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Patient Confidentiality and Data Protection

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“Come.”

Doctor Bashir entered the commander’s office, PADD in hand.

“Doctor. You had something confidential to discuss with me. Please take a seat.”

“Thank you, sir,” said the doctor. As the station’s CMO and CO respectively, Bashir and Sisko regularly met to discuss confidential medical matters concerning the crew and residents of the station, but the normally cocksure, confident Doctor Bashir looked hesitant today. He played with the PADD in his hands, looked down and then back up at Sisko, and launched into what he had to say.

“Commander, I’m sure you’re aware of Starfleet’s policy regarding disclosure of sexual relationships between Starfleet personnel and certain species?”

“Of course. We called it the Kirk Commandment in the Academy. Although I’ve forgotten the finer details.”

“Well, to summarise, sexual pairings between different species can be divided into three categories. The first is zero-risk, species pairings that pose no medical risk to either party. Human-Klingon, Ferengi-Vulcan, Bajoran-Human, and so on. Most known species combinations are zero-risk. However, some species are sexually incompatible, and these pairings fall into the known risk category. For example, Lurian body chemistry can react badly with Bajoran.”

Sisko nodded. He recalled that Bashir had had to treat a couple of station residents for skin irritation and even minor chemical burns after intimate encounters with Morn, Deep Space Nine’s silver-tongued resident Lurian.

“Any Starfleet personnel initiating sexual encounters which would fall into this category are supposed to disclose to their CMO, ideally before they actually occur, so that the people involved can be informed of the risks. There are usually actions we can take to mitigate the risks, too.”

Morn now had an open prescription, no questions asked, which reduced the acidity of his bodily secretions for a few hours. It seemed to be working, because Bashir had not reported having to treat any of Morn’s paramours for a long time.

“I see,” said Sisko. From the sound of it, the policy had not changed much since his academy days. “And the third category? That’s unfamiliar species, isn’t it?”

Bashir nodded. “That’s right. Although they like to call the category ‘low-data’ now. There are a whole range of species that we have very little data about, so we don’t know yet what the risks might be in the case of sexual relations. All Gamma Quadrant species are in this category, so far. As well as Cardassians.” Bashir flushed a little.

Interesting.

“Is that so?”

“Yes. We know Cardassians and Bajorans are compatible with each other, so that pairing falls under the zero-risk category, but other than that the Federation has no official information or research, so Cardassian pairings with any other species are currently classed as low-data.” Bashir looked at his feet for a moment, then back up. “Anyway,” he said, and swallowed, “all sexual relationships between Starfleet personnel and low-data species are also supposed to be disclosed to the CMO. For safety reasons.”

“That’s very interesting, Doctor, but I’m sure you didn’t come here just to give me a refresher on Starfleet xenosexual regulations.”

Bashir swallowed again.

“No, sir. It’s just, there’s been a slight change to the policy.”

“Oh?”

“Yes. Until recently, it wasn’t required that a CMO disclose his or her own sexual relationships with individuals in the known risk or low-data categories. Oversight wasn’t considered necessary, until the incident with Doctor Crusher of the Enterprise.”

“The Caldos Colony incident.” Sisko recalled hearing about the candle ghost situation, which had turned out all right in the end, but had been very embarrassing for all parties involved.

“So now CMOs have to disclose to another Starfleet doctor, or if none is available, to their...commanding officer.” The doctor was still flushed and nervously tapping the PADD with his fingers. His demeanour reminded Sisko very much of Jake talking about girls, though he hoped his discussions with his son wouldn’t quite reach this level for at least a few more years.

“So you’ve had or are intending to have a sexual relationship with someone?” He adopted the slightly paternal tone that he sometimes used with younger staff.

“Yes, sir. Ehm, actually I’ve been...involved with an individual from a low-data species for over six months.”

That was a surprise. Sisko was not unknown to indulge in a little gossip. With Dax as a friend, he really couldn’t be. And a good CO had at least a surface-level awareness of what was going on in his senior staff’s lives. But as far as he’d known, since arriving on the station the doctor had had nothing more than a few disastrous short-term relationships, and, if rumours were to be believed, a fairly impressive number of flings and one-night-stands. Sisko had been sure the doctor had been about to divulge some night of passion with a passing freighter crew member from the far reaches of the Beta Quadrant.

“Really? Doctor, I had no idea.”

“We’ve been keeping it quiet, sir. This person is extremely private. He wasn’t exactly thrilled when I told him I had to inform you.”

“Ah.” Male. Extremely private. Low-data species. And if Julian’d been in a relationship with this person for half a year, it had to be someone resident on the station or who visited regularly. Sisko mentally ticked through all the possibilities. Garak. Or Odo. Or Dukat. Or one of Dukat’s crew. But, Odo and the doctor? Sisko dismissed that idea as unlikely. There was no chemistry there, and was Odo even interested in sex? He had always struck Sisko as in love with his job and his job alone. As for Dukat, he was certainly not someone who would be discrete about his sexual forays, especially if they involved any of Sisko’s senior staff. And most of Dukat’s crew were rarely on the station. Bashir sometimes worked with Dukat’s medical team, but they were all women, as far as Sisko could remember. No, it had to be Garak.

“It’s not necessary to disclose the identity of the individual in the report if they aren’t also in Starfleet,” Julian said, gesturing with the PADD in his hand, “but it’ll be obvious to you who it is. You’ve probably figured it out already.”

“I think I have,” Sisko acknowledged. “Is your partner a resident of the station?”

“Yes.”

“A certain shopkeeper?”

“Yes, sir.”

“I see.” How to put this delicately? “And is there any medical risk?”

The doctor flushed an even darker shade than he’d been the entire conversation.

“No, sir. None at all.”

“Is there any requirement that this information go beyond me?”

“That’s at the discretion of the CO.”

Sisko nodded.

“Julian, if this is who I think it is, I hope you know what you’re doing. But tell Mr Garak that your secret is safe with me as long as you want it to be.”

Relief flooded the doctor’s features.

“Thank you, sir.”

“Not at all. I really don’t think Starfleet needs to know quite that much about my senior officers’ personal lives.”

“That’s a relief, sir. The report is required to be...quite detailed. I’m sorry.”

“Thanks for the warning, Doctor.” Sisko was not looking forward to learning about this particular aspect of the doctor’s personal life. He hoped that the report was not as in-depth as he’d unfortunately imagined when the doctor had used the phrase ‘quite detailed’. Nonetheless, he had to suppress a smile at the pathetic look that Julian had had on his face when he’d apologised. “Why don’t you leave the report with me and we won’t mention it again?”

Julian smiled for the first time since he’d entered Sisko’s office.

“Yes, sir! Thank you!” He passed the PADD to Sisko, who placed it on his desk without looking at it.

“You’re welcome, Doctor,” said Sisko, successfully maintaining his professional demeanour. “Was there anything else?”

“No, sir.”

“Well, then, dismissed. Let’s forget this conversation ever happened.” Sisko finally allowed his face to crack into a wide grin. “At least until Mr Garak is ready to accompany you the next time I have the senior staff over for jambalaya!”

Julian’s eyebrows jumped up.

“You’d do that, sir? Invite him along?”

“Of course. The chief brings Professor O’Brien, doesn’t he? Garak’s welcome whenever he wants to come. And if he never wants to, that’s fine too.”

If Sisko was any judge of body language, all discomfort had left Julian at this point. He was his usual overconfident self again. He grinned back at Sisko.

“I’ll let you know, sir. Thank you!”

“Doctor, go see Garak. I’m sure he’ll want to know how our meeting went.”

“Yes, sir!” Julian turned to leave. He’d nearly reached the door when he turned around.

“Commander, there is one other thing.”

“Go ahead.”

“Jadzia doesn’t know, but I think she suspects.”

“Doctor, I have no intention of revealing your confidential information to Lieutenant Dax.”

“No, of course not, sir! I just meant...you know how she is. When she thinks you’re keeping a secret from her she can be...persuasive.”

“You have a point, Doctor.”

“She knows that I was having a confidential meeting with you today. If she connects it with the change in policy...”

Sisko completed the doctor’s thought.

“And she is very familiar with the Kirk Commandment.”

No doubt protecting doctor-patient confidentiality, the doctor did not confirm this.

"And if she knows, it'll be all around the station in hours."

Sisko nodded.

“I just thought I should warn you, sir,” Bashir said, turning to exit.

Jadzia must have been waiting beside the door, because she appeared from one side, hands clasped behind her back and eyes bright, as soon as the door opened.

“Good morning, Julian.” She turned to Sisko. “Warn you about what?”