The emergency physician and patient confidentiality: a review

Confidentiality is a promise rooted in tradition, law, and medical ethics. Emergency physicians treat a variety of patients to whom confidentiality is of vital importance: employees, celebrities, victims of violence or disaster, minors, students, criminals, drug abusers, and patients with STDs. EDs should develop methods of ensuring confidentiality for all patients. Although confidentiality is an important principle that should be respected and guarded, it is not absolute. Various laws mandate disclosure of certain patient information; in addition, an overriding moral duty may occasionally require a breach of confidentiality. As Beauchamp and Childress noted, "the therapeutic role may sometimes have to yield to one's role as citizen and as protector of the interests of others." In general, however, circumstances requiring a breach of confidentiality are rare.     

Establishment of compulsory confidentiality in psychiatric practice. II. Establishment of compulsory confidentiality from the viewpoint of the psychiatric patient

The article deals with experience assembled during prestructured interviews with a sample of ambulatory psychiatric patients. The author draws attention to the fact that the sample of patients was little aware of the fact of mandatory medical secret and thus unable to make use of advantages that a significant source of escape of information is medical documentation in the widest sense of the word. Conversely, the trend of social changes will, no doubt, lead to extension and more detailed information of the patient on the nature and prognosis of his disease, as it is the case in advanced countries, whereby the patient will be entitled to decide to whom and to what extent these data on his person will be provided. In future it will be necessary, by developing the legal consciousness of the public, to make people aware of the fact that secrecy on revealed facts is one of the basic legal prerequisites of work in the health services and that the provision of any information to subjects, authorities or institutions without the patient's consent or without restrictions defined by law is not permissible.     

The child's conception of confidentiality in the therapeutic relationship.

39 6–15 yr olds who were involved in individual counseling at a comprehensive community mental health center were interviewed using a questionnaire designed to assess their conception of confidentiality in the counseling experience. A significant main effect for age was found. Four variables were examined as potential predictors of S's confidentiality score. Two of the variables, which involved Ss' perception of the maintenance or violation of their confidentiality in either a past or current counseling experience, were significantly related to their overall confidentiality score. Results suggest that children gradually evolve a conception of confidentiality consistent with professional guidelines. The importance of an atmosphere of trust in the counseling relationship and the child's perception of the actual maintenance of trust in his/her own counseling experience are emphasized. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Domestic violations of confidentiality.

In mental health practice, protecting the confidentiality of psychological information provided by clients is the cornerstone of professionalism. Often there are inadvertent violations of this axiom. On the basis of true examples, this article reveals the pitfalls associated with an office in the home, unsecured documents in the home, the telephone answering machine in the home, the family Internet account, the family computer, the shared fax machine, the shared mail box, the family dining table, the accidental revelation, the errant spouse, and exposure through litigation. Possible exceptions and special situations are discussed, and safeguards are recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Privacy and confidentiality.

Comments on 2 issues in the article by L. Everstine et al (see record 1980-31031-001). The 1st concerns the conclusion that a therapist, being no different from an ordinary citizen, must protect the common good and not hesitate to warn an intended victim; and the 2nd concerns the confusion between confidentiality and privilege. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of confidentiality conditions on self-disclosure of early adolescents.

A self-disclosure questionnaire was administered to 45 male and 45 female 7th–8th graders under 1 of 3 conditions: confidentiality explicitly assured, no instructions regarding confidentiality, and confidentiality explicitly not assured. A self-disclosure score was derived by summing the number of "true" responses to a 74-item questionnaire. Results do not support the hypothesis that Ss would more frequently disclose personal and possibly stigmatizing information when confidentiality was assured. Across conditions, males disclosed significantly more frequently than females, suggesting that females were more cautious and had a higher level of self-protective needs. Responses to a posttest questionnaire revealed significant overreporting of confidentiality instructions among males and females. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The adult client's conception of confidentiality in the therapeutic relationship.

50 outpatient psychotherapy clients, 26 inpatients, and 50 hospital employees completed a 20-item questionnaire concerning 4 areas relevant to privacy in psychotherapy. Scores on general attitudes revealed that Ss significantly valued confidentiality. Inpatients valued confidentiality significantly more than did the outpatient or nonpatient comparison groups. Data suggest that patients were generally unable to differentiate between privacy as an ethical concept and as a legal concept. Responses to casehandling questions revealed a low level of concern about these technical intrusions on privacy. Total scores for outpatients who perceived a violation in confidentiality in either a past or current therapy relationship were significantly lower than for Ss who indicated no history of past or current violations. Implications for client pretherapy preparation are discussed. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public attitudes toward psychotherapist-client confidentiality.

What does the general public expect of psychotherapists in terms of confidentiality and third-party access to information? A telephone survey was conducted to examine this issue. Generally, subjects believed that therapy information should not be revealed without authorization, but they nonetheless felt that confidentiality should be broken when a client reveals the occurrence of one of the following: murder (planned or confessed), suicide plans, child abuse, major theft, and treason/sabotage against the U.S. Subjects were concerned about unauthorized release of information to the courts, to a client's spouse, or to insurance companies, but felt that psychotherapists should be free to discuss clients with one another. As opposed to older subjects, younger subjects (aged 18-39) were against unauthorized disclosures to parents or the family doctor and believed that confidentiality should be maintained when a client reports illegal drug use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Protecting confidentiality rights: The need for an ethical practice model.

All psychologists must uphold the same ethical standards about confidentiality even though each state imposes different legal limits on their ability to protect clients' confidences. The resulting ethical-legal confusion is exacerbated by legally based confidentiality training that treats legal exceptions as if they were the rule and fosters the impression that attorneys are now the only real experts about this aspect of practice. This article provides an ethics-based confidentiality practice model that clarifies the ethical rule and puts its legal exceptions into ethical perspective. Like the Confidentiality section of the American Psychological Association's (2002) Ethical Principles of Psychologists and Code of Conduct, this outline would apply to all psychologists regardless of state laws, but the details of its implementation would vary according to role and setting. It can be used as a universal training outline, a consultation and supervision tool, a guide to professional practice, and a basis for clearer ongoing conversation about the ethics of "conditional confidentiality." Psychologists can use this practice model to regain their status as experts about the confidentiality ethics of their own profession. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinicians, microcomputers, and confidentiality.

[Correction Notice: An erratum for this article was reported in Vol 19(4) of Professional Psychology: Research and Practice (see record 2008-10700-001). In this article, the address given on p. 286 for correspondence to the author is incorrect. The erratum includes the correct address.] Despite the microcomputer's ever-increasing popularity, one of its greatest strengths, the ability to store enormous quantities of text and data on small, concentrated types of magnetic media, could turn out to be an important structural weakness in the wall of client confidentiality that psychologists have so carefully constructed over the years. In this article I examine the possibilities for such breaches of confidentiality when psychologists use microcomputers in their practice or research. Examples illustrate the ease and rapidity with which the microcomputer's magnetic media can be duplicated, damaged, or destroyed. Recommendations are made for guidelines and techniques to ensure and maintain the confidentiality of clinical and research information when one is using a microcomputer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Privacy, ethics, and confidentiality.

Discusses privacy and confidentiality with respect to primary providers of psychological services, focusing on the client–practitioner relationship, and does not attempt to resolve questions about data bases and the like. Confidential information should not be disclosed, except if required by law; but changes in laws should be sought where needed. Casual breaches in privacy should be avoided, and psychologists should generally not answer questions on the telephone. They should have a will calling for destruction of records or their being given to a responsible colleague for disposition, in case of death. All matters regarding confidentiality should be made clear to the client at the start of therapy. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)