Romanian Journal of Bioethics, Vol. 10, No.

3, July- September 2012

THE CONCEPT OF PATIENT-DOCTORMEDIA CONFIDENTIALITY

RELATIONSHIP IN MASS-MEDIA
Mihaela Cnnu*
Vasile Astrstoae**
Abstract
On a daily basis, printed or electronic newspapers present items that contain medical
information. They are either news of general interest or professional medical advice and even
"sensational" articles, the so-called media release cases. Much better placed on the page, often
as off-the-cuff publications or at the website opening for an even greater impact, these "cases"
are accompanied by pictures, many times shocking. In terms of journalism, newspaper
publishers explanation is that the press is a product and they have chosen the topic that sells
best. Therefore, the study aimed to define very clearly the doctor-patient-journalist-reader
relationship of such concepts as the public space, the private space, so where should end the
respect of the privacy of an individual and how can it be made public; when, whether and in
which context embarrassing facts about a person can be published, the right to publish the name
and the image, which is, in fact, the public interest, which is the limit between the right to
criticize and slander, how can the right of reply repair a persons image?, is confidentiality a
principle that cannot be broken or this should be individualized in each case?, and especially,
which are the implications of keeping or not the confidentiality? The concrete objectives of the
research which is the subject of this article were: Evaluating the media presentation of medical
topics; the sources underlying the documentation of journalists and how can be established the
collaborative relationship between them; the impact analysis of the so called interesting cases in
the media on the patient-doctor-media-reader relationship.
Key words: Ethics, right to information, patient rights, mass media

*PhD candidate, "Grigore. T. Popa " University of Medicine and Pharmacy, Iasi, Romania, email:
mihaela_cananau@yahoo.com
**University Prof., MD., PhD, "Grigore. T. Popa " University of Medicine and Pharmacy, Iasi, Romania
106

has become exponential in number and

has been conquering the power of
influence.
Since no other form of transmission
of information can rival that efficiency
and impact of mass communication,
the media became the uncrowned
queen of the realm of communication
while the message has turned into the
best-selling merchandise on the planet.
Therefore, the media is no longer a
fad of the elite or a "leaf" read during a
coffee break with friends [5], turning
into the main messenger of information
collected for the mass.
This is also confirmed by the fact
that daily, most of us will not start
work until we "get informed" on the
websites of national or local
publications.
Information we sift, especially with
an attractive title, such as an accident
with victims, a rape, a "sensational
disclosure" about a possible medical
negligence will spark more interest
than a story that tells us about a
medical congress or about the
allocation of funds for sanitizing one
section of a hospital.
Moreover,
these
so
called
interesting news are being served to us
with pictures and videos often
explicitly submitted and can be
accessed by everyone, even if such
warnings regarding the age or
"shocking images " are often designed
to stir our interest even more.

INTRODUCTION
In a society where politics and
justice are live on TV and newspapers
- most of them visible on the internet turned into public, often suburban [1]
debates, privacy often comes down to
just one definition in a dictionary.
Libraries have lost the battle in
favour to the internet, books gave way
to newspapers and culture has become
an obsolete notion that pales before the
TV debates, especially tabloids.
In this context, a fundamental right
of modern man, the right to
information becomes information [2]
at all costs, often violating the right to
privacy of the individual, whether a
public figure or not.
Therefore, this paper aims to
investigate the patient-doctor-media
relationship currently functioning in a
legally ambiguous frame.
Practically, Romania has no clear
laws governing the relationship
between confidentiality and the right to
information for people in need: ill
people, victims of accidents, rape or
attempted suicide.
Perhaps that is why, in this context,
where, theoretically, there are codes of
ethics for doctors and journalists, often
ignored although they are supposed to
enforce the rigour of the law.
The occurring events, filtered by
the media and offered for mass
consumption came to penning a new
and confused reality [3], where
valuable judgments are made about
people and events in real time, either
on television or by means of comments
on the internet pages of publications.
The media industry accredited the
popular spirit with digestible products,
mostly for medium intellectually gifted
people, able to understand the simple,
attractive, populist [4] message that

Material and methods

This research aims to analyze
journalistic articles published in the
media in 2007, by all publications from
the Moldavian area. Thirty two
publications, of over 10,000 articles on
various topics more or less medical,
but which have involved people who
107

received either medical or, in the case

of doctors, have presented difficult
situations they have faced in daily
activity, or have been involved in
media preventive activities for the
large audience on that particular
subject. We have analyzed: the sources
used by the journalist; the way the
sources have been cited; the motivation
of that article; the writing style;
keeping or not the confidentiality of
characters in the article; how they were
placed on the page.

tests.
We could also mention the article
published in the "Monitorul de Vaslui"
(27.03.2007): "We have the means, but
who knows ...", where the author,
Oana Nicoara, informs the population
that there is no need for women to go
to specialized clinics in Iasi to do a
mammogram as
Barlad Adults
Municipal Hospital is equipped with
such a high-tech device.
Another article of general interest
also bearing a positive connotation is
the information provided by Doina
Timu in the article "<The Electronic
ear> that changed the life of a girl from
Faraoani"
(12.01.2007).
When
publishing this text, the family of the
child who has undergone a cochlear
implant surgery - the girl suffered from
severe loss of hearing - gave their
consent to publish the name and the
photo of the girl. . The message is also
encouraging for other families in
similar situations, who find out, from
the media, that their children have the
possibility to regain their hearing as
well.
Attention should be paid to another
news article of general interest written
by Elena intaru (03/03/2007) "The
Middle Ages in the Infection Disease
Department in Onesti Hospital",
published in "Ziarul de
Bacau".
Publishing the statement of a patient,
the author describes certain images that
are unimaginable in the 21st century,
in a medical institution: "The floor was
messy; the doors of the patients rooms
could not close unless a rope was fitted
to keep the door closed while the toilet
room was used both by men and
women at the same time. Not to
mention that there was a strong smell
of urine and feces everywhere".
Elena
intarus
journalistic
approach determined the City Council

Results
Generally, in media newsrooms,
journalists are trained to work on a
particular
area
[6],
either
administrative, educational, health,
social, special (police, prosecution,
court, etc.), political, economic, sports,
entertainment. This means that the
journalist must know the laws in force
in the area, obtaining sources and learn
the specialized language. Because any
selected and consequently media
information should, in principle,
respond to some extent (beyond
average) to the curiosity of the
recipient [7].
We shall call this quality, which
distinguishes the true facts within the
selection process itself and their
transposition as informative messages,
facts of public interest (an approximate
translation of the pragmatic English
term newsworthy its value as news).
For example, the news that the
population was informed that they
could receive a free set of medical tests
("Testing Your Health Condition" Magda Olteanu, Ziua de Iasi,
15.05.2007), is a positive story of
general interest. Basically, by means of
this article, the author informs the
population that during a calendar year
they will have access to free medical
108

in Onesti to allocate the required

amount for sanitizing the Infectious
Disease Department that had not had
its walls painted for more than six
years. This time, we can say that
although the article was clearly a
critical twist, it definitely solved a
problem that the interviewed doctors
the chief of the department and the
medical director of the hospital claimed that they had struggled for
years to solve the sanitation issue
seeking money for this very purpose.
A very useful approach included
the advice provided by professionals
by means of newspapers articles such
as "The Sun-alcohol combination is
merciless"
(Adrian
Arnautu,
"Monitorul de Vaslui ", 30.05.2007),
"The season of fractures has already
started " (Cristina Lupu "Obiectiv de
Suceava" 16.12.2007), "The Heat
increases the risk of leptospirosis
disease" (Mihaela Zrnescu "Monitorul
de Vaslui" 29.08.2007), "The Cure
against the Virus causing Cervical
Cancer " (Elena intaruZiarul de
Bacau", 03.12.2007), "Husband and
wife poisoned by pickled mushrooms"
(Magda Olteanu, "Ziua de Iasi",
21.10.2007), etc.

grandmothers medicine? God forbid,

as we have children of our own, and
young
people
today
are
so
unpredictable... In this context, can
such information pass onto the news of
public interest? What kind of parent
would like to go through that? And
perhaps such an article could be of
public interest if the journalistic
approach
would
have
been
professional.
Surprisingly, out of
hundreds of articles that have been
selected, only twelve provide a
thorough analysis of the medico-social
phenomenon causing such behaviour.
Nine of these were discussed by
professionals - doctors, psychologists,
psychiatrists, social workers, and
teachers in Ziarul de Iai one in
Monitorul de Suceava, Ziarul de
Bacu and Monitorul de Neam.
.
Otherwise,
the
news
are
rudimentarily presented, maybe in a
shocking manner, yet failing to send
any messages. Moreover, either the
author of the text or the doctor treating
the person in difficulty explicitly gives
the name or sufficient information so
that the person in question can be
recognized by family, colleagues,
friends or teachers. One example is to
be found in the article "The Lies of a
Student set Paediatricians on Fire,"
written by Magda Olteanu ("Ziua de
Iai ", 09.06.2007). "A Teenage Girl
Who Tried to put an end to her Life
(...) Ana Maria Bratu, aged 14, was
transported yesterday to " St. Mary"
Hospital
with
voluntary
drug
intoxication. The teenager girl student
was in the seventh grade in a high
school in Iasi and has swallowed 14
pills of barbiturates". The text
continues with such details as the
parents probably know their child
better (...) it was found that the girl was

Other News
I called them "other news" because
it deals with a medical and social side
too difficult to be delimited - suicidal
gestures, attempts, or even rapes,
physical molestations, teenage alcohol
use, etc. The kind of news that we find
on the front page in the cuff newspaper
or on page three [8] mostly read after
page one. Unfortunately, this kind of
news is read among the first, during a
coffee break, with such comments as:
Have you read about that student who
has attempted to suicide because she
was heartbroken, after swallowing her
109

raped and that she was no longer a

virgin" provided by her treating
physician, Dr. Catalina Ionescu.
Basically, when they gave her name
and age and that the girl was not a
school but a high school student were
sufficient evidence that any of her
colleagues could be able to point
fingers and call her "suicidal" or direct
various sexual allusions to her. What is
the impact of such an article?
Stigmatization by colleagues, making
the parents of the teenage and her
brothers go through a delicate situation
in front of the family, neighbours,
colleagues at work or at school. Also
surprising is the negligence of the
doctor who has provided of
confidential data about the patient and
regardless her sexual experience and
the opinions of her parents., More
appropriate perhaps would have been
that the doctor send the girl and her
family to a psychologist than to
stigmatize her publicly. Olteanu
Magda has also written about another
16 years old teenager, pregnant in the
seventh month, needed care in "St.
Mary" Children's Hospital in Iasi
because she got drunk. Also, and this
time are absolutely all the details: "A
teenager pregnant in the seventh
month, required medical attention
because he got drunk. Elena Stirbu,
aged 16, living in Mironeasa village,
was admitted ..."("Pregnant woman
blind drunk" Magda Olteanu, Ziua de
Iai ", 01.05.2007). As in the previous
article, the patients doctor provides
medical details about the patient's
condition: "After the health of a
pregnant woman was established, she
was sent for tests and to the
obstetrician," said Dr. Solange Rosu,
head of the Emergency Unit of the
above mentioned hospital.

Even more unethical is the

comment of Doctor Solange Rosu,
who discusses about the state of the
pregnant woman without taking into
consideration that, on the one hand,
she is minor and, on the other hand, he
lacks the consent of the family
regarding the public disclosure of such
details. Which would be the
journalistic impact of letting the family
of the teenage patient know from the
papers which were the reasons why she
was dizzy, had headaches and vomited,
which caused her admission into the
hospital. Additionally, Mironeasa is
largely populated by Roma people and
therefore, the future mother would be
judged according to the gipsy laws
which are very strict with respect to
this types of circumstances, also
knowing the fact that the Roma women
are not allowed to make such mistakes,
especially if pregnant. With the same
voice and the same author we should
mention that in all her articles on
suicidal cases, Magda Olteanu does not
keep the confidentiality of patients,
regardless their age, the journalist of
Ziua de Iai discloses the identity of
a student who has tried to commit
suicide swallowing 120 pills belonging
to different types of medicines..
"Daniela Iftimie, a 20 years old
student, (.....) spent five days in a coma
(.....) and was diagnosed with severe
drug intoxication after she tried to end
her life by swallowing 120 pills ..."
The head of the Emergency Unit of St,
John Emergency Hospital , Dr. Tudor
Ciuhodaru gives, in turn, full details
about the patient's condition:" Just got
a dead patient. We have just received
a dead patient. No vital function was
responding. When being admitted in
the hospital, the patient was in
collapse, a third degree coma. We ask
the same question as in the previous
110

cases: Which was the journalistic

impact? The answer is also provided
by doctor Ciuhodaru: None of the
family members knows the reason why
the patient wanted to put an end to her
life. It is obvious that the disclosure
of the case with all the details
regarding her identity, in such a
suicidal context, may be able to lead to
another crisis of a disturbed patient, as
it was proved by the patient in this
case. It is obvious that in this case
confidentiality was neglected both by
the journalist and by her doctor. The
journalistic intent is definitely lacking
as it was only intended to get the
shocking news [9]: a student tried to
commit suicide by swallowing 120
pills failing to deeply discuss the
impact of such a gesture: how can a
young women with an education above
average be up to such an extreme
gesture?,
what pushed her to do such a
thing?; is it an exacerbated reaction
towards and external factor or about a
psychological painful condition? the
same words can be said about the
attitude of the doctor who, trying to
built a wonderful relationship with the
media, also amplified by the fact that
he is the spokesperson of that hospital,
has forgotten about the his professional
oath and failed in keeping the
confidentiality relationship between
the doctor and the patient.

patients confidentiality. We do not

know what caused the extreme gesture
of the 15 years old boy, Voicu G.,
living in Izlaz, Zorleni, who swallowed
73 Metoclopramid pills in a sudden
moment of madness, shows like in an
information melting pot a journalist
living in Barlad apart from the suicidal
attempt, tells, within the same article,
the story of a girl who has been bitten
by a snake and that all this time,
lipotimy has made victims among the
inhabitants of Barlad. (The Girl who
has been Bitten by a Snake, Bogdan
Andrei, Monitorul de Vaslui,
29.06.2007).
By stating only the name initial the
journalist probable believe that he has
respected the right to confidentiality to
that patient.
He has not still
questioned how many 15 years old
teenagers living in Izlaz, Zorleni, bear
the name Voicu and have a surname
with the G. initial. What happens to
a male teenager who is told by his
colleagues and friends that he tried to
commit suicide like a girl? This is
mostly common in small communities,
where such gestures are extremely easy
to identify.
The situation is more serious as the
boy proves to show higher mental
sensitivity.
On the other hand, the least medial
knowledge the journalist has to have
after a serious research should prevent
him from making a fool of himself by
writing that lipotimy makes other
victims. Lipotimy is, in fact, a state of
dizziness or in other words a result of
the condition and not the condition
itself.
This way of keeping the
confidentiality was seen in most of the
articles belonging to this type, as
many of the presented aggressions
were registered in the rural area and

Another way of presenting such

information is to disclose only the
name and the initials of the surname of
the person in difficulty. Nevertheless,
we can say that we witness more
confidentiality than in those cases
when personal information is made
explicit. The following examples are
meant to demonstrate that the mere
initial does not always cover the
111

therefore in small communities where

these are easy to identify.

by means of personal observation, a

clear image of what really happened.
Therefore, both professionalism and
honesty will be revealed by the written
text [12] that needs to be published the
next day.
It is also true that the appearance in
the media of all the above mentioned
cases entirely belongs to the doctors
who have offered journalists that type
of information, without having the
consent of the victims or their families.
The case is even worse as the
presented victims were minors in
Stuck for life by means of the
Hippocratic Oath, to their job and
patients, the doctor must cure the body
and also the spirit. Very often patients
believe that a certain doctor is good
if, apart from professional skills,
he/she talks to patients, listening to all
those details related to the disease and
to their physical suffering [13] What
patients actually want from the medical
staff is mainly the human side which is
then followed by the medical
proficiency.
The suffering patient equally
appreciates the medical competence
and the kindness of the doctor treating
him/her.
In this patient/doctor relationship,
the medical secret is the essence of the
communication between [14] them as
it protects the private information and
respects the dignity of patients.
There are doctors that will not
collaborate with the mass media until
journalists obey their professional
rules.
A clear example is the case of a
young woman suffering from syphilis
which was shown as general news: the
causes for the disease, manifestation of
the
disease,
transmission,
psychological
and
social
consequences. None of the personal

Discussions
Under the above mentioned
circumstances,
when
personal
information was published without the
consent of the victim, journalists can
be accused that they have not respected
the ethical norms supposed by the
journalistic act. This can be regarded
as an intrusion into the private life [10]
and a violation of the right to intimacy
of people in difficulty. The case get
more serious if the victims are
teenagers as their affective personality
has not been penned yet and the
explicit publication of their story in the
media
can
have
long
life
consequences. On the other hand, as it
should be the case in a professional
news room, the people responsible for
publishing the articles especially the
chief writer, must ensure that each
article that needs to be published
respects the writing rules and
deontology rules at the same time.
Even if the mass-media has the
exclusive role to inform [11] and not
educate, as it has been wrongly
assumed so many times, the news has
to be filtered thoroughly before its
publication. Starting from certain
discussions in the news rooms to the
proofreading of style and grammar, the
most important filter is represented by
the self censure dictated by the writer
s consciousness. In the pursuit for the
sensational, pushed back by the
competition and by the high
expectations of those who decide the
editorial policies, the writer must
remain a professional individual. We
shall not forget that the field journalist
is the first to arrive at the scene and the
one collecting the data and shaping it,
112

data of the young woman was

disclosed to the media. Unfortunately,
there are certain doctors who, running
across journalists inside the hospital,
would tell them to go to a certain room
as they would find a woman who has
swollen a huge amount of sleeping
pills because her boyfriend left her as
she was fat.
The journalist will definitely keep a
closer relationship with that doctor
who has provided him/her with useful
information as the main concern is not
to lose the opportunity for hot news
and be the first to get it, especially in
such a competitive media environment.
And nevertheless, which is the
absolute
medical
secret?
[15]
Experience has proved that limits
should be imposed in keeping the
confidentiality, such as children who
have been treated bad or abused,
serious contagious diseases, etc.
In
this
patient/doctor/media
equation, all those involved cane argue
for and against the taken decisions and
consequently, it is hard to clearly
identify who has made the mistake and
to what extent they have caused
negative consequences. This is also
determined by the fact that ethics and
deontology are regarded as unclear
[16] area situated between the
philosophical principles and the daily
activity. Two different visions are
involved in the ethics of the media and
therefore the connection of theory and
practice becomes difficult. While the
study of ethics requires deliberation,
careful distinction and long debates,
the news room staff has the tendency
to stress the ability to make good
decisions in stress situations [17] on a
daily basis. On the other hand, certain
doctors, sometimes from negligence or
from the desire to have their interview
published, ignore the code of

deontology and offer personal details

about those patients to whom they
have sworn that they would cure them
rather than harm them.
To this extent, clear and legally
provided milestones must be created to
ensure the journalist the dignity of a
hard work of informing their audience
[18], equally protecting the right to
privacy of an individual. We live in a
world where clear laws the medical
world with the Hippocratic Oath and
different deontological codes are to be
obeyed there are still breaches of
confidentiality. The current code of
deontology for journalist seems rather
unsteady and ambiguous in terms of
the journalistic limits that have to be
observed by a journalist, no matter if
working in a TV station, a radio station
or for a newspaper.
Conclusions
Confidentiality is a means of
patient protection ensuring the right to
private life. A clear distinction of the
concept of public person is also
required since the public person is not
similar to that person living his/her life
in the camera flashes.
Confidentiality is closely connected to
the autonomy of the patient and to the
essence of the medical profession. We
are practically facing two different
fundamental concepts on the morality
of the patient/doctor relationship. It
should also be mentioned that the
medical secret is grounded on the
fundamental right of individuals to
intimacy and confidence. In other
words, the medical secret is a basic
condition for the doctor/patient
relationship, a balance between the
professional consciousnesses, on the
one hand and the trust received from
the patient, on the other hand.
113

Confidentiality
is
essentially
related to the informed consent.
Theoretically, we can analyse them
separately, but in fact they have to be
treated as a whole as it has been
demonstrated that they often interfere.
Therefore, it can be said, without
fearing that this would be a mistake,
that breaching the confidentiality may
damage
the
integrity
of
the
patient/doctor relationship.
In Romania, confidentiality is
regulated by national laws and codes
of deontology. Nevertheless, the
studies that have been previously
performed show that serious breaches
of the patients rights have been
committed both by doctors and
journalists.
Although within the medical
environment the code of deontology,
included in its self regulation, also has
cohersion methods, journalists will not
always respect their code of
deontology, even if this exists. Under
the pretext of public interest,
journalists breach the individual rights
of patients publishing personal data
and photos of the victims, which
represents an intrusion in their lives, an
act which cannot always be justified.
The analysis of around 10.000
media articles in 32 publications in the
Moldavian area for a period of time of
one year has shown the large amount
of information, of interest, where
explicit information about people in
need is disclosed. Very often, these
articles are placed in a very good
location of the paper layout, the
information being provided, so many
times, by the doctor treating that
patient or by the spokesperson of the
hospital.
The failure to provide a clear legal
framework
able
to
prevent
interpretation
regarding
the

patient/doctor/media relationship has

frequently led to a large exposure of
victims in the media many times
without having given their consent.
Although the role of mass-media is
strictly to inform, it has been proven
that indirectly it has a training role,
mainly directed to those citizens with a
social condition below average. This
may be the reason why mass-media is
an important asset in the intent to
increase the awareness of the entire
community with respect to the
patients rights.
In this context, clear laws explicitly
regulating the patient-doctor/media
relationship must be adopted as it shall
ensure the protection of the victim, the
doctor and the journalist and create a
balanced relationship between the need
for information resources and the need
for
private
life
protection.

114

Bibliography
[1]. Coman C. Relaiile publice: principii i strategii, Editura Polirom, Iai, 2003.
[2]. Pdure A., Grama R. Dreptul pacientului la informare i consecinele nerespectrii acestuia
n republica Moldova. Revista Romn de Bioetic, 2011; 9(2):33-39.
[3]. Agee W.A; Ault P.H.; Emery Edwin Reporting and writing the news, Haspers end Row,
1993.
[4]. Bertrand J.C. O introducere n presa scris i vorbit,Editura Polirom,2001.
[5]. Coman M. Mass-media n Romnia post-comunist, Editura Polirom, 2003.
[6]. Craia S. Dic ionar de comunicare, mass-media i tiinta informrii, Editura Meronia, 2008.
[7]. Astrstoae V., Triff B.A. Esentialia in Bioetica, Editura Cantes, Iai, 1998.
[8]. Wilkes E. Patients wants versus patients interests: a commentary. Journal of Medical
Ethics, 1986;12(3):131-132
[9]. Astrstoae V., Ioan B., Gavrilovici C., Bioetica-cazuri celebre, Editura Junimea, Iai,
2005.
[10]. Astrstoae V., Loue S., Ioan B.G. (edit.), Etica cercetrii pe subieci umani, Editura
Gr.T.Popa U.M.F. Iai, 2009.
[11]. World Press FreedomCommittee, Asociaia Ziaritilor Romni, Fundaia pentru o Societate
Deschis Manual pentru ziariti din Europa Central i de Est 1992.
[12]. Coman M., Mass media, mit i ritual - o perspectiv antropologic, Editura Polirom, 2003.
[13]. Masson J.K.; McCall Smith R.A. Law and Medical Ethics, Butterworth, London, 1991.
[14]. Annas G.J. Judging Medicine, Humana Press, Clifton, New Jersey, 1998.
[15]. Astrstoae V., Stoica O. Genetic versus Bioetic, Editura Polirom, 2002.
[16]. Mattelart A., Mattelart M. Istoria teoriilor comunicrii, Editura Polirom, 2001.
[17]. Runcan M. A patra putere - legislaie i etic pentru jurnaliti, Editura Dacia, Cluj- Napoca,
2002.
[18]. Wilcox Dennis L., Cameron Glen T., Ault Phillip H. Agee, Warren K. Relaii publice.
Strategii i tactici 2002.

115