By Dr. Teresa Nicoletti, Partner, Geoff Bloom, Partner, Julian Grover, Special Counsel and Meghan Carruthers, Special Counsel.
The decision of the Queensland Civil and Administrative Tribunal (Tribunal) in Health Ombudsman v Rathie [2026] QCAT 180 is an illustrative reminder that if publishing any material that contains information related to a patient, patient confidentiality is not preserved merely by removing names, faces or other obvious identifiers. The obligation is broader than that. Practitioners must consider whether the patient has consented to the use of their information at all, and whether the proposed use is consistent with the trust inherent in the doctor-patient relationship.
The point is a practical one. Clinical material can be captured, stored and circulated with very little friction. What may begin as a photograph, anecdote or personal record can become a public and durable disclosure. In that setting, the difference between education and inappropriate disclosure may turn on matters that are easy to overlook at the time, including the scope of consent, the audience, the surrounding clinical detail and the likelihood that the patient could be recognised.
In the case of Health Ombudsman v Rathie [2026] QCAT 180, the intended purpose of the publication – whether amusement, bemusement or education – did not reduce the seriousness of using confidential patient information without consent, particularly where the treatment of that information was insensitive or demeaning.
The respondent was a senior specialist anaesthetist at Toowoomba Base Hospital. In 2023, he self-published The Anaesthetic Picture Book, a photo-based book intended to depict his day-to-day work as an anaesthetist. The book included photographs taken in the hospital environment, including clinical records, surgical procedures and material relating to patients, accompanied by commentary about their medical conditions, procedures and personal characteristics.
Although the patients were not named, the Tribunal accepted that the risk of identification was materially heightened by the context in which the book was published. The respondent practised in a regional centre, the book referenced his place of practice, included images taken within the hospital, and was promoted within the hospital itself. It was also made available for purchase on Amazon. In those circumstances, the removal of direct identifiers did not answer the confidentiality concern.
The respondent accepted the wrongfulness of his conduct, removed the book from sale, attempted to recover copies, cooperated with the investigation and undertook education and mentoring directed to ethics, privacy and professional obligations.
The parties agreed that the conduct amounted to professional misconduct and that the appropriate sanction was a reprimand and a fine of $30,000. The Tribunal accepted that position.
The Tribunal’s analysis did not turn on whether a patient’s name appeared in the book. Nor was it enough that the respondent believed that identifying material had been removed. The question was whether confidential patient information had been collected, used and published without consent, and whether the circumstances in which the book was produced and distributed created a real risk that patients could be identified.
Removing obvious identifiers does not necessarily remove the confidentiality risk. The assessment remains objective and contextual. In a regional setting, or where the clinical setting, procedure, timing or other details are apparent, a patient may still be identifiable even if direct identifiers are absent.
It did not matter that the disclosure occurred outside the formal clinical encounter. Patients provide information for the purposes of care. That information does not become available for professional storytelling, teaching, humour or commentary unless the patient has given informed consent or another lawful basis exists.
The sanction reflected the need for general deterrence. The respondent had demonstrated insight and remorse, and had taken remedial steps. Those matters were relevant to the need for specific deterrence, but they did not answer the broader protective function of disciplinary proceedings.
The ease with which clinical material can now be circulated explains the emphasis on general deterrence. A clinician no longer needs a publisher, editor or institutional platform to disseminate it. A book can be self-published, a post uploaded, and a photograph or clinical anecdote shared before there has been any careful assessment of consent, confidentiality or the risk of identification.
The difficulty is not only the ease of publication; it is the use of a patient’s private clinical experience for a purpose unrelated to their care. Patients are entitled to expect that information they disclose in connection with their care will not later be used for commentary, amusement or anecdote. Even without malicious intent, that kind of publication may seriously damage trust and warrant disciplinary sanction.
The practical consequence is that consent and purpose need to be considered before clinical images or patient-related information are taken, retained, used or published. If the proposed use is not necessary for care, and particularly if it is intended for publication or broader distribution, express and informed consent should be obtained unless there is another clear lawful basis for the use.
Health services should also ensure that policies on photography, mobile phone use, clinical teaching material and social media are understood in practical terms. General prohibitions on unauthorised disclosure may not be enough. Staff need to recognise that clinical images, screenshots, records, theatre material and contextual details may all constitute confidential patient information, and that publication can occur through informal as well as formal channels.
Remorse and cooperation remain important, but they do not erase the seriousness of a breach of this kind. They may reduce the need for measures directed at the individual practitioner, but they will not necessarily reduce the need for a sanction that denounces the conduct and deters others, particularly where confidential patient information has been published.
Health Ombudsman v Rathie is a useful illustration of how easily patient confidentiality can be compromised once clinical material is taken outside the context of care. The obligation is not satisfied by obscuring names or assuming that patients will not be recognised. It requires attention to consent, context and the purpose for which information is being used.
Clinical experience may be rich, unusual, challenging and even compelling, but it is not the practitioner’s property to publish. Where patient information is involved, professional judgment requires more than an assumption that the material has been sufficiently de-identified. It requires consent, a proper basis for use and, where those matters are absent, restraint.
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