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What are my rights to privacy?

The field of medicine has always regarded confidentiality as one of its highest ethical principles. Psychiatry

Psychiatry has put even greater restrictions on confidentiality given the highly sensitive nature of the issues patients discuss. As a result, no information is released to anyone without a written authorization by the patient allowing for such release.

has put even greater restrictions on confidentiality given the highly sensitive nature of the issues patients discuss. As a result, no information is released to anyone without a written authorization by the patient allowing for such release. A written authorization for release of general medical records is not enough. The patient must knowingly and specifically request psychiatric and/or drug and alcohol information to be released before it can be. Every effort is made to protect a patient's right to privacy. Federal laws encompassed under HIPAA (Health Insurance Portability and Accountability Act) have provided a framework for how patient privacy is to be maintained by clinicians.

Exceptions to the right to privacy exist, and it behooves everyone to know what those exceptions are. First, confidentiality does not apply when a patient is considered to be a threat to others, unless hospitalized. Second, confidentiality does not apply when the law requires mandatory reporting. This includes communicable diseases, child or elder abuse, impaired driving, and any other requirement in a particular jurisdiction. Third, depending on the state, court-ordered or subpoenaed records can be released without the patient's written authorization. However, a good clinician will usually notify the patient and attempt to obtain written authorization before honoring the court's request. Certain states (such as Connecticut) have laws that supersede the Federal HIPAA laws on "protected" records subpoenaed by the court. Most states still require the patient to sign a HIPAA authorization for release to the court. If a signed patient authorization cannot be obtained, appropriate steps should be taken under state law by the clinician to object to the subpoena. These actions usually involve engaging an attorney to file such motions in the state court system. Fourth, hospitals and offices may release minimally necessary healthcare information without the patient's written permission for the purposes of treatment, payment, or operations (such as quality control, peer review, and teaching). This is encompassed under the HIPAA rules (discussed later here).

The most important factor to bear in mind when a clinician releases psychiatric information about a patient to another person without that patient's consent is the concept of "duty to third parties." Most lawyers would prefer to defend a breach of confidentiality case than a wrongful death case. Clinicians understand this very well and in emergency situations may feel obligated to violate a patient's autonomy and confidentiality to protect him or her and the community from some greater harm. This is especially true if the patient is being evaluated in an emergency room. In those instances, clinicians will generally not feel comfortable discharging a patient before obtaining outside sources of information, and refusing to allow such contact will only delay discharge and probably ensure hospitalization under an involuntary commitment. A good clinician, however, will always inform the patient of his or her decisions and whom they are contacting.

Under HIPAA laws it is the provider's duty to protect the health information generated within the office or entity, but there are various ways in which one's healthcare information can be shared without written permission unless such release is objected to in writing beforehand. Under HIPAA, psychiatric and drug and alcohol information are specially protected, although limited amounts of information on these diagnoses may be shared for the purposes of treatment, payment, or operations. Unless provided with a written request, it is assumed that information such as appointments can be shared via phone, mail, or with family members. Patients also have the right to view and amend their healthcare information by submitting a written request. This can be denied under specific circumstances, but the patient has a right to know the reasons and may appeal such denials.

With respect to payment, one's health insurance company requires medical information for the purposes of payment because it wants to know what it is paying for. The term that insurance companies use to authorize payment is "medical necessity," meaning they want proof that the bill sent to them for a particular service was medically necessary and therefore deserving of payment. This also means that the clinician must send the insurer the diagnosis and the treatment rendered to demonstrate medical necessity, which may include copies of the clinician's documentation. If a patient refuses to allow the release of such information, either the clinician may refuse to see or treat the patient or, if seen, the patient will be responsible for the bill. It was the purpose of HIPAA to provide the patient with the right to make an informed decision on his or her health information privacy.

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