AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2005, Volume 7, Number 1.

Module 3

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Case 3.1: Respecting Privacy—No Students Please

Additional Information

Privacy and confidentiality are companion concepts in the patient-physician interaction. They differ in the following respect: privacy means that you don't have to share personal information or access to your person with others. Confidentiality—in the context of the patient-physician relationship—serves the purpose of persuading patients to relinquish their privacy on the condition that what they say and what the physician discovers in examining them will be kept confidential.

Patient privacy, however, must be balanced with the informational needs of others involved in the patient's care and also with the need for medical students to participate in patient care, as noted in Opinion 8.087, "Medical Student Involvement in Patient Care."

Opinion 5.059, "Privacy in the Context of Health Care"

...Physicians must seek to protect patient privacy in all of its forms, including (1) physical, which focuses on individuals and their personal spaces, (2) informational, which involves specific personal data, (3) decisional, which focuses on personal choices, and (4) associational, which refers to family or other intimate relations. Such respect for patient privacy is a fundamental expression of patient autonomy and is a prerequisite to building the trust that is at the core of the patient-physician relationship.

Privacy is not absolute, and must be balanced with the need for the efficient provision of medical care and the availability of resources. Physicians should be aware of and respect the special concerns of their patients regarding privacy. Patients should be informed of any significant infringement on their privacy of which they may otherwise be unaware.

Neither privacy nor confidentiality is absolute. The provision of affordable and efficient care often requires patients to come to health care facilities, rather than receive care in their homes. In such settings, patients must share many common areas, and many professionals participate in the care of each patient. Privacy cannot always be protected in such circumstances. In certain other circumstances, "overriding social considerations" as set out in Opinion 5.05, "Confidentiality," (see Case 2 Confidentiality) may warrant not only breaches of confidentiality but also an invasion of patient privacy. For instance, on the rare occasion when a person is suspected of physically abusing someone under his or her care (often a child, but possibly the elderly or physically or mentally impaired), superseding the obligations of privacy must be considered. It may be appropriate to implement covert video surveillance to monitor for the occurrence of such abuse. In all other filming scenarios, it is always desirable to obtain the patient's consent prior to filming or, at a minimum, to disclose to the patient that filming will occur (See also Opinion 5.045, "Filming Patients in Health Care Settings," and Opinion 5.046, "Filming Patients for the Education of Health Professionals").

In the case of Mr. Jonsen's refusal to divulge information in Ahmed's presence, Opinion 7.025, "Records of Physicians: Access by Non-Treating Medical Staff" and Opinion 9.123, "Disrespect and Derogatory Conduct in the Patient-Physician Relationship" should also be considered.

Opinion 7.025 states: "Only physician or other health professionals who are involved in managing the patient, including providing consultative, therapeutic, or diagnostic services, may access the patient's confidential medical information. All others must obtain explicit consent to access the information." This indicates that it would be a violation of Mr. Jonsen's confidentiality for Dr. Macklin to divulge what he learns from Mr. Jonsen.

If, however, it becomes clear to Dr. Macklin that Mr. Jonsen's refusal to allow Ahmed's observation is a bigoted refusal, he may decide to transfer Mr. Jonsen so long as emergent care is not needed. Opinion 9.123 states: "[When p]atients...act in a prejudicial manner toward physicians, other health care professionals, or others in the health care setting...[it] may constitute sufficient justification for the physician to arrange for the transfer of care."

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