Privacy is the broader of the two concepts it has at least four primary uses-physical seclusion, protection of personal information (“informational privacy”), protection of one's personal identity, and the ability to make choices without interference. Although the concepts of privacy and confidentiality are closely related, and the two terms are often used interchangeably, several differences between them are worth noting. This article addresses issues of privacy and confidentiality. This article focuses on these issues, examines some of the challenges that are presented in the emergency department, offers practical advice, and suggests solutions to common problems. In addition, it is important to understand the limits of these duties.
To meet these challenges as they arise, the emergency clinician must have a firm understanding of the moral and legal underpinnings of the duties to protect privacy and confidentiality.
The brief scenarios at the beginning of this article illustrate a few of the dilemmas that arise hundreds, if not thousands, of times a day in US emergency departments. ĭespite these obligations, there are daily challenges to protecting privacy and confidentiality in the unique setting of the emergency department. Virtually all physicians are taught from the time they enter medical school that there is a sacred duty to “protect the patient's secrets”. These duties are affirmed not only in the United States, but also internationally. The federal Health Insurance Portability and Accountability Act (HIPAA) privacy rules implemented in 2003 focused significant attention on privacy and confidentiality, but these are hardly new concepts or expectations. References to these are found in the Hippocratic Oath, religious texts, and virtually all modern Codes of Ethics.
Respect for privacy and confidentiality have been professional responsibilities of physicians throughout recorded history. Your Chair inquires about a patient you saw the other night who is the Chair's next-door neighbor. The patient is unconscious from a suspected overdose at a rave party and is under your care. What is the proper course of action?Ī distraught and overwrought mother calls your emergency department in search of her 21-year-old daughter who resides at home but hasn't returned at the usual time. When you try to call this patient to discuss this with him, you are told that he is an airline pilot and he is out of town. You receive a call from a pharmacist and discover that a prescription you have written for hydrocodone has been altered from 6 pills to 60. The trustee would like to know if his daughter can observe several of your shifts in the emergency department to prepare for the role. As you embark on your assignment, what are the considerations that must be given to privacy and confidentiality? How do you balance the need to take care of the most patients in the most efficient manner with the patients' right to confidentiality and privacy?Ī member of your Board of Trustees with a daughter who is an aspiring actress on television has just landed a guest appearance on ER.
You have been asked to participate on a team that will design your new emergency department to accommodate an ever-increasing patient load.