Ethics of communicating medical information

Confidentiality

• Core Rule: Protected Health Information (PHI) cannot be shared without explicit pt consent; survives death; applies to family, spouses, and employers.
• Mandatory Breaches (No Consent Needed):
  • Suicidal ideation: Active intent/plan $\to$ emergency psych eval, involuntary hospitalization.
  • Homicidal threat (Tarasoff): Identifiable victim + imminent threat $\to$ notify police and warn victim.
  • Abuse/Neglect:
    • Child abuse: Report to Child Protective Services (CPS) immediately (reasonable suspicion is enough).
    • Elder abuse: Report to Adult Protective Services (APS) immediately.
  • Reportable infections: Report to Department of Health (DoH) (e.g., HIV, Syphilis, Gonorrhea, Chlamydia, TB, Measles); DoH handles partner notification.
  • Legal: Subpoena signed by a judge (lawyer-only subpoena is insufficient).
  • Impaired driving: Counsel pt to stop driving first (epilepsy, severe dementia); if pt refuses, report to DMV.
• Do NOT Breach (High-Yield Traps):
  • Intimate Partner Violence (IPV): Do not report to police without consent in competent adults (safety risk); provide resources/safety plan (Exception: Gunshot/stab wounds).
  • Family inquiries: Never disclose details to spouse/family without pt consent; encourage them to talk to the pt directly.
  • Adolescent non-disclosure: Do not notify parents about confidential care categories.
• Adolescent Confidentiality (No Parental Consent/Notification Needed):
  • Emancipated minors: Married, active-duty military, or court-decreed $\to$ complete autonomy.
  • Confidential services for all minors:
    • Without confidentiality protections, minors simply avoid care, leading to severe individual and public health consequences.
    • STIs: Testing and treatment.
    • Contraception: Counseling and prescriptions (including emergency contraception).
    • Pregnancy care: Prenatal visits.
    • Substance use: Outpatient addiction treatment/rehab.
    • Mental health: Outpatient crisis counseling. c
  • Exam strategy: Always interview adolescents alone for part of the visit; establish confidentiality limits upfront.

Health Insurance Portability and Accountability Act (HIPAA)

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• It is not necessary to gain the patient’s consent for disclosure to the following parties:
  • Health care workers and service providers that are immediately involved in the patient’s care (e.g., as required for a referral to another health care provider or requesting a consultation)
    • Any other requests by health care workers to share information should be denied.
  • Parties that process health care payments
  • Health care operations providers (e.g., audits, legal services, administrative activities)
• The patient should give informal permission for the disclosure of their health information for the following unless the patient is incapacitated, in an emergency situation, or unavailable:
  • Information about the patient’s health status and location in the health care facility for anyone who asks for them by name
  • If a patient doesn’t want their family/friends to know their health status or that they are in the hospital, the physician should not disclose any information or attempt to contact them.
  • Notification of authorities in case of disaster if doing so would aid relief efforts