To the Editor: The article by Senanayake and Ferson1 on detention for tuberculosis included two case histories. In the case of “Patient 2”, we believe the details published were misleading and unnecessarily disclosed potentially identifying information. This case was presented in sufficient detail to allow identification of “Patient 2” by including date of admission, personal details, city of admission and details regarding his past history of alcohol addiction and attempts to self-discharge. All this information was not necessary and did not take into account all the relevant medical complicating factors.

We were surprised that, as the primary treating team involved in this patient’s care over the inpatient stay of 3 months and the following 6-month outpatient follow-up, we were not informed of the authors’ plans for publication, nor requested to comment on the facts of the report. We were also surprised to read details of the article in The Sydney Morning Herald on the day of the article’s publication in the Journal.2

An individual’s right to privacy is a fundamental human right. It is unfortunate that the careful consideration that had been given to his detention was not extended to publishing his case details. As Senanayake and Ferson point out, “Patient 2” recognised that his human rights were being “infringed” because he was being held in a “jail cell”, which was a temporarily modified isolation room in a public hospital under 24-hour guard.

In law, information provided to a medical practitioner by a patient becomes subject to a statutory duty to protect the patient’s privacy and a common-law duty of confidence is owed by the treating medical practitioner to the patient. The NHMRC Guidelines approved under Section 95A of the Privacy Act 1998 indicate that, when a patient history is published, an important principle is that a patient may not be identified or held up to ridicule.3 Furthermore, public access to medical journals on the Internet has allowed increased availability of such reports to the general public and increases the chance of family members and others identifying individuals.

The principle of protecting patient privacy has previously been respected by the Journal. An article published in 1994 reported a 1979 outbreak of tuberculosis in medical students who attended an autopsy of an immunosuppressed patient with unsuspected active tuberculosis.4 A report of the incident was not published contemporaneously, mainly to protect the privacy of the students involved.

As the report by Senanayake and Ferson suggests, our patient was socially disadvantaged, and several aspects of his behaviour were probably attributable to a Jarisch–Herxheimer reaction in conjunction with acute alcohol withdrawal. Although we recognise the need to serve the public interest in health service management activities, this must be balanced against the requirement for patient privacy regardless of social class. We suggest that the publisher has an obligation to ensure that patient consent is obtained, and that the primary treating team has been involved in the review of case details so that misleading and potentially identifying information is not released inappropriately.

In reply: We concur with the principle that patient privacy should be protected in case reports. As recommended by the International Committee of Medical Journal Editors,1 measures in place at the Journal include asking authors to obtain patient permission for publication where possible, and directing authors to remove potentially identifying patient information.

The article in question was not a case report. Case details were given to exemplify the circumstances that might lead to detention of a patient for public health reasons in New South Wales, and dates and some details were retained to illustrate the temporal flow of the story. We agree that this may have made the patient identifiable, if not to the general public, to himself or his family. We regret this editorial lapse, and have reworded the patient details in the electronic version of the article.2

Although chastened by our anonymous colleagues’ observations, we are somewhat puzzled as to why, given their concern about their patient’s privacy, they are determined to draw further attention to the exposing details. We assume that, in this case (as in the cases of detaining patients for treatment of tuberculosis), public interest prevails.

We also agree that case reports of detailed clinical histories require the input of the primary treating team, but the question of authorship should be determined by the involved parties, not the Journal. Be that as it may, as the article was a public health report (and thus not meant to be a detailed clinical exposition), we do not believe that the input of the treating team was required.