BMS 115 · Common Core (Tronc commun)Section 5.2 · Accountability in practice
Section 14 of 15
Professional secrecy
Define professional secrecy, explain the three sources that make the duty strong, and decide when a disclosure is permitted and what sanction follows a breach.
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Why this matters
Every patient hands you something they have told nobody else, and they do it because they believe you will keep it. That belief is not decoration: without it patients hide exactly what the nurse most needs to know — the infection, the pregnancy, the violence at home — and the care itself becomes unsafe. Secrecy is also the area where one sentence spoken in a corridor can end a career, so it has to be learned precisely rather than approximately. This section gives you the definition, the three grounds that make the duty strong, and the rule that decides whether a disclosure was permitted or a breach.
What you need to know first
You need no law yet. You need to accept two ordinary facts: people differ in how much privacy they want, so you cannot decide for the patient what is harmless to reveal; and you will often hold information that others — family, colleagues, journalists, the police — would very much like to have. Keep both in mind as you read.
Words to know (5)
Professional secrecy
The obligation imposed on health professionals to keep confidential the information obtained from a patient in the course of their profession, and not to share it with others. A nurse does not tell a neighbour that a well-known person is a patient in the ward.
Disclosure (breach of secrecy)
Making confidential information known to a person who is not authorised to receive it, whether by speech, writing, image, or careless exposure of a file. Reading a patient’s file aloud in a crowded lift is a disclosure, even without naming the patient.
Need to know
The rule that a colleague inside the care team may receive only the confidential information necessary for that colleague’s own part in the patient’s care. The physiotherapist needs to know about the recent fall, not about the patient’s divorce.
Defamation
Any statement, spoken or written, that lowers a person in the eyes of right-thinking members of the community; unlawfully revealing a patient’s secret can be treated as one. Telling the ward that a patient is the drunk from the market may defame him.
Premarital screening
Testing two people who plan to marry for inherited blood disorders and for infectious diseases, so that they can decide about the marriage and about children with full information. A couple about to marry is tested for sickle-cell disease, thalassaemia, hepatitis B and C and HIV.
One idea at a timeIdea 1 / 5
In one sentence Professional secrecy is the obligation to keep confidential the information a patient gives the professional, and to refuse to share it.
Professional secrecy is a duty owed to the patient, not a favour
Professional secrecy is the obligation imposed on health professionals to keep confidential the information obtained from a patient while practising their profession. It is not a courtesy you may grant or withdraw: it binds you from the moment the information reaches you, whether the patient told you directly, someone else told you, or a test result revealed it. A confidence belongs to the person it concerns, and not to the service that recorded it. This duty has been a cornerstone of medical ethics since Hippocrates, and some versions of the classical oath admit no exception at all.
For example
A patient tells the nurse during a dressing change that her husband beats her. That sentence was given in confidence. Repeating it to a colleague in the lift, even out of concern, is already a disclosure unless the patient agreed or a legal duty to report applies.
Think of it like
Think of the patient’s information as a letter addressed to the patient that you are holding for them. You are the guardian of the envelope, not its owner and not its editor. The comparison has a limit: unlike a letter, the confidence does not disappear once it has been opened in the patient’s interest, and it survives the patient’s death.
Pause and check yourself
A colleague from another ward asks you for a patient’s diagnosis, just to understand the case. May you answer?
Show the answer
Not without a need to know. Inside the team, a colleague receives only the information necessary for their own part in this patient’s care, unless the patient has given explicit consent. Curiosity about an interesting case is not a need to know, and a polite refusal is part of the duty.
Read detailed explanations
The four families of sanction and the numbers behind them
Cameroonian law does not answer a breach of medical confidentiality with a single penalty. The notes distinguish four families, and each one asks a different question. Civil. A civil action sounds in the tort of defamation and asks who must compensate the patient. Criminal. Criminal liability is separate and asks whether an offence defined by the Penal Code was committed. The civil and criminal mechanics — the elements the patient must prove, the wording of section 305 of the Cameroon Penal Code and the rule that defamation is an offence on complaint — are set out in 5.3. Disciplinary. Disciplinary liability is internal to the profession. Any medical professional who fails to meet ethical and professional standards breaches the Code of Ethics and falls under the jurisdiction of the Disciplinary Board constituted in accordance with the law, and a complaint made against a doctor must first be investigated by that board. Administrative. Administrative liability concerns public service. The public hospital is vicariously liable for damage caused by its officials — doctors, interns, residents and medical students — and a doctor working in a public hospital may be sanctioned up to dismissal from the Civil Service. As a civil servant the doctor faces four groups of disciplinary sanctions: first, written warning or blame entered on the file; second, delay of advancement for one year, or lowering by one or two grades at most; third, lowering of class and rank, or temporary dismissal for no more than six months; fourth, dismissal. Notice the progression: the scale runs from a notation to the loss of the post, and one act can advance along several of the four tracks at the same time.
How a secret actually escapes: modes of disclosure and the WMA turn away from absolutism
The classical oath is absolute: what the physician sees or hears in the course of treatment, or even outside it, in regard to the life of men, and which on no account should be spread abroad, is to be kept to himself, held shameful to be spoken about. Modern texts reject that absolutism, and the current position is both tighter in wording and wider in reach. The World Medical Association’s International Code of Medical Ethics, in the revision adopted by its 73rd General Assembly in Berlin in October 2022, states in paragraph 22 that the physician must respect the patient’s privacy and confidentiality even after the patient has died; that a physician may disclose confidential information if the patient provides voluntary informed consent or, in exceptional cases, when disclosure is necessary to safeguard a significant and overriding ethical obligation to which all other possible solutions have been exhausted, even when the patient does not or cannot consent; and that the disclosure must be limited to the minimal necessary information, recipients and duration. The 2006 revision of the same code used a narrower formula — a “real and imminent threat of harm” that could be removed only by a breach of confidentiality — and that older sentence is the one the lecture notes quote; it is no longer the current rule. The WMA Declaration on the Rights of the Patient then sets the boundaries in detail: all identifiable information about a patient’s health status, medical condition, diagnosis, prognosis and treatment, and all other information of a personal kind, must be kept confidential even after death; exceptionally, descendants may have a right of access to information that would tell them their own health risks; information may be disclosed only with the patient’s explicit consent or where the law expressly provides for it; and other caregivers receive it strictly on a need-to-know basis. Identifiable data must be protected in a manner suited to how it is stored, and human substances from which identifiable data can be derived — a blood sample, a biopsy specimen — carry the same protection. Because a secret is a piece of information rather than an object in a locked drawer, it escapes through ordinary habits. The notes list the modes: oral indiscretion; publication in a scientific journal giving information that can identify the patient; photographs; voice recordings; and professional behaviour itself, such as leaving the patient’s file hanging within the reach of users or visitors. Routine breaches are frequent in most health care institutions precisely because so many people — physicians, nurses, laboratory technicians and students — need access to the record in order to treat the patient or to learn. Where the patient speaks a different language, an interpreter is needed to make communication possible, and that interpreter inherits the confidence. The practical audit question is therefore not only “did anyone gossip?” but “who could reach this information, and what did the storage method make possible?”
Where secrecy gives way: statutory exceptions, notifications and the premarital examination
Exceptions are not moods; they are rules with an address. Each one names the authority that may receive the information, the fact that may be transmitted and the purpose that justifies the transmission, and the child-abuse example makes the mechanism visible: unexplained injuries plus a child who seems frightened of the parent or primary caregiver may amount to a reasonable suspicion of abuse, and reasonable suspicion can trigger a legal duty to report the suspicion to the authorities. The mandatory declarations follow the same logic — declarations of death, and declarations of contagious and epidemic diseases — while the denunciations of crimes cover poisoning, abuse, assault and injury to the person of children, especially sequestration, and criminal abortion. In every case, ask three questions before speaking: which rule authorises me, exactly what must I transmit, and to whom? Certificates have their own economy. They are requested by the interested parties and must be given to them; the doctor who draws up and issues a certificate is not bound to secrecy towards his own client in respect of that document, and disclosure of the certificate can only come from the patient himself. The premarital examination is the subtlest case, and the lecture notes need correcting here. The notes define premarital screening as testing couples who plan to marry for common genetic blood disorders, but they print the pairing twice — “sickle cell anemia and thalassemia and sickle cell anemia”. The standard list is the haemoglobinopathies, sickle-cell disease and thalassaemia, together with infectious diseases such as hepatitis B, hepatitis C and HIV/AIDS. The genetic test matters because two carriers can transmit a severe disease to a child, so the result belongs to both partners as a couple decision, and infectious screening has consequences for the other partner too. Secrecy then follows the shape of the consultation: if the professional is consulted by one fiancé alone, the secret is kept; but if the bride and groom agree to consult together and to communicate the findings before entering the marriage, there is no secret to keep, because the information has passed, with consent, between the two people it concerns. Consent inside the couple, not curiosity, is what opens the file.
Explore the diagram
Look at the whole drawing first. Then select one numbered part and connect it to the idea you just read.
Professional secrecy: what is protected, on what grounds, and when it yields
The confidence is held at the top, three sources explain why it is protected, one gate decides whether it may be opened, and four families of sanction stand behind it. Select any part to read what it is and why it matters.
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01 / 6What counts as protected
If the drawing is wider than this panel, scroll it sideways. Labels stay readable; the numbered explanations below show the same ideas.
What counts as protected
This band is the material the duty protects: a patient’s health status, medical condition, diagnosis, prognosis and treatment, and any other personal information from which the person can be identified. The protection does not stop at written records or at the patient’s lifetime. The WMA Declaration on the Rights of the Patient requires confidentiality even after death, with an exceptional right of access for descendants who need to know their own health risks, and the same protection reaches human substances — a blood sample, a biopsy specimen — from which identifiable data can be derived.
Teaching schematic, not a substitute for the Code of Ethics or the Penal Code. The exceptions shown are the ones the notes list; the fourth box compresses a graduated scale of civil-service sanctions, and in a real case several families of sanction can apply to one act at the same time.
Key points to remember
✓Professional secrecy is the duty to keep confidential the information obtained from a patient in practice; it binds the professional from the moment the information arrives and it survives the patient’s death.
✓Three sources explain its weight: the patient’s autonomy over personal information, respect for the person and their privacy, and the trust that makes patients speak and care safe.
✓Disclosure is the exception. It is permitted with explicit consent or where the law provides, and inside the team it operates strictly on a need-to-know basis.
✓Breaches are usually ordinary — an indiscreet remark, a visible file, a photograph, an identifiable publication — and they can attract civil, criminal, disciplinary or administrative sanctions.
Go deeper
Worked example
Three callers and one result. You are the nurse on a medical ward. Mr N., aged 28, has just been told that his HIV test is positive. An hour later a man telephones the ward, says he is Mr N.’s fiancé, and asks you to confirm the result because they are planning to marry in three weeks. Later in the same shift a police officer asks whether Mr N. was treated for a knife wound, and a colleague from another ward asks for the file “to see what he has”.
Name the secret before naming the callers. The confidence belongs to Mr N., not to the ward, and it covers the result and anything from which he could be recognised. The first move is to say precisely what information is at stake, because each caller asks for a different piece of it.
Apply a different rule to each caller. The fiancé calls with consent that has not been given, so the ordinary key is missing. The colleague has no need to know beyond his own part in the care. The officer has authority but not automatically a legal provision; a request is not an exception.
Go back to the patient and ask what he wants done. Mr N. is competent and may consent to telling his fiancé, refuse, or ask to tell him himself with your support. Record the answer in his own words, and record what he agreed to, since consent to one disclosure is not consent to every disclosure.
Route what remains through the proper channel. Tell the officer that you cannot answer from the desk and refer the request to the person the hospital procedure designates, who will check the legal basis and transmit only what that provision requires. Answer the colleague by offering the information his part of the care needs, and nothing else.
Nothing is told to the fiancé by telephone, the colleague receives only what his part of the care requires, and the police request is examined by the person responsible for it before any answer is given. Mr N. is supported to speak to his fiancé himself, and the whole exchange is documented with its reasons. Notice that no step required you to decide alone: each one required you to refuse politely, to name a rule, and to use the procedure.
Common misconception
The commonest beginner error is to read confidentiality as “say nothing to anybody, ever”, and the second, opposite error is to believe that anyone with an official-sounding title may be told everything. Both mistakes miss the same structure: the duty is owed to the patient, so it is the patient’s consent or a specific legal rule — and not the asker’s authority, usefulness or good intentions — that opens the file. A third error follows from the first two: beginners think that a breach requires a deliberate betrayal, and therefore fail to see that a file left in a corridor, a lift conversation or an identifiable case photograph has already broken the secret. The test is not “did I mean harm?” but “could this person properly receive this information, and did the rule allow it?”
Check your reasoning
Think of a time when you learned something private about someone — a relative, a neighbour, a fellow student — and you were not sure whether you were allowed to repeat it. What made the decision difficult: the content, the person who told you, or the fact that you had no rule to check? What rule would have settled it?
Reveal an answer
In most such memories the difficulty comes from having no rule, so the decision is made by instinct or by loyalty to whoever is asking. In the ward that instinct is not enough, because you hold information as a professional and the professional has a rule. The four questions that settle it are: who does this information belong to; has that person consented; does a specific legal or professional rule permit or require the disclosure; and if so, what exactly must be transmitted and to whom. Answering even the first two converts an uncomfortable silence into a defensible decision.
Where this comes from
BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey) · Chapter Four — Professional secrecy: definition and generalities, the Hippocratic Oath, the three sources of confidentiality, the WMA texts quoted, civil/criminal/disciplinary/administrative sanctions and the four groups of civil-service sanctions, modes of disclosure, special circumstances, premarital examination, certificates, statutory exceptions, mandatory declarations and denunciations of crimes
Correction to the supplied notes (premarital screening pairing) · Chapter Four, premarital examination: the notes print “sickle cell anemia and thalassemia and sickle cell anemia”, a duplication. This lesson keeps the standard pairing of haemoglobinopathies (sickle-cell disease and thalassaemia) with infectious screening (hepatitis B, hepatitis C and HIV/AIDS). Beyond the supplied notes: standard premarital screening list, and the notes’ own rule that the secret follows the shape of the consultation.
World Medical Association — International Code of Medical Ethics (2022 revision) · the notes quote the 2006 revision’s “real and imminent threat” formula in Chapter Four. The current paragraph 22, adopted by the 73rd WMA General Assembly (Berlin, October 2022), is the authority for the voluntary informed consent, the overriding ethical obligation and the minimal-disclosure wording used in the detailed explanations.
Correction to the supplied notes (“state or federal law”) · Chapter Four, special circumstances of disclosure: the notes require disclosure “as required by state or federal laws”, a United States formula. Cameroon is a unitary republic with regions, not a federation, so there is no state law and no federal law; the exception is stated in the teaching text as wherever the law or a competent authority imposes a duty to report.
Cameroon Penal Code, section 305 (defamation) · Supplied notes, Chapter Four, quoting section 305 of the Cameroon Penal Code; the quotation there describes the offence as destroying reputation by any means and omits the reference to the means described in section 152, which carries the publicity requirement. The wording used in this section follows the consolidated Penal Code (Law No. 2016/007 of 12 July 2016); the extension to the memory of a deceased person is as the notes give it.
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About this course and its sources
Bilingual lessons organised from the supplied BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey, St Louis University Institute Douala) and the international texts those notes reproduce — the Universal Declaration of Human Rights 1948, Pacem in terris 1963, the African Charter on Human and Peoples’ Rights (drafting launched at Monrovia in 1979 by Decision 155; adopted 1981; in force 21 October 1986), the 1959 Declaration of the Rights of the Child, the ICN codes of 1953 and 1973, and the Cameroon code of ethics of 3 March 1989. The short guided notes and the longer “Read detailed explanations” panels are written as two different jobs: the notes state one idea plainly, and the detailed panels add mechanism, vocabulary and worked judgement that the notes do not contain. Diagrams are original teaching schematics. Ethics, nursing and French-language review are pending.