Question normal

What is the standard convention for identifying or rather de-identifying protagonists in your writing to protect confidentiality? If a patient, provider, or institution doesn't consent to being written about because of the bad or sensitive nature of the subject, does that become forbidden material? I would imagine we would want to write about the most difficult aspects, but are also dually constrained by the difficulty or sensitivity of that very material. How do you get around that? For instance, I want to write about a patient with whom I've lost contact -- can I de-identify them and still tell their story?