The Topic Of Confidentiality In Healthcare Setting

There have been many reliable sources on the question of should patient confidentiality be an absolute right and never be broken? The last time people may have heard about doctor-patient confidentiality are in their favorite crime shows or some sort of documentary about the medical field and psych. “But, like most things on television, what you see isn't exactly reality.” The topic of confidentiality applies to other roles in the medical field but this issue is vital to psychologists, when patients get the help they need, particularly from psychologists. Psychologists disclose confidential information to make sure the safety of their patients are preserved. The problem however, is that patients ranging from adults to adolescents who have any relatives or family that are concerned for their mental health and not often they are informed of the full information until given consent without conflicts from the law. Both sides have agreeable solutions but before explaining the possible solutions there is evidence from the different sources that can back up both arguments from scholarly articles and articles written by psychologists and medical health professionals on how they view patient confidentiality with a quote from Cynthia Hsu “Patient confidentiality may mean all secrets discussed with a physician won’t come to light, but its not necessarily an absolute right. Most states recognize the right to confidentiality between a psychologist and their patient. The idea is that a patient should not be hindered by fear when seeking medical attention.

To get started on understanding the topic of confidentiality to this comes from K. Blightman on an Oxford editorial written and published in August 2013, that states; “Preservation of confidentiality is necessary to secure public health, failure to maintain the obligation may result in suboptimal treatment” (Blightman). What should be done is that of course confidentiality can’t be absolute but it should be important to treat the patient a lot better than harming them to make things worse, In Hsu’s article written and published in June 2012. “Can Doctor-Patient Confidentiality Be Broken” she claims that there are exceptions and not every state gives the patient the right to confidentiality, “The American Medical Association’s code of ethics states that confidentiality between a doctor and a patient is vital. But not all state and federal laws are not in line with this notion”. Although this may be true, it can be corrected.

From the side that respects the confidentiality and also addresses the law and their decision on confidentiality breach with evidence from Stephen H. Behnke’s article written and published in March 2002. “Confidentiality in the treatment of adolescents” this also explains the question of confidentiality with the law. Behnke has stories on his experience with children and their parents and how he struggles to share information to a parent, he seemed to follow code of ethics to keep information but it wasn’t enough to keep the confidentiality of the child he worked to help, he can’t exactly promise a minor that information will be kept from a parent who has legal custody. Behnke says that “A parent with the legal right to treatment information may choose however counterproductive in the psychologist’s eyes to exercise that right.” It is of course important for a parent to know what their child goes through in their life but is it really ethical for some psychologists to keep that from them unless given permission to do so.

Trust is needed and is essential for free flow of information necessary and enable the doctor to diagnose logically and treat properly, the one important fundamental skill psychologists need along with effective communication. In an interview from August 2019, with lead school psychologist, Debbie Doubrava she has mentioned“as long as you make it a priority but eventually it can’t be kept any longer, someone will have to know.” The amount of sessions needed for a person with any mental problems could be less than they really need if they don’t have any amount of trust in their psychologist if they seem to be sharing information without consent. There is an act, a series of laws that is explained in Bernadette Bruha’s article “Counseling and Confidentiality: What You Need to Know” written and published in November 2018, the Health Insurance Portability and Accountability Act, also known as HIPAA; its known for protecting people’s personal health information, including mental health records. Any medical health professional that violates HIPAA could face civil or even criminal penalties. Breaching doctor-patient confidentiality in such situations would be accidental a lot. It could be common how a thing like that can happen, even in plain sight or anyone just can let information so serious slip out during conversation or even leave a paper around that have the full details. According to Sandeep Jauhar writer of a New York Times article from November 2015, “Protect Doctor-Patient Confidentiality” Mentally ill patients may not seek treatment, and psychiatrists, saddled with new legal liabilities, may decline to treat them. “It’s more likely minimize harm if the confidence of patients at the greatest risk for violence is maintained.” Another piece information in this editorial that comes from what the World Medical Association states that confidentiality may be breached when the expected harm of maintaining privacy is believed to be “imminent, serious” and unavoidable. Jauhar tells a story about a case in 1976; “The case of Tarasoff v. Regents of the University of California, a highly known case in most medical editorials in which the Supreme Court of California ruled that mental health professionals had a “responsibility to protect” the intended victims of their violent patients through a direct warning or by notifying the police.” However, the Tarasoff case has been interpreted to confer and obligated to warn individuals who are specifically targeted by psychiatric patients.

Going back from Behnke’s article on confidentiality with adolescents “Clinical judgement will indicate to what extent maintaining an adolescent’s privacy is central to the treatment”. In this case the confidentiality situation is different with children because they’re still learning at a young age but still carry mental problems, a psychologist may conclude that an adolescent’s wish not to have information shared reflects an appropriate separation and so should be honored. “A psychologist may feel strongly that revealing information to a parent could harm the patient or be destructive to the treatment.” The story told in this article is about an 8 year old child named Michael who develops signs of anxiety and headaches and continued to have that kind of trouble and his mother would set up sessions between him and a therapist, during the process of helping him a code of ethics were set up as a guide to protect the confidentiality of what issues Michael goes through. “When Michael reached high school and expressed a wish that the therapist not speak with his mother, the therapist revisited the issue of confidentiality. A compromise was reached whereby the therapist would speak to Michael’s mother only with Michael present.” It seems ethical to discuss a matter like that with a concerned parent not only to keep trust between yourself and a psychologist/therapist/psychiatrist but it builds some sort of development with families and make lives much better than they were before.

Looking back on Bruha’s article on what is needed to know about counseling and confidentiality she lists points on when it can be broken starting with “self harm; if a client is actively suicidal and shares information with a counselor, the counselor must reach out and seek help to get the client immediate resources to save his/her life.” “Child abuse; if a client reveals that they are aware of child abuse, then counselors as mandated reporters are bound to break confidentiality and report a concern of abuse to the proper authorities.” Threats of harm to others; if a client discloses they have plans and intent to carry out harm against an identifiable person, the counselor must break confidentiality to protect that person.” Elder abuse; if a client reveals knowledge of an elderly person being abused, counselors are bound to report that allegation to the proper authorities.” Billing; counselors may break confidentiality to submit your name and information to insurance or other sources for the purpose of being paid for their services. This should be discussed in the initial session to ensure no issues pertaining to the payment will arise later.” And last point is subpoena which is a rare one since it involves criminal or civil violations if a counselor is complied to hand over records depending on state laws. All of these points Bruha provided are there for most likely so that people can be aware of how something so simple can be broken.

The list can go on with how an agreement can break but these six points are most likely the common cause and solutions can be made by the ones who are the most professional, but the point of explaining most of this is to try and reduce the chance of these causes, if any of these situations occur, counselors should be transparent about breaking confidentiality. “The counselor should discuss what issue is taking place and why breaking confidentiality is necessary” (Bruha) And of course the patient should also accept that information is also shared with other healthcare teams who share the same concern. “Alternatively, it could be argued that non-disclosure may result in negligence on behalf of the doctor for omitting important facts relevant to care. Disclosures should always be limited to reveal only the relevant and appropriate information.” (Blightman) In addition to that information from the patients point of view throughout their process of controlling their mental illness. They go through possibly an extreme amount of life changes, traumatic experiences or any other form of symptoms related to mental illness, especially unwilling to share their most private feelings with a stranger unless they know their secrets are safe. It’s probably why confidentiality is effective for counseling. A patient who doesn’t trust their counselor is unlikely to be honest so they may never receive the necessary help to cope with the issues, Most people enter in learning psych believing that good citizens prevent serious injury to others, even if that means breaking promises.

Clearly, both sides of the arguments support their explanations and pertain to the topic of patient confidentiality. However, making the decision of having patient confidentiality be absolute does not seem likely to happen for a while because of legal and safety precautions that are set in medical fields, it will still be an important ethical and legal duty for doctors and may disclose personal information. Anyone working in the psych field would also follow the code of ethics to protect the personal health of patients. Most states in the U.S. should consider thinking about how vital information can be when it comes to the health of an individual and if it is necessary then consent should be given. “We are more likely to minimize harm if the confidence of patients at the greatest risk for violence is maintained.” If any personal information is breached then the law should try and minimize the harm it could cause and make safety the main priority no matter the circumstances, of course the law could make sure that if no one can keep information confidential then they will have to be reminded to follow the terms of HIPAA but not everybody learns that right away and anyone working in the field of psychology will still face the challenges.

Works Cited

1. Benhke, Stephen H. “Confidentiality in the Treatment of Adolescents.” Monitor on Psychology, American Psychological Association, Mar. 2002
2. Hsu, Cynthia. “Can Doctor-Patient Confidentiality Be Broken?” Findlaw, 8 June 2012
3. Blightman, K, and SE Griffiths. “Patient Confidentiality: When Can a Breach Be Justified?” OUP Academic, Oxford University Press, 28 Aug. 2013
4. Bruha, Bernadette. “Counseling & Confidentiality: What You Need to Know.” In Public Safety, 14 Nov. 2018
5. Jauhar, Sandeep. “Protect Doctor-Patient Confidentiality.” The New York Times, The New York Times, 19 Nov. 2015
6. Debbie Doubrava. Personal Interview. 19 August, 2019