Q. Is it true that everything I tell my doctor is strictly confidential?
A. No, it is not, and this can pose problems for both doctors and their patients. When a doctor takes the Hippocratic oath, she swears to reveal nothing that she learns in the course of her work as a physician. As far as I’m concerned, that means not even revealing the names of your patients to others without a good reason, but this is not always possible or even practical.
In reality, state and federal laws may interfere with this confidentiality. For example, in some states, physicians are required to report the names of people with sexually transmitted diseases (such as gonorrhea or syphilis) to the various state boards of health so that those who came into contact with the infected individual can be notified. (In many states, infection with HIV is excluded from this requirement. Because it produces a fatal and contagious disease [AIDS], People infected with HIV maybe the object of serious prejudice and discrimination with regard to such things as employment and housing opportunities. Yet even this law can be carried to extremes: Until a recent change in New York State law, doctors were forbidden to disclose whether or not newborns were infected with HIV, and such children had to wait until the ravages of AIDS became apparent to receive treatment.)
There are situations, however, when a patient’s right to privacy may be seriously undermined by the indiscriminate disclosure of medical information. A patient’s medical records can include some very sensitive material; for example, a patient may tell her doctor about a substance abuse problem (her own or that of a family member), an extramarital affair, an incidence of criminal behavior, or that she is being treated for a psychiatric disorder such as depression. If your doctor is not scrupulous about maintaining confidentiality, such highly-personal information can turn up in your insurance file or even in your personnel file at work. For example, some employers closely monitor their employees’ medical treatment in an effort to keep insurance costs down. Sometimes, a personnel officer or the company physician may actually ask to see a patient’s medical file to verify treatment; if the person photocopying the file is not careful to include only the pertinent medical information, she may send the employer the patient’s personal revelations.
Under certain circumstances, a physician’s records could even be subpoenaed by a court of law and the physician held in contempt of court if she refuses to comply or if she changes anything on the records. Given the relatively easy access to a patient’s medical file, patients may hold back important information from their physicians for fear of it becoming public knowledge. Patients have no choice but to protect themselves against unwarranted intrusion: if you are concerned about divulging a confidence to your physician, ask her directly about her feelings on maintaining patient confidentiality and, more important, what concrete steps she has taken to protect patient privacy.
A doctor who is conscientious about maintaining her patient’s confidences will have instructed her staff on the importance of maintaining patient privacy, particularly when they release information to insurance companies, employers, and other interested parties. If you confide something to your doctor that you do not want broadcast to the rest of the world, I suggest that you give her clear instructions not to write down the sensitive information, particularly if it has no direct bearing on your health.
Many doctors these days have two sets of patient files: the written records and the ones they maintain in their heads. Although many groups can lay claim to the written records, a private interaction between a doctor and patient that is not recorded can remain solely between the doctor and the patient.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”