WBR1128

Author	[[PageAuthor::Vidit Bhargava, M.B.B.S [1] (Reviewed by Will Gibson)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::The patient has an absolute right to his privacy. It’s a physician’s duty to respect this privacy and not share health information with anyone, including patient's family, colleagues or other parties. This is known as the principle of confidentiality. In which of the following cases is a physician legally bound to overlook this principle?]]
Answer A	AnswerA::Spouse of a cancer patient is extremely worried about his health and wants to know about the illness so that she can support him emotionally.
Answer A Explanation	AnswerAExp::A patient has full right to confidentiality of his information. Although the spouse means well, it will be unethical to divulge information with seeking consent from the patient first.
Answer B	AnswerB::An employee has been absent from work for about 2 weeks and the employer calls the physician threatening him that his patient might lose the job unless he is told about the specific nature of the diagnosis.
Answer B Explanation	[[AnswerBExp::A physician must not give any details about a patient without his prior consent. Even confirming that the patient is undergoing treatment or admitted to the hospital is unethical. However, if a patient has authorized outside parities to be informed, the physician can provide the desired information.]]
Answer C	AnswerC::A colleague asks about his 17 year old son, who tested positive for syphilis.
Answer C Explanation	AnswerCExp::A minor cannot make medical decisions except in cases of sexually transmitted diseases, contraception, pregnancy, drug addictions and trauma/emergency. In this situation the teenager can choose to withhold information from his parents.
Answer D	AnswerD::State police wants to gather a person’s medical records, who is convicted of rape.
Answer D Explanation	AnswerDExp::The right to confidentiality holds true even in this case. A valid warrant is needed for a physician to divulge patient information.
Answer E	AnswerE::A patient who recently tested positive for HIV asks you not to reveal this information to his new girlfriend.
Answer E Explanation	[[AnswerEExp::The patient needs to tell all his sexual partners about his diagnosis as this is a sexually transmitted condition. In order to protect others, a physician is legally bound to convey this information to at-risk parties if the patient refuses to do so.]]
Right Answer	RightAnswer::E
Explanation	[[Explanation::A physician is bound ethically and legally to maintain patient information confidentiality. He is not supposed to discuss this information with anyone, unless specifically requested by the patient. General principles for exceptions to Confidentiality are: ƒƒ* Potential physical harm to others is serious and imminent ƒƒ* Likelihood of harm to self is great ƒƒ* No alternative means exists to warn or to protect those at risk ƒƒ* Physicians can take steps to prevent harm In the scenarios mentioned above, the patient diagnosed with HIV needs to inform his girlfriend about his condition. If not it is physicians duty to inform her to prevent harm. Educational Objective: A physician is bound ethically and legally to maintain patient information confidentiality. There are a few important cases in which the physician may share patient information. References: First Aid 2014 Page 59,60]]
Approved	Approved::Yes
Keyword	WBRKeyword::Ethics, WBRKeyword::Behavioral Science, WBRKeyword::Patient Privacy, WBRKeyword::Privacy, WBRKeyword::Confidentiality, WBRKeyword::HIV, WBRKeyword::Sexually transmitted disease, WBRKeyword::STD, WBRKeyword::STI, WBRKeyword::Sexually transmitted infection
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