I am often asked if a patient can tell me something in confidence: “just between us doc, okay?” The assumption is that as a doctor, anything you tell me stays between us. I’ve even had patients ask me not to include the confidential information in their file. Most of the time, this isn’t a problem. But there are exceptions, situations wherein spite of our doctor-patient relationship I am obligated to breach this secrecy.
Usually this has to do with potential harm either to the patient or to someone they have identified. For example, if you told me that you are planning your suicide, I am required to do something to stop you. I can even mandate you to be forced to stay in a hospital for a few days to have a psychiatric evaluation. If you are unwilling to go, the police can force you into temporary care.
A similar situation exists if you’ve told me that you are going to harm someone else. An obstetrician colleague called me in the emergency department. One of her patients had phoned her and told her that she could no longer take it and was going to kill her husband. The obstetrician wasn’t sure what to do as she had an established doctor-patient relationship with this distraught woman. Did that mean that her interactions were protected by the veil of doctor-patient confidentiality? This also was an exception. Once a physician is aware of a realistic threat to an identified person, that physician is under an obligation to take action to protect that individual. In this case the best way forward was for the obstetrician to contact the police who made certain that her patient was treated and the patient’s husband was taken out of harm’s way.
Potential or actual abuse, whether of a minor, someone in a domestic relationship or the elderly, is another important situation where we have to notify the authorities. If we are mistaken, we are protected from prosecution as long as it can be shown that we had a reasonable reason to be concerned and that we proceeded in the proper fashion.
Certain infections must also be reported such as some sexually transmitted illnesses and tuberculosis. Public health officials can then track the patient and their contacts so that treatment can stop the spread of the illness.
While the movies and TV may lead you to believe that anything you tell your doctor is protected by patient-doctor confidentiality, the truth is that there are limits.