Physician-Patient Relationship and Confidentiality PDF

WE MAKE DOCTORS Physician-Patient Relationship and Confidentiality OBJECTIVES Recognize the importance about the physician-patient relationship Define confidentiality Establish how confidentiality is determined in the Physician-patient relationship Note the exceptions to confidentiali...

WE MAKE DOCTORS Physician-Patient Relationship and Confidentiality OBJECTIVES Recognize the importance about the physician-patient relationship Define confidentiality Establish how confidentiality is determined in the Physician-patient relationship Note the exceptions to confidentiality and the rationale behind them Analyze diseases that require reporting by CDC Define specific cases such as patient HIV positive  DOCTOR-PATIENT RELATIONSHIP Defined as: “A consensual relationship in which the patient knowingly seeks the physician’s assistance and in which the physician knowingly accepts the person as a patient.” This unique relationship encompasses 4 key elements: Mutual knowledge Trust Loyalty Regard.  DOCTOR-PATIENT RELATIONSHIP The doctor-patient relationship is a powerful part of a doctor’s visit and can alter health outcomes for patients. It is important for physicians to recognize when the relationship is challenged or failing. If the relationship is challenged or failing, physicians should be able to recognize the causes for the disruption in the relationship and implement solutions to improve care. Factors the challenge the physician patient relationship  CONFIDENTIALITY Is a core precept of the medical profession and is manifested into the practical application of the bioethical principles of autonomy (informed consent) beneficence (do good) nonmaleficence (do not harm), and justice, (be fair). Medical information, privileged communication, and patient’s protected health information (PHI) should under normal circumstances, never be disclosed to any other person without consent  CONFIDENTIALITY The physician is ethically and legally obligated to keep to the patient´s medical information confidential Confidentiality upholds patient autonomy and privacy The patient may waive the right to confidentiality (e.g., if an insurance company requests patient information of the patient allows the physician to disclose information to a family member). Verbal or written consent is needed before releasing medical information Individual hospitals or physician practices may have additional policies to verify the identity of the receiver (e.g., via pone call) before sharing information Health care providers should make their best efforts to ensure the safety of patient information (e.g., patient information should not be discussed in public áreas, even withtin the hospital setting)  The patient has suffered penetrating wounds from an assault (e.g., a stab or gunshot) The patient may endanger the public (e.g., driving while impaired or with epilepsy). The patient has transmissible infectious disease The physician may be legally obliged to notify a public health oficial Special The patient should be encouraged to inform any third parties that may have been infected (e.g., exceptions to sexual partners) In most states, the physician does not have the confidentiality right to inform third third parties without the patient´s conset The patient intends to cause harm to others or commit violence (e.g., planned homicide or assault). The patient posses a threat to themselves (e.g., suicidal intent) Older adul abuse Child maltreatment The patient is a minor and care does not involve sexual or addiction treatment  Health Insurance Portability and Accountability Act (HIPPA) Was passed by the U.S. Congress to protect the privacy of electronic health information. The HIPAA establishes rules for the protection of individually identifiable health information, including information about the individual's physical and mental condition at any point in time, provision of health care, and related payments. HIPAA rules apply to all instances of the use of patient information for medical education.  CONFIDENTIALITY All US states have reportable disease lists. It is the ethical and legal responsibility of the health care provider, not the patient, to report cases of these diseases. Reportable diseases per the CDC are divided into several groups: Mandatory written report. Examples: gonorrea and salmonellosis. Mandatory reporting by telephone: Examples: rubeola (measles) and pertussis (whooping cough). Report of total number of cases. Examples: varicella (chickenpox) and influenza. Cancer cases are reported to the state Cancer Registry. For general reference, diseases reportable to the CDC include HIV REPORTING Code of Medical Ethics Opinion E-2.23 With regard to HIV-infected patients, exceptions to confidentiality exist. If a physician knows that a seropositive individual is endangering a third party, the physician should, within the constraints of the law (1) attempt to persuade the infected patient to cease endangering the third party; (2) if persuasion fails, notify authorities; and (3) if the authorities take no action, notify the endangered third party. HIV REPORTING HIV reporting involves balancing patient confidentiality with public health responsibilities. key points that are generally considered correct regarding HIV reporting: 1.Mandatory Reporting to Public Health Authorities: In many jurisdictions, healthcare providers are required by law to report new cases of HIV to public health authorities. This reporting is done to monitor and control the spread of the virus and is typically carried out in a way that protects patient confidentiality to the extent possible. 1.Confidentiality and Privacy: The confidentiality of an individual’s HIV status is crucial. Healthcare professionals must protect this information and only disclose it to others when legally required or when the patient has given explicit consent. Unauthorized disclosure of a patient's HIV status is considered a breach of confidentiality and is both unethical and, in many cases, illegal. HIV REPORTING 3.Duty to Inform: Healthcare providers have a duty to inform patients about the importance of notifying their sexual partners or others who may be at risk of exposure to HIV. 4.Anonymity in Reporting: In some jurisdictions, HIV reporting is done anonymously to ensure that the individual’s identity remains confidential. Public health authorities receive information about the case, but not the personal details of the patient. 5.Informed Consent for Testing: Before testing for HIV, healthcare providers are typically required to obtain informed consent from the patient. Patients should be aware of how their results will be reported and used, including any mandatory reporting requirements. It is important to note that laws and ethical guidelines regarding HIV reporting can vary significantly by jurisdiction, so healthcare providers should be familiar with the regulations and ethical standards in their specific area of practice.  BOARDS It is never permissible to talk about a patient in public areas where the patient could be compromised. It is never permissible to reveal information about a particular patient to those who are not directly involved in the patient’s case For Medical cases presented tor educational or advisory purposes, due diligence must be exercised to ensure that all patient identifiers have been removed or not revealed  BIBLIOGRAPHY American Medical Association, Principles of Medical Ethics (rev. 2001) and Code of Medical Ethics Fischer MD, Conrad, Oneto MD, Caterina, Master of the Boards, USMLE Medical Ethics, Kaplan Publishing (3rd ed. 2012) American Medical Association, Jatin M. Vyas, MD, PhD, Reportable Diseases, Medline Plus, https://medlineplus.gov/ency/article/001929.htm HIV Infection Reporting -- United States, MMWR Weekly, CDC (1989 rev. 2001) https://www.cdc.gov/mmwr/preview/mmwrhtml/00001425.htm Laura Lin, MBA, JD, Bryan A. Liang, MD, PhD, JD, HIV and Health Law: Striking the Balance between Legal Mandates and Medical Ethics, Virtual Mentor, Ethics Journal of the American Medical Association, Vol. 7, n. 10 (2005) AMBOSS