A gastroenterologist notices one of her patients at the hospital cafeteria while waiting for her friend, a hospitalist, to meet her for lunch. The patient greets the gastroenterologist and has a brief conversation before leaving. The hospitalist arrives to the cafeteria and says, "I saw you talking to my old neighbor. He's a close family friend, and I heard that he has colon cancer. I've been really worried about him, especially since his wife had a stroke recently. Are you treating him?" Which of the following is the most appropriate response by the gastroenterologist?
Confidentiality is a basic tenet of medical ethics and a prerequisite for a trusting physician-patient relationship. Physicians are ethically obligated to protect patient privacy and maintain confidentiality in most situations, including during interactions with other physicians who are not directly involved in the patient's medical care.
The hospitalist has asked the gastroenterologist whether a certain man, a former neighbor and close family friend, is being treated by the gastroenterologist. Because the inquiry is based on personal and not professional interest or medical necessity, the most appropriate response by the gastroenterologist is to avoid divulging the man's protected health information, such as his diagnosis, treatment, and whether he is, in fact, the gastroenterologist's patient (Choice A). Identifying the man as a patient and admitting to treating him could indirectly confirm a diagnosis of colon cancer, which is a breach of patient privacy because sharing this information is not medically necessary. Therefore, the most appropriate response is for the physician to state that they cannot say whether or not the patient is under their care.
(Choice B) Although this statement does not directly admit to treating the patient, it insinuates that the patient has a serious medical diagnosis, which violates patient confidentiality. In addition, encouraging the hospitalist to "check in" with the patient is not advisable because the patient may not wish to share his diagnosis or receive support from others at this time.
(Choice D) The gastroenterologist is not required to lie to protect patient confidentiality; a more neutral statement that neither confirms nor denies a therapeutic relationship with the patient is sufficient.
(Choice E) To protect patient privacy, discussion of protected health information should take place in a private location rather than a public area (eg, cafeteria, elevator). However, because the hospitalist is not directly involved in the patient's care, the gastroenterologist cannot discuss whether or not the patient is receiving treatment.
Educational objective:
Patient confidentiality prohibits physicians from disclosing a patient's protected health information (eg, diagnosis, treatment) to anyone not directly involved in the patient's medical care, including physician colleagues. Physicians should not identify their patients when it is not medically necessary because doing so is a breach of patient privacy.