From Hippocrates to HIPAA: Privacy and confidentiality in Emergency Medicine—Part I: Conceptual, moral, and legal foundations

Abstract

Respect for patient privacy and confidentiality is an ancient and a contemporary professional responsibility of physicians. Carrying out this responsibility may be more challenging and more important in the emergency department than in many other clinical settings. Part I of this 2-part article outlines the basic concepts of privacy and confidentiality, reviews the moral and legal foundations and limits of these concepts, and highlights the new federal privacy regulations implemented under the Health Insurance Portability and Accountability Act of 1996. Part II of the article examines specific privacy and confidentiality issues commonly encountered in the ED.

Medicine and the Media: Balancing the Public's Right to Know With the Privacy of the Patient

“…When patients fear that the information they provide will not remain within the confidences of the immediate health care environment, they may resist offering full disclosure. 11,12 The passages of the Hippocratic Oath explicitly address the need for privacy of health information by advocating that "[w]hatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private." 12,13 The American Medical Association Principle of Medical Ethics directs physicians to prescribe to the obligation that "[w]hatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private."…”

“…12,15 Patient health information should not be disseminated unless an interest of higher priority exists. 11 Examples of situations that may necessitate release of patient information include the need to ensure protection of the patient and others as well as certain legal obligations to report. 11 The 1976 case of Tarasoff v the Regents of the University of California is perhaps the most famous court decision imposing a duty to warn.…”

“…11 Examples of situations that may necessitate release of patient information include the need to ensure protection of the patient and others as well as certain legal obligations to report. 11 The 1976 case of Tarasoff v the Regents of the University of California is perhaps the most famous court decision imposing a duty to warn. After a psychologist and psychiatrist team failed to advise of the potential risk posed by one of their patients, who later committed a murder, the Tarasoff court held that physicians have a duty to warn a third party of the potential threat imposed by one of their patients.…”

“…After a psychologist and psychiatrist team failed to advise of the potential risk posed by one of their patients, who later committed a murder, the Tarasoff court held that physicians have a duty to warn a third party of the potential threat imposed by one of their patients. 11 Other statute-based laws require that certain types of patient health information be reported, including infectious diseases and injuries arising from suspected child abuse and gunshot wounds. 11 Common Law Tort Actions.…”

“…5,10 PaTienT-reLaTed PrivaCy and ConfidenTiaLiTy Both legal and ethical standards influence the obligation of health care professionals to maintain the privacy and confidentiality of patient information. 5,11 Moral and Ethical Obligations. Patients should feel comfortable in openly relaying information to their health care professionals.…”