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.
Dr. Marianne Legato, Professor Emerita of Clinical Medicine at Columbia University is an internationally known academic physician, author, lecturer, and specialist in gender-specific medicine. She is founding member of the International Society for Gender Medicine and also the founder and director of The Partnership for Gender-Specific Medicine at Columbia University and its next iteration, The Foundation for Gender-Specific Medicine. These enterprises are the first collaborations between academic medicine and the private sector focused solely on gender-specific medicine: the science of how normal human biology differs between men and women and of how the diagnosis and treatment of disease differs as a function of gender and sex. Her ground breaking textbook on Gender-and Sex Specific Medicine has been published in 2017 in the 3rd edition.
She has published extensively on Gender and Sex Specific Medicine, both scientifically and for the lay public. She is also the founding editor of the journal Gender Medicine, and the Journal Gender and Genome, published for the scientific community. In 1992, Dr. Legato won the American Heart Association’s Blakeslee Award for the best book written for the lay public on cardiovascular disease. She is a practicing internist in New York City and has been listed each year in New York Magazine’s “Best Doctors” since the feature’s inception in 1993.