Physicians' Casual Chats Could Betray Relationships
Would doctors discuss patient information in situations that did not fully protect patient privacy, ie, socially or in conversation with doctors unrelated to the patient's care? More than three-quarters of respondents -- 77% -- said "no," 8.4% said "yes," and 14.2% found an "it depends" middle ground.
Two respondents confessed that they yielded to the temptation to name names when they treated movie stars. Most, however, like the one who said, "The issue prompting discussion might be more important than the patient's privacy," cited therapeutic reasons for compromising privacy. Another noted that "there are potential emergent issues that require some degree of disclosure immediately, eg, needle sticks involving blood-borne contagious diseases."
The majority of respondents were stalwart in defense of informal conversations about patients with other physicians -- which one respondent characterized as "critical to ensuring optimal healthcare" and another called "the best ongoing CME we have -- as long as privacy is upheld." Maintaining anonymity, of course, is easier in big cities than in small towns. Some respondents who insisted that they would never use a name said they did mention age, race, gender, and clinical situation, and as one doctor indicated, "In a smaller community, sometimes details make [identity] apparent."
For most respondents, going beyond the casual consult was off limits. One noted, "I'd have little concern regarding discussing the facts of a case with other physicians [emphasis the respondent's], either conversationally or to elicit potentially helpful opinions, provided that the patient's identity was protected. This would not extend to purely social conversation with non-physicians. Some of our stories might be entertaining, but they shouldn't but used for that purpose."
Two doctors who had a different view pointed out, "Physicians tell physicians funny stories about patients every day. Usually names are not important," and "This kind of connecting with others and defusing workday tensions keeps us alive and functioning and -- to some extent -- prevents burnout."
Physician-Patient Confidentiality Has Limits
Physician-patient confidentiality is absolute -- except when it isn't. An oft-cited illustration of the rare need to breach this boundary is when a patient is a danger to others.
Still, only slightly more than half of the respondents -- 53.3% -- answered "yes" to this question: "Is it ever acceptable to break patient confidentiality if you know that a patient's health condition may be harming others (ie, a patient with HIV or sexually transmitted disease who does not inform their spouse or partner)?" Some 20.1% said "no," and the remaining 26.7% said "it depends."
"Yes" respondents mentioned the physician's "duty to warn," and noted that "One's freedom of confidentiality only goes as far as someone else's rights." Another expressed the view that "Confidentiality is an administrative rule, whereas [avoiding] the likelihood of harm is more of a moral rule and ought to supersede." A doctor who preferred a deliberative approach answered, "I would discuss the situation with the patient, the hospital ethics committee, and a lawyer. If it is permitted under the law, I would not hesitate to help an innocent partner in danger."
Among the "it depends" group was a respondent who said, "I would have to be very close to the patient and his spouse to break such confidentiality. If I had no relationship with the spouse at all I would not break the confidentiality in any way."
Is the Morally Right Behavior More Important?
In response, ethicist Dr. Moon says, "Physicians don't have a duty to people they don't have a doctor-patient relationship with. Our duty is to the patient, and we are not expected to seek out the patient's sexual partners. However, knowing that a patient is HIV positive and that he hasn't informed his significant other of that fact changes the level of duty on the part of the provider."
A good starting point, Dr. Moon continues, is to ascertain the patient's reasons for nondisclosure. "A patient might not want to reveal her HIV status to a partner because she fears violence from the partner," Moon says. "The doctor's decision about whether to disclose against the patient's will needs to be grounded in the particulars, and in a very therapeutic doctor-patient alliance. No blanket statement can be made about this."
Adds Moon, "A person who willfully puts other people at risk is not a healthy person -- not a mentally healthy person or an emotionally healthy person -- and a good doctor-patient relationship entails your working hard to make this person healthier." Moon agrees with the many respondents who said that before moving toward disclosure they would do their best to persuade the patient to tell his or her partner.
The rules of bioethics call for respecting autonomy, promoting well-being, and avoiding harm, Moon notes. She continues, "Manifesting these imperatives in a doctor-patient situation requires the virtues that we expect of physicians -- the capacity to put the patient's well-being first, to respect people as humans who need to make rational choices about their own lives, the capacity for honesty, and the courage to do the right thing."
Medscape Medical Ethics © 2011 WebMD, LLC
Cite this: Gail Garfinkel Weiss. 'Some Worms Are Best Left in the Can' -- Should You Hide Medical Errors? - Medscape - Jan 04, 2011.