Medical Confidentiality: Patient Privacy Rules in Spanish Medical Ethics

Article 27: Medical Secrecy and Confidentiality

1. Medical secrecy is one of the pillars on which the doctor-patient relationship is founded, based on mutual trust, regardless of the modality of professional practice.

2. Medical secrecy obliges the physician to maintain the confidentiality of everything the patient has revealed and entrusted to them, what they have seen and deduced as a result of their work, and which relates to the patient's health and privacy, including the content of the clinical record.

3. Being a physician does not authorize access to confidential information of a patient with whom there is no professional relationship.

4. In computerized healthcare institutions, medical managers shall ensure a clear separation between clinical and administrative documentation.

5. The physician shall not collaborate in any health database unless the preservation of the confidentiality of the information stored therein is guaranteed.

6. The physician may cooperate in epidemiological, economic, management, and other studies, on the express condition that the information used does not allow any patient to be identified, either directly or indirectly.

7. The physician shall preserve the confidentiality of patients in their social, working, and family environment.

Article 28: Protection of Patient Privacy in Institutions and Public Disclosure

1. The medical director of a healthcare center or service shall ensure the establishment of the necessary controls so that the privacy and confidentiality of patients and the documentation referring to them are not violated.

2. The physician shall ensure that the public presentation of medical documentation in any format does not include any data that could facilitate the identification of the patient.

3. The presentation of medical cases that have been photographed or filmed for teaching or scientific dissemination purposes is permitted, provided that explicit authorization has been obtained or anonymity is preserved.

4. When a health problem occurs in persons of public notoriety, the physician responsible for their care, or the one specifically designated for this purpose, may provide information, noting the authorization of the affected person or their legal representative. In all cases, the physician shall exercise extreme prudence in the provision of information.

5. The death of the patient does not exempt the physician from the duty of professional secrecy.

Article 29: Professional Secrecy in Team Practice

1. The physician must require from their health and non-health collaborators absolute discretion and strict observance of professional secrecy.

2. In the practice of medicine in a team, each physician has the duty and responsibility to preserve the confidentiality of all data known about the patient.

3. The physician must have a reasonable justification for communicating confidential patient information to another physician.

Article 30: Exceptions to Professional Secrecy

1. Professional secrecy must be the rule. However, the physician may disclose the secret exclusively, to whomever they must, within its proper limits, with the advice of the College if needed, in the following cases:

• a. In diseases subject to mandatory reporting.
• b. In birth and death certificates.
• c. If their silence would result in harm to the patient themselves or to other persons, or in a collective danger.
• d. When they are unjustly harmed by maintaining the patient's secret and the patient allows such a situation.
• e. In cases of abuse, especially of children, the elderly, and persons with mental disabilities, or acts of sexual assault.
• f. When called by the College to testify in disciplinary matters.
• g. Even if the patient authorizes it, the physician shall always endeavor to maintain secrecy, given the importance of society's trust in professional confidentiality.
• h. By legal mandate:
  1. 1. In the injury report, which every physician is required to send to the judge when attending an injured person.
  2. 2. When acting as an expert witness, inspector, forensic physician, examining magistrate, or similar.
  3. 3. Upon request in a judicial proceeding for a presumed crime requiring the contribution of the patient's medical history, the physician shall inform the judge that they are ethically bound to keep professional secrecy and shall endeavor to provide exclusively the data necessary and adjusted to the specific case.

Article 31: Communication of Medical Examination Results

1. The results of medical examinations required by law must be explained to the person examined. Only the relevant company or institution shall be informed regarding fitness for work or the limitations or risks for work assignment.

2. The results of examinations performed within the framework of health surveillance shall be communicated exclusively to the affected person. However, the physician of a preventive medicine or occupational medicine center must transmit any result that is useful to the patient, with their consent, to their responsible physician.