Reporting abuse. All clinicians are obligated to report suspected child abuse or neglect. Some state laws also may require physicians to disclose abuse of vulnerable groups such as the elderly or the disabled and report to the local department of health diagnosis of communicable diseases such as HIV.3
Circle of confidentiality. Certain parties— including clinical staff on an inpatient unit or a psychiatrist supervising a resident— are considered to be within a circle of confidentiality.3 You do not need a patient’s consent to share clinical information with those within the circle of confidentiality. Do not release a patient’s information to parties who are not in the circle of confidentiality—such as family members, attorneys representing the patient, and law enforcement personnel—unless you’ve first obtained the patient’s consent.
Document the reasoning behind your decision to disclose your patient’s personal information without the patient’s consent. Show that you engaged in a reasonable clinical decision-making process.3 For example, record the risks and benefits of your decision and how you arrived at your conclusion.3
Other scenarios
Multidisciplinary teams. Members of a multidisciplinary treatment team—such as physicians, nurses, or social workers—should only receive confidential information that is relevant to the patient’s care. Other clinicians who are not involved in the case—although they may be seeing other patients on the same unit—should not have access to the patient’s confidential information. Discussions with these team members must be private so that others do not overhear confidential information.
Insurance companies generally are not party to the patient’s records unless the patient agrees to allow access by signing a release. If the patient’s refusal to allow disclosure results in the insurance company’s refusal to pay, then the patient is responsible for resolving the issue.7
Scientific publications and presentations. When you present a case report for a scientific publication or at a meeting, alter the patient’s biographical data so that someone who knows the patient would be unable to identify him or her based on the information in the case report. If the information is so specific that you cannot prevent patient identification, either do not publish the case or offer the patient the right to veto the manuscript’s distribution. If necessary, have the patient sign a consent form to allow publication or presentation of the case report.
Confidentiality violations
Breach of confidentiality may be intentional, such as disclosing a patient’s personal information to a third party as in this case, or unintentional, such as talking about a patient to a colleague and having someone overhear your discussion.8 Violating confidentiality may result in litigation for malpractice (negligence), invasion of privacy, or breach of contract, and ethical sanctions.8
Closing remarks
No aspect of psychiatric practice seems to generate stronger emotions than the potential legal repercussions of our work. Keeping up with patients’ needs, billing issues, and advancements in medicine leaves little time for tracking changing state and federal laws or case precedents. For the past 4 years it has been my pleasure to provide information on the legal issues psychiatrists face and provide possible means of avoiding legal pitfalls.
Although I have decided to pursue other projects, I wish to give readers my thanks and to suggest resources—only a few among many great ones—that may be useful guides for a variety of legal issues.
Jon E. Grant, JD, MD, MPH
- Journal of the American Academy of Psychiatry and the Law.
- Appelbaum PS, Gutheil TG. Clinical handbook of psychiatry and the law. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.
- Lifson LE, Simon RI, eds. The mental health practitioner and the law. Cambridge, MA:Harvard University Press; 1998.
- Simon RI, Shuman DW.Clinical manual of psychiatry and the law. Washington, DC: American Psychiatric Publishing, Inc. ; 2007.
Editor’s note
Current Psychiatry thanks Dr. Grant for writing the Malpractice Verdicts column since 2004. The column will continue in a new format in the February 2008 issue.