Privacy and confidentiality

Confidentiality - My Lips Are Sealed

• Ethical and legal duty to protect patient information, a cornerstone of the patient-physician relationship.
• Information can only be shared with written, informed consent, or in specific, legally-mandated situations.
• Exceptions to Confidentiality:
  • Patient intends to harm self (suicidal) or others (homicidal).
  • Suspected child, elder, or vulnerable adult abuse.
  • Reportable communicable diseases (e.g., TB, gonorrhea, hepatitis).
  • Gunshot and knife wounds.
  • Court orders or subpoenas.
  • Impaired drivers or pilots, depending on state law.

⭐ The Tarasoff v. Regents case established the physician's "duty to protect" or "duty to warn" identifiable third parties if a patient presents a serious danger.

Exceptions to Confidentiality - When to Spill

• Patient consent is the primary exception. Otherwise, confidentiality is breached only in specific, legally mandated situations to protect vulnerable individuals or the public.
• Suicidal/homicidal intent (Duty to Warn/Protect).
• Abuse (child, elder, domestic).
• Vulnerable populations (e.g., impaired drivers with uncontrolled seizures).
• Epizootic diseases (reportable animal diseases that can affect humans).
• Diseases (reportable communicable ones: TB, hepatitis, STIs).
• Wounds from violent crime (gunshots, stabbings).
• Court order or subpoena.
• 📌 Mnemonic: SAVED W/C

⭐ Tarasoff Duty to Protect: Arises from a patient's credible threat to an identifiable person. Requires notifying police and/or warning the potential victim. Failure to do so is a major ethical and legal breach.

Special Populations - Tricky Privacy Cases

• General Rule: Patient confidentiality is paramount, but exceptions exist for vulnerable populations and public safety.
• Minors (<18 years): Parental consent is typically required for treatment. Exceptions include:
  • Emancipated Minor: Legally adult (married, military, financially independent). Can consent for all treatment.
  • Mature Minor Doctrine: Varies by state; allows minors with sufficient maturity to consent for specific care (e.g., STIs, contraception, substance abuse).

⭐ Tarasoff Doctrine: If a patient makes a credible, specific threat of harm to an identifiable person, the physician has a "duty to protect" the potential victim, overriding HIPAA.

HIPAA Rules - The Privacy Police

• HIPAA (Health Insurance Portability and Accountability Act) establishes national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge.
• Core principle: Safeguards Protected Health Information (PHI), which includes any identifiable health and demographic data.
• Disclosure is permitted without authorization for:
  • TPO: Treatment, Payment, and healthcare Operations.
  • Public health activities (e.g., reporting communicable diseases).
  • Reporting suspected child/elder abuse and neglect.
  • Legal compliance (e.g., court orders, subpoenas).

⭐ High-Yield: A patient's family and friends can be informed about their condition/location if the patient does not object and it's in their best interest (e.g., patient is incapacitated).

High‑Yield Points - ⚡ Biggest Takeaways

• HIPAA is the primary federal law protecting Protected Health Information (PHI).
• Confidentiality is not absolute; major exceptions include danger to self/others, reportable diseases, and suspected child/elder abuse.
• The Tarasoff decision created a "duty to warn" potential victims of credible threats.
• Minors can often consent to care for STIs, substance abuse, and pregnancy without parental notification.
• Patients have a right to access and obtain copies of their medical records.