CONFIDENTIALITY
Physicians have a strong professional mandate to maintain the confidentiality of patients.
Communications between patient and physician are highly privileged and this confidentiality
can only be violated when there is potential harm to a third party or if there is a court order
demanding the information. Medical information cannot be passed to anyone without the
direct consent of the patient. Confidentiality also includes keeping a patient’s medical
information private even from his friends and family unless the patient expressly says it is
okay to release the information. The fact that a patient may have a good relationship with his
family and friends is absolutely no excuse to assume that the patient wants his medical
information passed on to them. I have an excellent relationship with my mother; however,
even though I am a doctor (or maybe because of it) she does not want me to know her list of
medications. She has no obligation to give me a reason why she does not want me to know
which medications she is taking. If I call her doctor and say, “I just want to help mom with
her meds. What is she on?” Her physician is supposed to respond, “I’m sorry, but your
mother hasn’t authorized me to give you that information. I know you mean well, but I just
can’t talk to you about your mother’s medical problems.”
For example, a 42-year-old man is hospitalized with chest pain. The patient is
awake and alert. His wife comes to you demanding information about the patient,
saying that she is his wife. She shows her identification card verifying this. What
should you tell her?
You cannot release medical information to anyone about a patient unless the patient gives
you permission to do so. Although it may seem rude and unreasonable, you must tell the
patient’s family members that you must ask your patient for permission before you can
release his medical information.
For example, the wife becomes infuriated and storms off the floor, threatening to
sue you. You apologize to the patient for upsetting his wife by not speaking with her
about his private medical problems. The patient responds “On the contrary, Doctor, you
did great. Although she is still my wife, we are finalizing our divorce and we do not
live together. I expect to be divorced and remarried within the next few months. She
only wanted information about me to use against me in the divorce proceeding. Thanks
for protecting my confidentiality.”
RELEASE OF INFORMATION
Information transfer between physicians involved in the care of patients is a common
occurrence. However, the information can only be transferred if the patient has signed a
consent or release form requesting the transfer of information. It is the patient who must sign
the consent to release the information, not the health-care provider. This is how the system
guarantees that the patient’s medically privileged information only transfers to those people
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to whom the patient wants it to go.
For example, you receive a phone call from another physician who is well known to
you in your local community. The physician says that one of your former patients has
transferred his care to him and he is asking for a copy of the patient’s medical record.
What do you tell him?
You should tell another physician requesting information to send you the patient’s signed
release form before you send him the information.
GIVE MEDICAL INFORMATION TO THE PATIENT FIRST, NOT THE FAMILY
For example, your patient is awaiting the results of a biopsy to tell whether or not
she has cancer. Her son calls you and asks you to give him the information because the
family is concerned that the bad news will depress his mother. He is sincere and
genuine in his concern. What do you tell him?
Medical information such as the result of a biopsy must go to the patient first. There is no
basis for informing the family and not the patient. It is exactly the opposite: without direct
instruction from the patient, the family should not receive the patient’s confidential medical
information. Maybe the patient wants her family to know and maybe she doesn’t. It is always
the patient’s decision. There is a rare exception in the case of a patient with a psychiatric
disturbance in whom to inform if a medical condition might induce a suicide attempt.
RELEASE OF INFORMATION TO GOVERNMENTAL ORGANIZATIONS AND
THE COURTS
For example, an investigator from, a local law enforcement agency comes to your
office. He shows you proper identification stating that he is a government employee. He
is looking for your patient’s immigration status and for his medical condition. What do
you tell the investigator?
If a member of a law enforcement agency comes to you with a subpoena or a court order
that constitutes a search warrant then you must furnish him with the information that he
requests. If the investigator does not have a search warrant, then you must refuse him access
to the files. You are not under any obligation to make immigration status investigations of
your patients nor to provide this information to third parties unless it is at the request of the
patient. This right of privacy also covers genetic information. You must keep the medical
information private from a patient’s co-workers as well.
BREAKING CONFIDENTIALITY TO PREVENT HARM TO OTHERS
The right of a patient to privacy is not absolute. There are some exceptions as to when
confidentiality can be broken in order to protect others. The Tarasof case (1976), in which a
mentally patient told the psychiatrist of his intent to harm someone, is a famous example of
this. In this type of case, the physician must inform law enforcement as well as potential
victim. Confidentiality is only broken in this way to prevent harm to others; this rarely done.
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Other cases in which it is lawful to break confidentiality include partner notification for
STD diseases such as syphilis and HIV. The patient’s right to confidentiality in such cases is
less important than another person’s right to safety. However, all efforts must first be made
to enlist the patient to inform the intimate partner. No lawsuit against physician for breaking
confidentiality in order to notify innocent third party that his health may be at risk has been
successful.
MEDICAL RECORDS
The physician or health-care facility physically owns the medical record, but the
information contained within it is the property of patient. Although the medical report as a
physical object remains always in the hands of the health-care facility, the patient has an
absolute right to free access to the information it contains. The information contained within
a patient’s medical record is covered by all the same rules of confidentiality as any other
privileged medical information. You cannot release the medical record without the consent of
the patient. No one except those directly involved in the care of the patient has a right to
access to the record. Patient cannot take sole possession of the physical medical record but
they have a right to access or copy the information.
For example, you have a new patient with a complex history who has been trying to
get a copy of her record from her previous doctor. The other practice said she must
provide them with a valid reason for why she needs the chart. You call the other doctors
office trying to get the chart. The practice administrator informs you that the patient is
extremely unpleasant and difficult. In addition, because the patient has not paid her bill
the prior practice feels no obligation to provide you with the chart. The patient returns
to see you the following day and asks what has become of her record. What do you tell
her?
The patient has a right to her medical records. No one has a right to interfere with this for
any reason. You should tell her that she should be allowed a copy of the chart. A patient does
not have to give her doctor a reason for requesting her own property, and she is entitled to
this information whether or not she is “pleasant.” Furthermore, the medical record should not
be “held hostage” to compel a patient to pay her medical bills. The need for information to
take care of patients outweighs the physician’s right to payment.
CORRECTING MEDICAL RECORD ERRORS
When an error in a chart needs correcting the doctor should draw a line through it and then
initial the correction. This allows anyone reading the chart to see what was originally there
and it ensures that medical errors are not being covered up. You cannot just remove pages
from the chart or cover them over with correction fluid if there are mistakes. This makes it
look as if you are hiding medical errors. If you forget to put in a note or document something
and want to add it the next day, you cannot put a note in the chart with the old date. If you
forgot to put a note in the chart documenting a patient’s condition yesterday, you cannot write
a note today with yesterday’s date on it. In other words, you cannot ‘backdate’ notes. Your
notes must always bear the current date and time.