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When to Break Doctor–Patient Confidentiality

By Debra Wood, RN, contributor

Doctor–patient confidentiality remains a major tenet in medical practice, and is usually expanded to advanced practitioners, as well. 

The objective of this confidential relationship is to make patients feel comfortable enough to seek treatment and provide any and all relevant information. This helps the doctor to make a correct diagnosis and provide the best possible care.

Yet, in some cases, the provider must speak up; in others it can become an ethical dilemma to determine the best course of action.

The American Medical Association’s Code of Medical Ethics states that physicians may disclose information without a patient’s consent to other health care personnel who are or will be providing care to the individual, to authorities when required by law, and if the physician believes the patient will seriously harm himself or someone else. 

Otherwise, the physician has a duty to not release information, even to family members. 

Some doctor–patient confidentiality is upheld in many states for adolescents, as well, who can seek care for sexually-transmitted infections or substance abuse without the provider notifying the patient’s parents. 

[WORK in the state you choose with a part-time or full-time locum tenens job.]

Mandatory reporting

In all 50 states and the District of Columbia, physicians, nurses and other health care workers are required to report child abuse and neglect; in these cases, medical ethics and doctor–patient confidentiality does not come into play. 

States vary in their rules about elder abuse reporting, but every state has mandatory reporting. Some, such as Delaware and North Carolina, require any person with reasonable cause to believe there is abuse to report it to adult protective services. Other states, including Florida and New York, specifically mention physicians and/or other health care professionals. 

Domestic violence reporting laws vary by state, with some requiring reporting of injuries caused by acts in violation of criminal laws or the use of weapons or specific domestic violence statutes. Clinicians should know the laws in the state where they are practicing. 

The Medscape Family Physician Ethics Report found that 18 percent of the physicians responding to the survey have suspected a patient was a victim of domestic abuse but did not report and did not investigate further. Some of the physicians said they feared a worse outcome if their suspicions were reported. 

Substance abuse

In most states, health care providers are not required to report patient substance abuse, said Celia Fisher, director of the Center for Ethics Education at Fordham University in New York and chair of the American Psychological Association’s Task Force that developed the Ethics Code for Psychologists.

The thinking is that no mandatory reporting will encourage people with a substance problem to tell that to their physicians or other health care provider in order to get help. 

“In most instances, health care providers will refer the patient to an addiction specialist who is often a psychologist,” Fisher said.

Locum tenens physicians should become familiar with the resources in the community in which they are working. 

“If a patient is going through withdrawal or is inebriated at a point that needs medical attention, the provider can reach out for medical assistance without the client's consent,” Fisher continued. 

“If an inebriated patient is threatening to harm him or herself or another identified person, then after carefully assessing the situation, the provider may take steps to seek hospitalization or inform authorities and the person identified to be at risk of harm from the patient.”

In some states, it is mandatory for a health care professional to report a colleague who is suspected to have a substance abuse problem. Seventy-eight percent of respondents to the Medscape survey said they would report an impaired colleague, up from 76 percent in 2014. 

Inadvertent breaches

Some of the most difficult to control breaches of patient confidentially occur inadvertently, by chatting about a case in the hallway or on the elevator. You never know who is in hearing distance. Physicians and other clinicians should always seek a private space to discuss a case with colleagues. 

Additionally, with electronic records, maintaining doctor–patient confidentiality has become more challenging, with some health information systems being hacked and held for ransom. All computer systems should have protections to prevent misuse of patient information. 

Cybersecurity systems monitor who has looked at patient records, and clinicians should only access the records of a patient in their care. 

Find more information:
AMA Code of Medical Ethics: Privacy, Confidentiality & Medical Records.

LOCUM LEADERS, an AMN Healthcare company, places physicians and advanced practitioners in short- and long-term locum tenens positions across the U.S.