When Seeing Patients, Is Three a Crowd?

Jeffrey Segal, MD, JD

Disclosures

December 02, 2015

In This Article

Patients Have a Right to Privacy

An old joke says that the best way to keep a secret is to tell it to only one person, and that person should be dead.

All kidding aside, the greater the number of people who handle information, the more likely that confidentiality will be breached. That's why physicians take histories and examine patients behind closed doors, in addition to employing numerous measures to safeguard their medical records.

The doctor/patient relationship is sacred. With limited exceptions, everything the patient says to the doctor must be treated as confidential and can't be disclosed without the patient's explicit consent. The Health Insurance Portability and Accountability Act (HIPAA) mandates that what happens in the exam room stays in the exam room.

This principle is founded in common law, plus state and federal statutes. And there's a strong rationale for this: If patients fear that their deepest secrets and concerns will be disclosed, they may not be candid with their doctors, who need patients to feel comfortable if they're to skillfully diagnose and treat them.

Fortunately, most doctors build a significant level of trust with their patients, which allows them to examine them alone, one on one. Some physicians simply do this routinely, being careful to respect the patient's wishes and dignity, whereas others do so after giving patients the option to have a chaperone present, as recommended by the American Medical Association (AMA). The chaperone is usually a member of the doctor's staff, but a friend or relative may step in if the patient prefers and the physician agrees to it.

But what happens when a patient doesn't request a chaperone and later alleges that a doctor behaved inappropriately—or even illegally—when the door was closed? Does privacy suddenly switch from being a shield to becoming a sword? If there are no witnesses, how can a doctor defend against baseless allegations? Let's take a look.

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