Confidentiality and Disclosure

Ethical oaths and specific statutes protect the confidentiality of physician-patient communication, an ethical and legal bedrock of the therapeutic relationship. Even well-meaning family involvement without the patient's consent violates the patient's right of confidentiality. Protection of private patient information is essential to encouraging patient candor in revealing symptoms and behaviors relevant to diagnosis and treatment. Protection of a patient's secrets, private thoughts, and feelings is also required by decency.

Patient utterances are also protected by the doctrine of privilege, which grants patients the right to exclude otherwise relevant and admissible testimony in a court of law. This privilege can be invoked only by the patient. Additionally, most states have professional licensing statutes that incorporate the ethical and legal confidentiality mandates and make them a clear part of professional practice. All patients are entitled to confidentiality unless they give permission for disclosure or they clearly can no longer express a preference (eg, a severely confused, comatose, or decisionally incapacitated patient). Even in these cases, secrets should be guarded, although decisions about care may require discussion with appropriate surrogates. When a patient can no longer make health care decisions, prior expressed preferences should be respected whenever possible.