should not be a thing in the medical field. Most of the time a patient delegates the responsibility of decision making to his or her family about a treatment plan. This alone breeches the patient confidentiality ethics because there is a third party involved in the sharing of the information. This could be a good thing because sometimes patients may be too sick or not in the right state of mind and a next of keen will have to be involved in the treatment of the patient sometimes without the consent of the patient.
Secondly, during the visits by physicians there are always informal advocates who are present. These may include family members or other people who have come to pay a visit to the patient or interns who need to learn one thing or another. It is always difficult to send away the family members because they usually want to know the progress of their patient. And even if you manage to keep them away during the physician visit, the patients themselves will tell them everything about their health and the progress of their treatment. This beats the point of having patient confidentiality.
Thirdly, in most cases the bills of the patients are being paid by either family members or well-wishers. It beats logic that you will have the information about this patient kept confident and not tell the people who are taking care of the patient. Then how do they know what they are paying for if they do not even know what the patient is suffering from (Riaz et al, 2017). For instance, if they want to hold a fundraising, they have to tell the well-wishers what the patient is suffering from; like cancer. This way people will empathize with the health condition of the patient and decide to give a hand to cover the bills. However, hiding this information will make people ignorant and they will assume that it is nothing serious.
Also, family members are the full support that a patient needs in hiss or her journey to recovery. What sense will it make when a patient is the only person who knows what they are suffering from and are fighting their battles alone. One could argue that a patient can talk to a therapist instead of disclosing their information to other third parties. However, there is love and emotional support in family that a patient needs which he or she cannot get by simply sharing with practitioners alone. For instance, a patient who is married cannot keep their health conditions a private matter between them and the practitioners, they will have to share that information with their partners too. It could be so unfair if the partner is kept out of light on what is going on with the health of their spouse (Hosseini, 2019). So, the fact that the family needs to know and be there for the patient, breeches patient confidentiality.
In addition to that, patients may not give full information and encounter about their health issues. In this case, practitioners will gather more information from the family members on their observations of how the patient is affected or if the patient is compliant and adheres to medication. These are tiny bits of information that will help a practitioner to prescribe the right treatment plan for the patient. The family of the patient will also help in monitoring the progress of the patient after they are discharged. They could be liable to report any negative effects the medication has on the patient and prompt for a change in the treatment plan. They can also ensure that the patient adheres to medication in order to get better. All this cannot be possible if patient confidentiality is followed to the letter.
There is no confidentiality when it comes to pediatric patients. Children cannot fully express themselves and say what their problem might be. They would vaguely point out a stomach ache, toothache or a headache. In real sense it could be more than that and that is why a parent or guardian is required. This way, the parent can talk of the symptoms they have observed and any other thing that may seem off with the health of their child. this will help a practitioner diagnose the child and recommend or prescribe medication for the child. it would not make sense at all if patient confidentiality was respected in this case.
A mental health patient would come for treatment or a therapy session and in the course of it he or she would confess to wanting to harm himself or other people. This gives direct permission for a practitioner to disclose this information because the patient is an immediate danger to himself or to others. This information could be crucial in helping save a life only if patient confidentiality is broken. It is possible that the patient said that due to their mental health status and meaning no harm but you cannot take the chance of sitting on that information without disclosing it to the police. In the end if something of that kind happens and someone gets hurt, the practitioner will still be held responsible because they had the information. In this case, how patient confidentiality will sue you instead of protecting you as a practitioner.
They say no one is above the law and that includes patient confidentiality. A court of law can give an order for the information of an individual to be disclosed. It could be a criminal whose files or medical conditions are required in order to determine if he or she is in his or her right state of mind. Releasing the information could also help in determining where this individual was at a given period, it could help prove that they are innocent in case the crime happened at the same time they had visited the hospital. This could be used as a piece of evidence in the proceedings of the case in a court of law. Failure to disclosing the required document or information will lead to charges of obstruction of justice. Therefore, with or without the consent of the patient or the ethical codes of patient confidentiality, the information will be disclosed. This will be assumed to be in the best interest of the patient and that of the public.
In healthcare facilities, medical errors occur all the time. An employee or practitioner could mistakenly disclose the information of a patient verbally or non-verbally. Sometimes the Protected Health Information (PHI) may not be as protected as it sounds due to unsecure access and unauthorized personnel could access the information. With the new technology, it is possible to hack into computers of hospitals, schools and companies (Noroozi, et al 2018). All these instances put the patient’s information at risk of being disclosed at any time. Even if HIPAA protects the right of the patient to confidentiality, once the information is disclosed it cannot be taken back. The people responsible for breeching patient confidentiality may be punished but the information of the patient will remain known regardless.
On the other hand, patient confidentiality is very important. It builds trust between the patient and the practitioner. When a patient knows that their information is safe and secure, they will be able to open up about matters concerning their health without leaving out anything. Usually, when there is no trust between the two parties, the patient will leave out bits of information that may be very important in doing the right diagnosis. Otherwise, patient confidentiality helps to improve the quality of healthcare services because a patient will give out the right information and the right treatment plan will be used.
Patient confidentiality will help protect a patient from stigma incase they are suffering from a stigmatizing condition like reproductive or sexual. This increases the willingness of a patient to seek medical attention instead of keeping it to themselves and risking major problems. If there was no confidentiality in the medical field then most people would never come forth to talk about their deepest issues to a stranger in the name of a practitioner. So, more people get to seek medical attention and poor health is eradicated from the society. Patient confidentiality will prevent the healthcare facility and the practitioners from being sued of breaking the medical codes of ethics. If patient confidentiality is breeched, the practitioners responsible will have to face the law and suffer the consequences. Therefore, no legal actions can be taken if confidentiality is respected.
It is clear that there are more advantages of not having patient confidentiality as compared to having it in the codes of ethics. Without the confidentiality rule in healthcare, the patient will have a better chance of getting better with all the help and support he or she will get from family, friends and well-wishers (Hartigan, 2018). On the other hand, the only advantage of patient confidentiality is building trust and enabling a patient to willfully give information about their health condition. However, this can also be achieved without the issue of having patient confidentiality. Actually, family members of the patient cannot entrust you with their patient if you cannot give them information about the progress of their patient. This definitely brings a dilemma on the issue of patient confidentiality but there are more pros of not having patient confidentiality than there are in having patient confidentiality.
References
Petronio, S., Sargent, J., Andea, L., Reganis, P., & Cichocki, D. (2004). Family and Friends as Healthcare Advocates: Dilemmas of Confidentiality and Privacy. Journal of Social and Personal Relationships, 21(1), 33–52. https://doi.org/10.1177/0265407504039838Riaz, S., Khan, E. A., & Jafar, T. (2017). Ethics in health care settings: practices of healthcare professionals and perceptions of patients regarding informed consent, confidentiality and privacy at two tertiary care hospitals of Islamabad, Pakistan. Journal of Ayub Medical College Abbottabad, 29(3), 472-476.
Hosseini-Ghavam-Abad, L., Asghari, F., Bandehagh, A., Najafipour, S., & Bigdeli, S. (2019). Patient privacy: Awareness and attitudes of Iran University of Medical Sciences medical students. Medical journal of the Islamic Republic of Iran, 33, 12.
Noroozi, Mahshad, Ladannaz Zahedi, Fataneh Sadat Bathaei, and Pooneh Salari. (2018): “Challenges of confidentiality in clinical settings: compilation of an ethical guideline.” Iranian journal of public health 47, no. 875.
Hartigan, L., Cussen, L., Meaney, S., & O’Donoghue, K. (2018). Patients’ perception of privacy and confidentiality in the emergency department of a busy obstetric unit. BMC health services research, 18(1), 1-6.
Pathophysiology of Shock
Pathophysiology of Shock
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Pathophysiology of Shock
Shock refers to an acute diffuse reduction in the total peripheral vascular resistance and cardiac output. It is classified as either a circulatory shock or a cardiogenic shock. The term “shock” is typically used to describe the clinical condition but it can also refer to a reaction from the body after suffering damage to blood vessels or the heart muscle, as in how an individual would react if shocked by “shocking” news about their long-held assumptions about how people were supposed to live (Font et al., 2020).
Circulatory shock is a state of low blood pressure, which may be caused by numerous diseases. When the heart fails to pump enough blood through the body, the organs and tissues of the body are deprived of oxygen and nutrients. The resulting ischemia causes damage to these tissues, urine output falls and metabolic acidosis develops. Circulatory shock may develop abruptly but more commonly develops as a slow deterioration of organ perfusion over time. Circulatory shock can be viewed as a medical emergency since it leads to impaired function of vital organs such as the liver, kidneys, or brain (Font et al., 2020). As result, circulatory shock is associated with high mortality rates if left untreated.
A person may be at risk for developing shock when they have significant external trauma or internal bleeding that leads them into hypovolemic shock. Hypovolemic shock is typically the result of a significant loss of fluids, electrolytes, proteins, or blood. It can also be considered to be a state of circulatory failure that occurs when there is a sudden loss or drop in blood pressure resulting from inadequate fluid volume in the circulatory system. In this type of shock, patients may show signs and symptoms associated with hypovolemic shock. The main cause of hypovolemic shock is blood loss; however, this can occur naturally when delivering a baby or through injuries such as gunshot wounds and major cuts. In hypovolemic shock, the heart begins to lose its ability to contract and pump blood (Font et al., 2020).
Normal Anatomy of Major Body System Affected.
The major body system affected by shock is the cardiovascular system. The normal anatomy of the cardiovascular system is as follows:
The heart is located in the middle of the upper chest or thorax. It consists of three chambers: a left and a right atrium, and left and right ventricle. Each chamber has one mitral valve to regulate blood flow from one side of the heart to another. There are several coronary arteries that each go to supply branches for the myocardium (heart muscle) in different parts of your body, including arms, legs, and other muscles in addition to your heart. There is one pulmonary artery that goes from your lungs up through your neck into your heart. Shock usually restricts oxygen from reaching the brain which can result in dizziness, fainting, or seizures. The article also discusses other possible effects and diagnoses related to the various body systems affected by shock.
Normal physiology of the major body system affected
The physiology of the major body system affected by shock involves a reduced blood flow to the brain due to injury, which causes changes in mental state and potentially death. At this point, we cannot say for sure what major body system symptoms are caused by shock, but it is known that this major body system can be affected depending on external circumstances such as the severity of the injury or emotional trauma. The major body affected by shock can be affected by other things such as hypothermia, and some of the major physical symptoms that may occur depend on this. There is a danger of death from hypoxia if the person is unable to breathe. Major body system affects The cerebral, renal, respiratory, and cardiovascular systems are all affected by shock. Respiratory failure caused by shock can be mistaken for anaphylactic shock, as these are some of the symptoms that can overlap very closely. Depending on the severity of injury or trauma relation to heart rate, blood pressure and oxygen usage will vary in these systems.
The brain is the most affected system in shock. The brain is made up of neurons, and these are responsible for the thoughts, emotions, and memories that occur within a human being. An extremely sudden change in blood flow to the brain leads to neurogenic shock or CNS shock. A decrease in blood flow can lead to loss of consciousness and this can be mistaken for death by suffocation, which is a specific risk. Blood poisoning occurs because of an infection of the bloodstream, often caused by injury or trauma. Blood poisoning, also known as sepsis, causes loss of function due to inflammation and infection within the body’s vital organs. Blood poisoning can lead to much worse consequences than permanent death from CNS shock.
Mechanism of Pathophysiology
The mechanism of the pathophysiology of Shock involves three separate phases: alveolar flooding, hemodynamic collapse, and ischaemic brain. The processes in these three steps are interdependent; they may also be separated into physiological processes of the lung, systemic blood pressure, and cerebral blood flow. Hemodynamic collapse occurs when the heart is unable to maintain adequate cardiac output to maintain normal systemic blood pressure and thus perfusion pressure of the tissues. This results in systemic hypotension, which may lead to irreversible hypoxic injury, acidosis, and death if not successfully treated (Dugar et al., 2020). In patients who have suffered a major hemorrhage and their vital signs show reduced or undetectable blood pressures, giving volume (crystalloid + colloid) is not sufficient. Therefore, when the pressure in the lungs falls suddenly (as with suffocation), this leads to alveolar flooding which leads to hemodynamic collapse which leads to ischaemic brain damage (Dugar et al., 2020).
Prevention of Shock
There are various prevention mechanisms for shock. Avoiding various lifestyles like smoking, unsafe sexual intercourse and unhealthy eating habits can help. But, there are also techniques to use in combat if the body is already in shock. If the person has a poor immune system and has cuts or open wounds, it is vitally important that those wounds be covered with clean dressings or bandages.
In cases of poor circulation, laying the person on his back, raising his legs 12 inches from the ground [or] putting both legs up on a bed may restore blood flow to healthy tissue by elevating blood pressure. Consideration should be given to the location of the wound since most wounds involve blood loss, and higher elevations of the legs may make the hemorrhaging worse.
If blood is leaking from fractures of a limb or spine, elevating it below heart level can help to fill that gap and prevent shock. If shock is imminent, placing blood pressure cuffs on both sides of a leg will bring blood back into circulation (Shen, 2021). Shock may also occur if there is a lack of tissue oxygenation due to some kind of interruption in circulation. Tissue damage occurs if circulation is stopped for an extended period without restoring oxygen to tissues.
Treatment
Treatment of shock involves restoring blood flow and oxygenation to the tissues, which may lead to recovery.
The treatment of shock is based on four parameters:
• Blood pressure (BP)
• Temperature
• Respiration Rate (RR)
• Oxygen levels in the blood (SpO2)
Restoring BP and RR is important for treating all forms of shock. Restoring temperature, respiration rates, and oxygen saturations are necessary to treat severe shock (Shen, 2021). All other parameters help treat moderate to severe shock. The ability of the body to generate heat is called core body temperature and depends on several factors like muscle activity, metabolism, and exercise.
Besides core temperature, the body also maintains blood flow, oxygenation, and acid/base balance (among others) through other vital functions at other body parts. Among some of the more important blood parameters, we have blood pressure (BP), which is measured in millimeters of mercury (mmHg or Hg). BP must be maintained, as with a drop in it comes an increase in the risk of shock. If a person’s BP drops too low or falls into a lower range of normal values he may suffer from circulatory collapse, which can lead to death.
References
Dugar, S., Choudhary, C., & Duggal, A. (2020). Sepsis and septic shock: Guideline-based management. Cleveland clinic journal of medicine, 87(1), 53-64.
Font, M. D., Thyagarajan, B., & Khanna, A. K. (2020). Sepsis and Septic Shock–Basics of diagnosis, pathophysiology and clinical decision making. Medical Clinics, 104(4), 573-585.
Shen, Z. A. (2021). The prevention and treatment of shock after severe burns. Zhonghua shao shang za zhi= Zhonghua shaoshang zazhi= Chinese journal of burns, 37, 1-4.
Pathophysiology of Crohn’s Disease
Pathophysiology of Crohn’s Disease
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Pathophysiology of Crohn’s Disease
Crohn’s disease is a human chronic disease normally associated with the human digestive system. The disease is inflammatory; that is, the affected body organs are inflamed, and normally the disease effects are observed in the lining of the digestive system tract. The disease is termed chronic as it threatens or can cause serious health complications that may lead to death. The disease is further characterized by specific inflammation of the bowel. Due to inflammatory effects on the bowel, the disease is also referred to as inflammatory bowel disease.
Research studies reveal that the exact cause of the disease is yet to be known. Scientific researches portray poor diet and psychological to be the main suspects as causative agents of the disease (Petagna et al., 2020). General weakness of the individual immune system is the main contributing factor to the start of inflammation in the digestive tracts. A weak immune system makes it difficult for the cells, particularly the white blood cells, to fight the invading bacteria or virus and thus easily contract the inflammation effects. Crohn’s disease is also associated with hereditary genes. The disease is common to members whose family members initially had a history of the disease. As per clinical experts, heredity matters influence increases the chances of disease contraction.
Crohn’s disease is not associated with any age bracket; the disease can occur at any age. The health statistic describes the disease to be mostly associated with the young generations. In the concept of ethnicity, Crohn’s disease can be present in any ethnic group though the scientific research studies portray that whites are most susceptible to contracting the disease. As initially described, Crohn’s disease is an inflammatory disease; hence smoking cigarette puts an individual at a high risk of developing inflammations in the digestive tract. Cigarette smoking may not be an immediate cause but increases the risk of developing the disease. Clinical specialists also describe the nonsteroidal anti-inflammatory medications such as diclofenac sodium, ibuprofen and naproxen sodium as risk factors for the disease.
Having described the risk factors of Crohn’s disease, it is also important to understand the health complications related to the disease. The main complication caused by Crohn’s disease is bowel obstruction. The disease affects the general thickness of the intestinal walls. Inflammations, as well as irritations caused by the disease, increase the narrowing of the intestines. The overall result of the narrowing of the intestines is the blocking of the digestive contents or, rather, the food materials being digested.
Increased bowel inflammation may lead to chronic conditions causing sore developments in the bowel. The developed sires are ulcers (Svolos et al., 2019). Ulcers may develop in any part of the digestive system tract. Increased ulcers or rather chronic ulcer conditions may lead to the development of fistulas. Fistula is the abnormal connection between the different body parts, thus malfunctioning the affected parts. Perianal fistulas (occurring at the anal parts) are the most common fistulas. Fistulas, therefore, can occur between the intestines and the skin or even between the intestines and any other body organ.
Crohn’s disease at chronic levels may lead to increased blood clots in the arteries and veins. Blood clots in the body may reduce blood flow or rather circulation in the body leading to serious health conditions to an individual’s health. Increased inflammation in the intestines may lead to colon cancer development. Colon cancer is one of the most life-threatening cancer in human cancer diseases. Anal complications may also develop in severe conditions. Tearing of the tissues in the anal parts is termed an anal fissure. The condition is normally associated with painful bowel movements and can easily lead to anal fistulas (perianal fistula).
Other body complications related to Crohn’s disease include skin disorders, liver disease, anemia, osteoporosis and arthritis. Skin disorders are due to abnormal skin functioning due to fistula conditions. Malnutrition may develop in individuals with Crohn’s disease. This is because the abdominal pains caused by the intestine inflammations make it difficult to eat or, rather, difficult to absorb nutrients by the walls of the affected intestines. Main symptoms of the disease become only when the condition of the affected individual becomes severe. Symptoms vary from mild to severe (Tomazoni & Benvegnu 2018). Fever, fatigue, abdominal pains, blood in stool, mouth sores, reduced weight and loss of appetite, kidney stones, anaemia, eye inflammation, poor growth among young children, and skin inflammation.
Clinical specialists describe that prevention of Crohn’s disease is normally challenging. Effcts of Crohn’s disease can only be prevented from worsening, thus reducing the effects on the affected individual’s general health. Regular body checkups form the major way of preventing the disease. The early diagnosis of the disease is better as an individual can get better medical attention from the disease specialists. Change in the lifestyle activities that promote good health also aids in the prevention of the disease. Lifestyle changes such as avoiding cigarette smoking can be helpful, especially to the affected individuals. A proper and balanced diet at all times is also advised. Reduction of fried diets and an increase in vegetable consumption reduces chances of the Crohn’s disease.
Another measure in preventing Crohn’s disease considers the addition of mineral supplements, especially for individuals with vitamin D deficiencies. The measure is majorly recommended for young children. Reduction in dairy product consumption is an essential measure in the prevention of the disease. Dairy products worsen Crohn’s disease symptoms, especially abdominal pains and diarrhea (Torres et al., 2020). Dairy products for lactose intolerant individuals reduce the digestive activity of the digestive system. For example, digestion of sugar in the milk, or lactose, may not occur properly.
Proper medication for the affected casualties is the major form of treatment. Medication includes all the medical methods that aim to suppress individuals’ immune systems that result in the discovered symptom. Increased frequency of medication reduces the effects of the discovered symptom. Proper treatment over time reduces the effects of inflammation of the affected body organs.
Medical surgeries for the affected individuals are another form of treatment. Medical surgeries are meant to remove the affected parts or the diseased body parts. Surgeries do not mean to cure the disease but aid in returning the affected body parts to their normal and the best possible quality of their functioning. The measure of treatment only becomes necessary when the medications are no longer in a position to control or rather suppress the symptoms. Finally, as initially discussed, proper nutrition and a balanced diet reduce the symptoms that affect individual health. A balanced diet normally replaces the lost nutrients and increases the energy during the metabolic reactions in the human body.
REFERENCES
Petagna, L., Antonelli, A., Ganini, C., Bellato, V., Campanelli, M., Divizia, A., … & Sica, G. S. (2020). Pathophysiology of Crohn’s disease inflammation and recurrence. Biology direct, 15(1), 1-10.
Svolos, V., Hansen, R., Nichols, B., Quince, C., Ijaz, U. Z., Papadopoulou, R. T., … & Gerasimidis, K. (2019). Treatment of active Crohn’s disease with an ordinary food-based diet that replicates exclusive enteral nutrition. Gastroenterology, 156(5), 1354-1367.
Tomazoni, E. I., & Benvegnú, D. M. (2018). Symptoms of anxiety and depression, and quality of life of patients with Crohn’s disease. Arquivos de Gastroenterologia, 55, 148-153.
Torres, J., Bonovas, S., Doherty, G., Kucharzik, T., Gisbert, J. P., Raine, T., … & Fiorino, G. (2020). ECCO guidelines on therapeutics in Crohn’s disease: medical treatment. Journal of Crohn’s and Colitis, 14(1), 4-22.