A 45-year-old primary care physician is managing a busy outpatient clinic. Throughout the day, the physician encounters several situations involving complex confidentiality and privacy issues. In which of the following scenarios is the physician legally required or ethically obligated to disclose patient information to appropriate authorities or third parties without the patient's explicit consent? (Select all that apply)
- A 7-year-old child presents with patterned bruising on the back, and the caregivers provide a history that is inconsistent with the injuries.Answer
- A 30-year-old man with acute psychosis states he has a specific plan and a weapon to kill his former employer later that evening.Answer
- A 24-year-old woman is diagnosed with active pulmonary tuberculosis following a positive sputum culture.Answer
- DA 28-year-old competent woman confides that her spouse pushed her during an argument, but she explicitly begs the physician not to notify law enforcement.
- EA 16-year-old adolescent requests treatment for a gonococcal infection and asks that her parents not be informed of the clinic visit.
Answer
The scenarios requiring a breach of confidentiality are the child with suspected abuse, the man threatening to kill his former employer, and the woman with active pulmonary tuberculosis.
Patient confidentiality can and must be breached in specific situations designed to protect public safety and vulnerable individuals. These include mandated reporting of suspected child or elder abuse, reporting of highly contagious communicable diseases (like active tuberculosis) to public health authorities, and the duty to warn or protect identifiable third parties from imminent threats of serious harm (the Tarasoff principle).
Step-by-Step Solution
Key Concept
Exceptions to Patient Confidentiality (Child Abuse, Duty to Warn, Reportable Diseases)