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Patient-Doctor Confidentiality

Confidentiality is a set of rules that dictates the protection of health information shared by a patient with a physician. In general, this information should only be used to dictate medical decision-making steps and can only be disclosed to a 3rd party with the patient’s express consent. While there are some specific situations where patient-doctor confidentiality may be broken (e.g., when the patient is at risk for self-harm Self-harm Psychiatric Assessment), these situations are considered exceptions and clinicians ought to make sure that confidentiality is not unnecessarily jeopardized.

Last updated: 15 Jun, 2021

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Overview

Definition

Confidentiality describes a set of principles observed to maintain private information shared by a patient with their doctor during the course of their medical care Medical care Conflict of Interest.

  • Done with the intent of protecting the patient’s intimacy and privacy
  • Underlying principles: 
  • Protected health information (PHI): information generated while providing medical care Medical care Conflict of Interest that can be used to identify a patient
  • PHI may only be communicated with 3rd parties after patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship provide express consent.

Legislation

  • Many countries protect the confidentiality of medical information by law.
  • In the United States, protection of medical information is required by the Health Insurance Portability and Accountability Act (HIPAA): All medical staff should be familiarized with the local legislation regarding the handling of medical information and the institutional protocols for compliance Compliance Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. Veins: Histology.
  • Security rule: protection of electronically stored PHI (ePHI) via adequate administrative, physical, and technical safeguards
  • Physicians Physicians Individuals licensed to practice medicine. Clinician–Patient Relationship must use discretion to communicate with patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship when using electronic communication Communication The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups. Decision-making Capacity and Legal Competence and/or social media while remaining compliant with the HIPAA. 

Breaches of confidentiality

  • Violations must be self-reported to the competent government body (Department of Health and Human Services ( HHS HHS Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are serious, acute complications of diabetes mellitus. Hyperosmolar hyperglycemic state occurs due to a relative deficiency of insulin or insulin resistance, leading to severe hyperglycemia and elevated serum osmolality. Hyperglycemic Crises) in the United States).
  • Penalties depend on the jurisdiction and local penal code but can be as high as $1.5 million in the US for willful neglect Neglect Child Abuse.

Limits of Confidentiality

There are situations when confidentiality may be breached. While there is no legal obligation to inform patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship of the limits of confidentiality, some argue that there is an ethical duty to do so.

Adequate disclosure

Discussion of PHI for clinical purposes is covered under HIPAA, including:

  • Discussion with other clinicians
  • Contextual information to demonstrate pertinence for diagnostic imaging modalities, laboratory tests, and/or pathology
  • Referral to other institutions

Inability to give consent

The clinician Clinician A physician, nurse practitioner, physician assistant, or another health professional who is directly involved in patient care and has a professional relationship with patients. Clinician–Patient Relationship must use the information to act according to the patient’s best interests if a situation arises where the patient is unable to provide consent of disclosure:

  • The patient is determined to be incapable.
  • Medical emergencies (e.g., MI MI MI is ischemia and death of an area of myocardial tissue due to insufficient blood flow and oxygenation, usually from thrombus formation on a ruptured atherosclerotic plaque in the epicardial arteries. Clinical presentation is most commonly with chest pain, but women and patients with diabetes may have atypical symptoms. Myocardial Infarction, life-threatening trauma)
  • Inability to express consent due to the current diagnosis (e.g., coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma)

Exceptions due to requests from public health bodies or law enforcement

  • Threat to public health
  • Investigations of child or elder abuse
  • Investigations of fraud
  • Imminent threat to self or identifiable 3rd parties 
  • Threat to national security

References

  1. Tariq, R.A., Hackert, P.B. (2021). Patient confidentiality. StatPearls. Treasure Island (FL): StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK519540/
  2. Darby, W.C., Weinstock, R. (2018). The Limits of Confidentiality: Informed Consent and Psychotherapy. Focus (American Psychiatric Publishing), 16(4), 395–401. https://doi.org/10.1176/appi.focus.20180020

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