In May, the Turkish Ministry of Health asked family doctors to provide it with the medical records of patients with chronic psychotic disorders registered at communityl mental health centers. “The medical record files of patients with schizophrenia, paranoid disorders, psychotic disorders and bipolar disorders should be filled in and dispatched,” the official letter said. The Health Ministry’s latest move comes as a fresh indication that despite criticism and controversy over efforts to collect personal data, the government continues to try to compile detailed profiles of citizens.
The ministry’s request led Kemal Kilicdaroglu, the main opposition Republican People’s Party (CHP) leader, to claim on March 17 that the police have been profiling all Turkish citizens. Speaking at a CHP parliamentary meeting, Kilicdaroglu charged that police intelligence “has collected online the personal information of all people in the country via the DEVA 1 and DEVA 2 [software] programs.”
In a joint statement June 5, the Turkish Medical Association (TTB), the Turkish Psychiatry Association, the Turkish Specialized Family Doctors Association and the General Practitioners Association stressed that sharing medical records without patient consent was unacceptable and warned that the ministry’s effort amounted to a constitutional violation. It called for new legislation to regulate how the ministry is allowed to collect, process and share medical records in line with the constitution and international treaties to which Turkey is a signatory.
According to CHP deputy Aytun Ciray, a physician and a former Health Ministry undersecretary, the Justice and Development Party (AKP) government began collecting medical records in 2012. “That year, the Health Ministry began storing the hospital records of all patients under a legal provision adopted in an omnibus law. A legislative decree allowed it access to the medical records of third parties,” Ciray told Al-Monitor.
He recalled that the Constitutional Court, taking up a CHP petition, had ruled against the Health Ministry’s Health Net 2 project, under which personal information was collected. “The court ruled that this practice breached [principles of] personal freedoms and security and the protection of privacy since it entailed the selling of patients’ personal information. They were collecting all types of personal information, including addresses and medical information,” Ciray said.
He acknowledged the ministry’s right to collect statistics to compile the country’s health map, but he also said, “The method is wrong. One cannot seek to obtain information without the patient’s consent. If they want to map diseases, they could easily use codes for patients.”
Following the latest controversy over psychiatric records, the Health Ministry maintains that it was motivated by the aim to “ensure that patients receive treatment at community mental health centers.” Ciray is unconvinced. “Even if they claim to be building new hospitals and planning to direct [patients] to new psychiatric centers, the measure is still misplaced. Three years ago, the same ministry was inclined to pass patient information to pharmaceutical companies and newly established private hospitals,” he said.
The TTB in the statement it issued called on family doctors to resist the ministry’s demand, stressing that the government was pressuring physicians and medical institutions into following procedures that violate patient and human rights. “We urge family doctors to know they hold ethical and legal responsibility over the handover of such data and to refuse filling in those forms,” it said.
While efforts against the misuse of personal information continue in legal and democratic arenas, the Health Ministry appears bent on abusing its e-Nabiz (e-Pulse) electronic records system. The ministry's press office issued the following written statement in response to questions from Al-Monitor about its demanding patient records and the problems it might cause: "It’s out of the question for the Health Ministry to share the medical records of any patient with any party. We have developed e-Nabiz, a modern system through which citizens can access all their health records. Citizens can share the information in the system only if they wish to. The ministry is currently working on means to identify health problems and their prevalence in a given region without using people’s names. Determining the prevalence of a given health problem in a given region and taking measures accordingly is a duty of the Health Ministry and related institutions. No one has the authority or the right to know the identities and personal information of the patients in question. We are extremely meticulous and sensitive on this issue."
The TTB, however, underscored that the police had sought the personal information of psychiatric patients through the e-Nabiz system. Sharing medical records without the patient’s consent is unjustified even for the stated purpose of integrating community mental health centers, the organization contends. “For doctors to find the correct diagnosis, patients should be able to disclose to them what they have been through, what they have seen and what they know without any reservations,” the TTB said. “And to make those disclosures comfortably, patients should have trust and confidence that doctors will keep the disclosed information and events confidential. The circulation of such information is extremely dangerous.”
In an interview with Al-Monitor, Cengiz Gulec, former head of the Psychiatry Department at Ankara’s Hacettepe University Medical Faculty, raised additional concerns. “We don’t know what purpose the ministry is pursuing with this practice, but in psychological research, personal information is never enough. You cannot determine the outlook and prevalence of a given illness only via patients who have resorted to family doctors,” Gulec said.
“The notes I keep about my patients are my own private files. Those files are something that must remain between the patient and the doctor only. Sharing them is an affront to the basic principle of confidentiality,” he said. “Moreover, a psychiatric patient’s medical record in a general hospital and his/her records while under private treatment are two completely different things. This is something that requires utmost sensitivity. We are concerned about protecting not only the [names of] patients in psychiatry departments but also their confidential information.”
The Health Ministry’s real reason for identifying psychiatric patients remains a mystery, but allegations of all-encompassing profiling in Turkey is preventing the TTB, psychiatrists and others from concluding the intention is good.
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