1
Florida Heart CPR*
Confidentiality
1 hour
Objectives: Upon Completion of this course the student will know the following:





Where does the duty of confidentiality come from?
What does the duty of confidentiality require?
What kinds of disclosure are inappropriate?
When can confidentiality be breached?
What if a family member asks how the patient is doing?
Confidentiality is one of the core tenets of medical practice. Yet daily health care
professionals face challenges to this long-standing obligation to keep all information
between health care professional and patient private.
Where does the duty of confidentiality come from?
Patients share personal information with health care professionals. You have a duty as
a health care professional to respect the patient's trust and keep this information private.
This requires the health care professional to respect the patient's privacy by restricting
access of others to that information. Furthermore, creating a trusting environment by
respecting patient privacy can encourage the patient to be as honest as possible during
the course of the visit.
What does the duty of confidentiality require?
The obligation of confidentiality both prohibits the health care professional from
disclosing information about the patient's case to other interested parties and
encourages the health care professional to take precautions with the information to
ensure that only authorized access occurs. Yet the context of medical practice does
constrain the health care professional's obligation to protect patient confidentiality. In the
course of caring for patients, you will find yourself exchanging information about your
patients with other health care professionals. These discussions are often critical for
patient care and are an integral part of the learning experience in a teaching hospital.
As such, they are justifiable so long as precautions are taken to limit the ability of others
to hear or see confidential information. Computerized patient records pose new and
unique challenges to confidentiality. You should follow prescribed procedures for
computer access and security as an added measure to protect patient information.
What kinds of disclosure are inappropriate?
Florida Heart CPR*
Confidentiality
2
Inappropriate disclosure of information can occur in clinical settings. When pressed for
time, the temptation to discuss a case in the elevator may be great, but in that setting it
is very difficult to keep others from hearing the information exchanges. Similarly, extra
copies of handouts from teaching conferences that contain identifiable patients should
be removed at the conclusion of the session. The patient's right to privacy is not being
respected in these sorts of cases.
When can confidentiality be breached?
Confidentiality is not an absolute obligation. Situations arise where the harm in
maintaining confidentiality is greater than the harm brought about by disclosing
confidential information. In general, two such situations that may give rise to exceptions
exist. In each situation, you should ask - will lack of this specific information about this
patient put a specific person you can identify at high risk of serious harm? Legal
regulations exist that both protect and limit your patient's right to privacy, noting specific
exceptions to that right. These exceptions follow.
Exception 1:
Concern for the safety of other specific persons
On the one hand, the 1974 Federal Privacy Act restricts access to medical information
and records. On the other, clinicians have a duty to protect identifiable individuals from
any serious threat of harm if they have information that could prevent the harm. As
mentioned above, the determining factor in justifying breaking confidentiality is whether
there is good reason to believe specific individuals (or groups) are placed in serious
danger depending on the medical information at hand. The most famous case of this
sort of exception is that of homicidal ideation, when the patient shares a specific plan
with a health care professional or psychotherapist to harm a particular individual. The
court has required that traditional patient confidentiality be breached in these sorts of
cases.
Exception 2:
Concern for public welfare
In the most clear cut cases of limited confidentiality, you are required by state law to
report certain communicable/infectious diseases to the public health authorities. In
these cases, the duty to protect public health outweighs the duty to maintain a patient's
confidence. From a legal perspective, the State has an interest in protecting public
health that outweighs individual liberties in certain cases. In particular, reportable
diseases in most states include (but are not limited to): AIDS and Class IV HIV, hepatitis
A and B, measles, rabies, tetanus, and tuberculosis. Suspected cases of child,
dependent adult, and elder abuse are reportable, as are gunshot wounds. Local
municipal code and institutional policies can vary regarding what is reportable and
Florida Heart CPR*
Confidentiality
3
standards of evidence required. It is best to clarify institutional policy when arriving at a
new site.
What if a family member asks how the patient is doing?
While there may be cases where the health care professional feels compelled to share
information regarding the patient's health and prognosis with, for instance, the patient's
inquiring spouse, without explicit permission from the patient it is generally unjustifiable
to do so. Except in cases where the spouse is at specific risk of harm directly related to
the diagnosis, it remains the patient's, rather than the health care professional's,
obligation to inform the spouse.
Confidentiality:
Case 1
Your 36-year-old patient has just tested positive for HIV. He asks that you not inform
his wife of the results and claims he is not ready to tell her yet.
What is your role legally? What would you say to your patient?
Confidentiality:
Case 1 Discussion
Because the patient's wife is at serious risk for being infected with HIV, you have a duty
to ensure thatshe knows of the risk. While public health law requires reporting both
your patient and any known sexual partners to local health officers, it is generally
advisable to encourage the patient to share this information with his wife on his own,
giving him a bit more time if necessary.
Confidentiality:
Case 2
A 75-year-old woman shows signs of abuse that appears to be inflicted by her
husband. As he is her primary caregiver, she feels dependent on him and pleads with
you not to say anything to him about it.
How is this case different from Case 1? How would you handle this situation?
Confidentiality:
Case 2 Discussion
In this case, the required reporting laws can be interpreted in a number of justifiable
ways. The laws supporting reporting elder abuse (and child abuse) allow you to break
Florida Heart CPR*
Confidentiality
4
confidentiality and report suspected abuse. However, if you think it is possible to give
this woman support and access to other services without reporting the case
immediately, those alternatives will help her more in the long run. Either way, you
have an obligation to address her abusive situation.
Confidentiality:
Case 3
A 60-year-old man has a heart attack and is admitted to the medical floor with a very
poor prognosis. He asks that you not share any of his medical information with his
wife as he does not think she will be able to take it. His wife catches you in the hall
and asks about her husband's prognosis.
Would you tell his wife? What are you required to do legally?
Confidentiality:
Case 3 Discussion
The duty to maintain confidentiality remains strong in this case as information about
the patient's health does not directly concern others' health, welfare, or safety. There
is no imminent danger to others here. However, the wife is certainly affected by her
husband's health and prognosis and every effort should be made to encourage an
open dialogue between them. It remains his responsibility to do so.
Florida Heart CPR*
Confidentiality
5
Florida Heart CPR*
Confidentiality Assessment
1. Patients share personal information with health care professionals. This requires
the health care professional to respect the patient's privacy _______to that
information.
a. by restricting access of others
b. by only informing their healthcare staff
c. by only telling a few people
d. by not telling their families
2. ________ patient records pose new and unique challenges to confidentiality.
a. Paper
b. The abundance
c. Unofficial
d. Computerized
3. Confidentiality is not an absolute obligation. Situations arise where the harm in
maintaining confidentiality is greater than the harm brought about by disclosing
confidential information, such as:
a. Concern for the safety of other specific persons
b. Concern for public welfare
c. Concern for the physician’s reputation
d. Both a and b
4. Creating a trusting environment by respecting patient privacy can encourage the
patient to be as _____ as possible during the course of the visit.
a. Pleasant
b. Honest
c. Satisfied
d. Helpful
5. Reportable diseases in most states include:
a. Measles
b. HIV/AIDS
c. Influenza
d. A and B
Florida Heart CPR*
Confidentiality