I certainly can, and I should preface this by saying I'm married to a civil litigation lawyer. Confidentiality has been an obsession of mine since the day I met her, and actually since the day I walked into first-year medicine.
To give you an example, I was quite concerned about the confidentiality of the lady in the video that I showed today. I had reassurance from the committee that it would not be archived or shared on the Internet, and in fact that it would be shared only by the people in the room. I also went to the extent of calling her last Sunday afternoon and explaining to her what I was going to be using it for and got her permission to use it. She is an educator as well and she really wanted you to be part of that experience.
In my practice, with regard to these confidential details, they are not archived; they are simply documented. When I see that, I know what it is and I write it down. I don't need to keep that information, but some things do need to be archived and kept. For instance, if someone had a CAT scan five years ago and this year we find a tumour, we often go back and look at the CAT scan to see if that tumour was there. Did we miss it? How small was it? How could we have avoided that error?
So I think it's important that the information be available, but it has to be available only through the most secure firewalls. Getting through those firewalls, particularly if you're not in the hospital and in the facility inside, can be very difficult. From my office, it can be very difficult. Even though I share an electronic medical record with 85% of the doctors in my community, I can sometimes have a hard time getting that neurology consult, that CAT scan from last year.