COMMENTARY

Was Matt Lauer Too Naive About Patient-Doctor Confidentiality?

Arthur L. Caplan, PhD

Disclosures

January 08, 2018

Hi. I am Art Caplan at the Division of Medical Ethics at the NYU School of Medicine.

When is it necessary to maintain privacy if you are a physician and someone tells you something, whether it is at a party or at a social event? Is it only when you are bound by a formal relationship—the doctor-patient relationship whereby you and the patient have agreed to see one another and payment is exchanged? Is that the limit of where privacy ends, inside that relationship?

I don't think so. Interestingly enough, Matt Lauer, the NBC Today show host who fell from grace recently when he was accused of sexual harassment, provides an example of how this notion of privacy needs to be extended beyond the formal doctor-patient relationship.

I am told that he was in the green room with someone else waiting to go on a television show. It was a sex therapist that he knew because she had appeared on his program; her name is Laura Berman. (There's nothing secret about this; it has already been discussed on Twitter and other social media.) They are in the room together. He asked everybody who was in that green room to leave, and he puts a question to her: "Look, I am having trouble in my marriage. My sex life is bad. Sexual aids and sex toys—is that something that helps? Is that something that my wife is likely to respond well to or negatively to?"

She talks about it with him, but later she talked about it with news people and said that she had had this discussion after the problems that Lauer was revealed to have had with other women.

She is not bound by the doctor-patient relationship; she was not in any formal relationship when they had that discussion in the green room. But when you tell everybody else to leave, when it is someone who you know, when it is clearly a sensitive subject like sex or drug use, that often gets stigmatized. I think it is fair for the person to assume that if they are talking to a doctor or a therapist, they are going to get privacy.

It's true—Lauer did not say, "Do not discuss this with anybody." But in the mere act of saying, "I want to talk alone" or "I want to ask you something privately," whether you are a therapist or, for that matter, just a friend or social acquaintance, I think people expect that you are going to keep their secrets. As an experienced therapist, I think, in this case, that should have happened.

You are not going to jail and you are not losing your license if you are not in a doctor-patient relationship and you spread sensitive information, personal information, about others to third parties—or worse, talk about them on television. But you have to exercise ethical sense. When people ask you to discuss something, a medical problem or a personal problem, you can certainly refuse and say that you only want to do that in the office or in a doctor-patient relationship. Once you go so far as to say, "Okay, let's talk," then I think you ought to extend the ethical protections of privacy and confidentiality that would be expected in any doctor-patient relationship.

I am Art Caplan at the Division of Medical Ethics at NYU. Thanks for watching.

Talking Points: Is This or Is This Not a Patient Confidentiality Breach?

Issues to consider:

  • Some healthcare professionals contend that the improper disclosure of highly sensitive information can harm patients' reputation or result in lost opportunities, financial commitments, and humiliation.[1]

  • Breaches of confidentiality in clinical practice due to carelessness, indiscretion, or sometimes even maliciousness jeopardize the doctor-patient relationship.[1]

  • Some healthcare professionals believe that more education is needed about the importance of confidentiality at the undergraduate level and through awareness campaigns among medical professionals that stress the need for greater care and attention in the management and handling of clinical information.[1]

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