Personal privacy and intimacy
In a doctor/patient consultation where there are close personal relations, it can be difficult for both parties to broach sensitive issues such as sexuality and mental illness. The patient may keep quiet about these, and the doctor may hold back from asking about such matters. The same applies to intimate examinations – which can be particularly problematic if the patient is underage. Consequently, there is a risk of an incomplete examination, possibly resulting in misdiagnosis and wrong treatment.
When information on personal, private and health affairs is shared in both consultations and social contact, considerable challenges arise in respect of patient confidentiality. In practice, the degree of formality of a consultation with family and friends will tend to vary.
In some cases, the doctor will be asked for assistance with health problems in an informal setting. She/he may be tempted or feel pressured into giving advice, or carrying out simple diagnosis or treatment outside the formal setting of a GP consultation. In such situations, it is extremely easy for the doctor to do inferior work and make mistakes, and the risk of breaching patient confidentiality increases considerably. 'The patient' might also regard this as a GP consultation while the doctor feels that she or he has merely given informal advice.
The doctor's personal feelings for the patient will easily colour her or his professional assessment and lead to either overtreatment or undertreatment
In this context, it is worth remembering the Norwegian Health Personnel Act's definition of health care: 'The term health care shall mean any act that has a preventive, diagnostic, therapeutic, health-preserving or rehabilitative objective and that is performed by health personnel.' (5). The commentary on the wording of the Act also specifies that when health care is given, the services performed must be justifiable, and that health personnel must comply with the provisions of the Health Personnel Act regarding information, the duty to keep patient records etc. (6).
If health care is given in this informal manner and it later results in a negative outcome for the patient, the fact that nothing has been registered in the patient record will therefore pose considerable problems.