Confidentially between you and me

I want to pose an ethical dilemma that is not discussed in the medical literature.

We all know the importance of patient confidentiality. Even if we know very little about medical ethics, all healthcare workers receive federally mandated training on the Health Insurance Portability and Accountability Act, a.k.a. "HIPAA Privacy Training.” HIPAA protects the privacy of health information, which includes medical records, insurance and billing information, and conversations about patient care. Patients can file a complaint with the provider, insurance, or even the US government if they think that their health information isn’t being protected. Health professionals have an obligation to maintain patient confidentiality.

Here lies the dilemma. The principle of confidentiality operates on a healthcare need to know basis. Some exemptions are defined by statutes for reporting child abuse, certain communicable diseases, and gunshot wounds. Otherwise, we are ethically and legally bound to keep patient information secret. There is no ethical dilemma here, as the right thing to do is clearly evident; but, what if the patient you are casually discussing in the hallway is you?

Recently, I found myself in this situation. Friends and family are always eager to hear the gory details of a hospitalization or medical procedure; however, I found that my medical and teaching colleagues are often uneasy, almost nervous. Was she clearing her throat, "Ahem!” Or did I hear "HIPAA!” before she politely changed the subject? These colleagues aren’t responding from a lack of compassion, rather I think they may feel akin to the bank teller who’d rather not know the combination to the safe (bank robbers won’t be able to pry any information out of the teller, who will also remain innocent of any possible charges of embezzlement). In a similar way, some colleagues and coworkers might prefer blissful ignorance. If you don’t know something, it can’t hurt you, or me, in the case of sharing my personal medical history with someone who may use it to keep me off the intramural soccer team. It seems there is an ethical basis to encourage patient confidentiality even when the patient is you.

But, what if sharing information with someone, especially a fellow healthcare provider or medical educator might save a life? To continue the banking metaphor, the teller is now able to rescue someone locked in the vault. I found myself eager to share my medical information with friends, family and colleagues as sort of an "unsolved mystery” or ultra-challenging case-study. Like Dr. House on TV, I discovered new correlations between physiology and pathology that were so rare it was almost newsworthy. I shared journal articles with an uncle in Connecticut who said he had similar symptoms and couldn’t wait to share the information with his doctors. Seen from the perspective of public good, it seems that revelation of confidential information may be an ethical obligation.

Former Raiders physician Robert Huizenga said that it was only after he left the team that players came to him for confidential medical advice. In fact the NFL has a confidential hotline (mockingly called 1-800-You-R-Cut) for players to report head injuries (Roberts, 2008). It seems sharing one’s personal medical information is an ethical dilemma even when it comes to sharing it with a doctor. <./p>

I don’t think a single answer to this dilemma can be applied across all cases and situations, but I do know one universal principle still applies: any ethical obligation to share confidential information is the patient’s and not the provider’s.

Roberts, S. (2008). RX for a medical dilemma. Sports Illustrated. Retrieved April 2, 2009, from http://vault.sportsillustrated.cnn.com/vault/article/magazine/MAG1147452/index.htm


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