It's common for physicians to receive information about patients from other individuals, also called collateral information. When you receive unsolicited information about a patient from a third party, knowing what to do with it may help alleviate your sense of unease and promote good patient care.
Receiving collateral information
Collateral information can typically come from a family member or close friend of your patient. It could also arrive through social interactions within your community, calls or emails from patients' employers or schools, or social media posts and direct messages. Maybe one of the following scenarios sounds familiar to you.
- While her teenage daughter is out of earshot in the waiting room, a woman tells you that she thinks her daughter has an eating disorder.
- A patient's adult son calls your office to say that his father is suffering serious cognitive issues, including impaired driving, and requires assessment at his upcoming appointment.
- During a local school sports event, a fellow parent mentions his concerns about a member of the community who seems severely depressed: "Isn't he one of your patients? Is there something you can do?"
This information might cause a distressing sense of conflicting responsibilities. On the one hand, you might feel a responsibility to act on the information, if it is in the patient’s best interest or if it poses a safety risk. But, you might feel uncertain about how to proceed, because the information came through an unconventional channel.
Potential next steps
How you handle collateral information will depend on circumstances. It can be helpful to determine the answer to two questions regarding the information received.
- Is the information credible?
- If so, is there any action that needs to be taken?
When answering these questions, use your judgment to consider the following factors:
- The relationship between your patient and the person providing the information
- The person's involvement in your patient's care, and their familiarity with your patient's health
- The context in which the information is being provided
Give thought to the rationale of the person providing the information, and consider whether it is corroborated by other elements of the patient's health and history. Where possible, it can be helpful to undertake your own assessment of the patient to gauge the validity of the information.
If you determine the information is not credible or actionable, it may not be necessary to include it in the medical record. However, be sure to document any action taken in regard to information provided by a third party. If you have questions about specific instances of receiving collateral information, reach out to the CMPA for advice.
Privacy implications
Privacy legislation generally permits the collection of collateral information only if it is reasonably necessary for the provision of healthcare, and if collecting the information directly from the patient is not reasonably possible. For example, it is often appropriate and necessary to collect collateral information from family members in circumstances where the patient is mentally unwell and threatening to harm themselves, or where the patient is unconscious or incapacitated. Although it may be appropriate in these types of cases to collect collateral information, you are generally not permitted to share any patient information with the person providing the information without consent or other legal authority.
Consistent with this privacy principle, physicians should generally refrain from performing searches on social media to obtain health information about a patient without their consent, subject to limited exceptions (e.g. safety concerns).
Receiving collateral information can become a greater challenge when the person providing the information asks you not to share with the patient the fact that they are the source of the information. While there is no duty of confidentiality to the third party, there may be some exceptions in privacy legislation that permit or require withholding any information that could lead to the identity of the person who disclosed the information (assuming that you act on the information and include it in the medical record). For example, Ontario’s Personal Health Information Protection Act (Section 52(1)(e)(iii)) allows information to be withheld from the patient if it was provided in confidence by a third party and the physician thinks it would be reasonable for the individual’s identity to be kept confidential.
Members who want to know more about handling collateral patient information should contact the CMPA.
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