For optimal medical care, confidentiality is essential. Patients should be able to safely disclose their medical histories, illnesses, feelings, and unhealthy habits and know that this sensitive information will be protected and safeguarded.
When doctors and administrators uphold doctor-patient confidentiality, it prevents situations in which potentially sensitive or embarrassing information is released into the wrong hands, leaving patients with no choice but legal recourse. For example, what if a breach of medical data led to the public exposure of an employee’s struggles with substance abuse? This could cost the person his or her job, as well as future employment opportunities. In addition, the revelation of a pregnancy to an employer might have unfair professional consequences.
What Is Doctor-Patient Confidentiality?
Doctor-patient confidentiality is a legal agreement that governs communication between medical providers and patients. The idea encompasses patients’ personal privacy as well as their constitutional rights. Doctor-patient confidentiality is safeguarded by legislative action and case law. It protects patients’ personal data in the form of electronic health records as well as one-on-one conversations with providers.
According to the American Medical Association, “Patients need to be able to trust that physicians will protect information shared in confidence. They should feel free to fully disclose sensitive personal information to enable their physician to most effectively provide needed services.” In other words, physicians have an ethical obligation to maintain confidentiality; the well-being of their patients could depend on it. The AMA goes on to note that, with some exceptions, patients have the legal and ethical right to decide with whom their personal health information is shared.
Doctor-patient confidentiality ensures that patients receive precisely the care they need, freeing them to fully disclose all the information a provider may need to determine the right treatment, without fearing that what they say will be used against them at a later date or made public in a way that could cause personal embarrassment. Examples abound: A patient might be hesitant to disclose that he uses medical marijuana, fearing it could jeopardize his career or professional reputation. Meanwhile, a woman receiving fertility treatments might worry that she will be discriminated against if her supervisors know she is planning a pregnancy.
With that said, potential challenges can arise in connection with doctor-patient confidentiality. In some cases, for instance, family members may be in the dark about their relative’s health problems or treatment history, as the patient hasn’t authorized the provider to disclose that information. Additionally, stipulations on doctor-patient relationships can vary by locality, which means arranging for the legal sharing of patient records can be complicated.
Doctor-Patient Confidentiality and Legal Compliance
The confidentiality observed between doctors and patients is defined and protected by laws. By understanding these laws, we can better understand the parameters of the doctor-patient relationship.
The Role of HIPAA
The primary legislative action that governs doctor-patient confidentiality is the Health Insurance Portability and Accountability Act, or HIPAA. This law protects patient confidentiality and provides guidelines for upholding patient rights. HIPAA has three basic components:
- The privacy rule dictates which forms of patient information are considered to be protected and defines the scenarios in which protected information may be used and shared.
- The security rule gives healthcare organizations guidelines for storing and securing electronic patient records.
- The breach notification rule stipulates that, if patient information is lost or compromised in any way (such as due to a cyberattack), providers are required to inform patients of the breach.
Consequences of a HIPAA Breach
Providers or healthcare organizations violating HIPAA rules face consequences. The consequence is determined by the severity of the violation and by whether the offending party knew they were violating the guidelines.
- For minor violations, the breach may be dealt with internally, by an employer.
- In more extreme situations, the offender may be terminated from his or her position.
- In some instances, the offending party may be subject to sanctions, censure or other consequences from a professional board.
- Criminal charges may also be made, which can include fines and even imprisonment.
The Role of Healthcare Administrators
Healthcare administrators (such as practice managers or hospital chief operating officers) play an important role in helping physicians maintain full HIPAA compliance. For example, it’s the role of administrators, in conjunction with the information technology team, to provide doctors with electronic health records systems that are safe and robust, and to train doctors, nurses and technicians on using the records systems.
Administrators also play an important role in responding to information breaches. Remember, HIPAA requires administrators to alert patients in the event of verified data breaches. The administrator also may determine the appropriate disciplinary action following a breach.
Doctor-Patient Confidentiality: Tips for Health Administrators
Healthcare administrators have an obligation to their doctors to provide a work environment that supports compliance with privacy laws and supports the providers’ right to practice without undue anxiety about information breaches.
Administrators also have a duty to provide patients with space where they can receive confidential clinical care. Hospital administrators have a fiduciary (that is, trust-based) obligation to the board and the community to avoid unnecessary penalties or fines related to HIPAA violations as well.
Administrators can employ a few basic strategies to create clinical settings that support doctor-patient confidentiality.
Think About the Layout
One critical consideration is the physical layout of the practice. Doctors and patients should have private locations in which to discuss sensitive matters.
Additionally, patients should have privacy at any time they need to provide information about their health, their finances, or their contact information. This includes the reception area, which should be laid out to shield patients from other people in the waiting room.
Protect Medical Files
Administrators should be proactive in safeguarding medical files and medical information, only allowing appropriate staff to have access. While patient records are generally kept electronically today, some physical copies may be on file to prevent fraud. It’s important that any physical medical files are properly indexed and stored in a secure, controlled room where only authorized staff members can access them.
Invest in IT
Technology is a crucial factor in promoting patient confidentiality. Robust cybersecurity is paramount for ensuring that electronic medical records are encrypted and that they are safeguarded against hackers and cybercriminals. Additionally, IT-based programs such as telehealth give patients an opportunity to speak to doctors one-on-one from the privacy of their own home.
Ensure Doctor-Patient Confidentiality
Healthcare administrators who are looking to enhance doctor-patient confidentiality may benefit from the following resources.
- Threat Stack, “HIPAA Compliance Tips & Best Practices — Building Your Foundational Knowledge.” Discover some of the best practices for complying with HIPAA.
- Compliancy Group, 10 Tips for Protecting Patient Health Information in the Workplace. Find out some of the precautions that health administrators can take to keep patient information confidential.
- HealthIT Answers, “5 Tips for Protecting Your Electronic Health Records.” Get some advice on how IT teams can help protect patient confidentiality.
- Health IT Security, “Must-Have Telehealth, Remote Work Privacy and Security for COVID-19.” Consider some of the ramifications of telehealth on patient confidentiality.
Doctor-Patient Confidentiality: Additional Resources
Healthcare administrators can seek additional resources in the following categories.
Resources on Teens
Providers who work with teens face unique challenges, as they strive to uphold privacy concerns for patients who are still minors. Some helpful resources include:
- Verywell Health, “HIPAA Guide for Parents and Patients.” Learn more about how HIPAA pertains to teenagers. Though this article is written for parents, it contains helpful reminders and summaries useful for healthcare administrators.
- American Medical Association, Confidential Health Care for Minors. Review some of the ethical considerations when administering confidential care to minors.
Resources on Veterans
For those seeking to deliver confidential care to military veterans, these resources address some significant issues.
- U.S. Department of Veterans Affairs, HIPAA Information. Find out what HIPAA means for veterans and their medical caregivers.
- U.S. Department of Veterans Affairs, “What Is VA Doing to Protect Your Privacy?” Review some of the legal considerations with regard to confidential veterans’ care.
Resources on Older Patients
Caring for older patients can bring up complicated privacy considerations, especially when the patient suffers from dementia. Consider these resources:
- Better Health While Aging, “10 Things to Know About HIPAA & Access to a Relative’s Health Information.” Consider some of the legal parameters regarding aging patients’ health information.
- AgingCare, “How HIPAA Impacts Caring for Aging Parents.” Think about some of the privacy issues that arise when dealing with elderly patients.
Resources on Mental Health and Substance Abuse
These resources offer information about the role of doctor-patient confidentiality in caring for mental health and substance abuse patients.
- U.S. Department of Health and Human Services, Can a Minor Child’s Doctor Talk to the Child’s Parent About the Patient’s Mental Health Status and Needs? This page offers helpful insights into privacy concerns among teens and adolescents receiving mental health care.
- SAMHSA, Substance Abuse Confidentiality Regulations. Explore confidentiality regulations that impact substance abuse care.
Upholding Doctor-Patient Confidentiality
Regulations and best practices that relate to doctor-patient confidentiality are ultimately in everyone’s best interest: They help patients seek the care they need, and they allow providers to deliver optimal treatment. Healthcare administrators play a crucial role in establishing environments where confidentiality is championed.
Centers for Disease Control and Prevention, Diseases & Conditions
Centers for Medicare and Medicaid Services, HIPAA Basics for Providers: Privacy, Security, and Breach Notification Rules
Healthy Foster Care America, Confidentiality Laws Tip Sheet
HIPAA Journal, “What Happens If You Break HIPAA Rules?”
Iranian Journal of Public Health, “Challenges of Confidentiality in Clinical Settings: Compilation of an Ethical Guideline”
Journal of Patient-Centered Research and Reviews, “Confidential Care for Adolescents in the U.S. Health Care System”
State of California Office of Health Information Integrity, Federal and State Health Laws
U.S. Department of Veterans Affairs, CSR&D Frequently Asked Questions on Certificates of Confidentiality