Doctor/Patient Confidentiality

My girlfriend has developed a nasty cough along with her developing interest in drugs. Her constant, deep, raspy, phlegmy cough really concerns me, but what troubles me even more is that she refuses to go see a doctor in fear that they may detect marijuana or ecstacy usage. Her argument, which is understandable to a certain extent, is that her mother would be completely destroyed if it was somehow revealed to her that those drugs were found in my girlfriend (we’ll call her Angel). This cough is also accompanied by body ache and such. It has persisted for quite a few weeks now, and doesn’t seem to be shaken away by simply halting the smoking. She doesn’t smoke marijuana or take ecstacy too often, but it really does seem that the usage has been taking it’s toll on her body.

It seems to me that Angel’s cough may be something serious, and yet she refuses to go to the doctor. I am curious as to what the patient/doctor confidentiality restrictions are when the patient is a minor. Perhaps a few facts and some suggestions as to how I can convince her to go to the doctor?

Thanks for you help,


IANADoctor or Lawyer, but as far as I know, the doctor keeps everything secret unless the courts subpoena Angel’s medical records in order to investigate a crime. And it would have to be a serious crime, like a violent felony or something. Unless your local prosecutor has a huge stick up his butt, he’s not going to subpoena medical records to prosecute recreational drug use.

If Angel is a minor, the situation is hazier. I think in most states MD’s are still required to maintain confidentiality, but I could be wrong.

How old is she? I think doctors are required to maintain confidentiality even for minors, but that’s in Britain - not sure about the states.

Sounds to me like it’s a chest infection - in which case it could be cleared up by just a normal course of antibiotics, but it might last for ages if she doesn’t see a doctor. How often is she taking ecstacy? If she’s using it regularly, she could just be generally tired and run down, which will make her more prone to infections because her immune system will be a bit suppressed. Otherwise, it’s probably completely unrelated. I don’t think the marijuana is likely to be involved - did she smoke cigarettes before she started smoking spliffs? If so, her lungs are unlikely to react badly to spliffs. Otherwise, she might be better off making marijuana brownies or something.

IANAD either, but a see no reason for her doctor to order a drug screen for a productive cough. Tell her the likely tests done would be a culture of her sputum, a chest x-ray, and maybe some blood tests. See needs to be seen today if possible. She sounds very ill. Sounds like a she has a bad infection and they need to rule out pneumonia, TB, etc.

IANAL/D either but remember that is is NOT illegal to have done drugs. Walk up to any police officer and tell him/her that you smoked a joint last night and they can’t do a thing (except maybe frisk you in the hopes of finding drugs on you). If this weren’t the case then nobody would go to drug rehab clinics since the police could simply arrest anyone walking throught the door.

That said you should see what laws exist in your state regarding minors and patient confidentiality. Some laws regarding abortion are being passed that require a doctor to inform the parents and I do not know if such things extend beyond that narrow requirement.

I would recommend calling an AIDS clinic for advice. NOT because I think she has AIDS but because these clinics are experts in confidentiality and can certainly inform you on how everything works and what resources exist to see her get help.

All of that said her health is of utmost importance. I lived in terror of my parent’s too but at some point the prospect of not living at all supercedes all other concerns. STRONGLY encourage her to see a doctor.

Confidentiality can also be broken if you reveal anything that indicates you are planning to hurt yourself or someone else. This doesn’t usually come up in a physical exam, but you never know…


You mean like taking illegal drugs? Some doctors might consider a history of drug use as an indication of an intent to use in the future. Some would also consider this harmful to the patient. In this case would a doctor be justified in informing the girl’s parents? For me this would be a stretch, but oddly enough, not everybody thinks like me.


Well, I am a doctor, and I can’t imagine a plausible scenario that would cause me to spill casual drug use info to parents without a minor’s consent, or to the police unless a credible threat of harm to self or others is made. I would need to know about smoking and drug history to be thorough in the evaluation of the symptoms, and I’d urge your gal to be honest.

Having said that, be aware that medical records confidentiality is under siege: Insurers are getting more and more access to them, with the argument that since they’re paying for the care, they’re entitled to know what they’re getting for their money. Employers want it, governmental agencies want to know details of substance abuse or alcohol treatments, etc. etc. it’s messy. But a run of the mill visit for respiratory symptoms shouldn’t be a red flag to outsiders for examining drug use.

And yes, her symptoms are serious enough to merit a visit to a doc. I’d be most concerned about bronchospasm, especially in view of her smoking history. Infection’s also a consideration

Qadgop, MD

IAAAD*, and here in KY, a doctor can treat a minor without consent in certain cases, such as birth control, pregnancy, and drug and alcohol counseling. He doesn’t have to treat such things–for instance, some doctors may not want to prescribe birth control or offer drug counseling without the parents’ knowledge–but all he can do is send you elsewhere. He cannot give the information to the patient’s parents.

I can’t imagine a situation in which your GF would run afoul of her mother or the law by admitting to her doctor that she uses recreational drugs. Several people admit it to me every day, and it’s never occurred to me to tell anyone else.

As for drug use as a credible threat of self-harm, I think there’s a spectrum at work–would it be a threat of self-harm if she told me she was going to go to Applebee’s and eat some fried cheese sticks? If she said that she sometimes doesn’t wear her seat belt? I put the usual recreational drug use in this class. If you know that a patient is using drugs to the point that you fear overdose, or if he says that he likes to get loaded and drive around every night, that’s probably another story. I’m not sure.

A legal question–let’s say someone admits to me that he uses marijuana, and then gets picked up on a possession charge. Can they subpoena his medical record from my office to support their case?

Dr. J

  • I am almost a doctor

Thank you for all of your (educated) insights :slight_smile:

I’m going to relay this information to Angel and see if I can get her to go to the doctor.

Angel and I are 15 years old – 16 in a couple of months. We live in the States.

She has taken ecstacy about 5 - 6 times now. She has managed to keep it under relative control, but her cravings for drugs in general seems to be increasing as of late. Which is somewhat concerning to me…She’s also been able to resist taking ecstacy for about 4 weeks after the last ‘hit’.


IANAL, but I have treated them. It’s exceedingly unlikely. Any decent doc would fight it tooth and nail, and in Wisconsin at least, there are state laws passed to prevent this type of behavior. The state medical society would be sure to involve itself, and it wouldn’t be afraid to mobilize public opinion against such moves. Again, it has to be a clear and present danger to life and limb to merit breaking confidentiality, both ethically and in many cases, by statute.

Having said that, be aware that there are cases where a patient has consented to release quarterly medical reports to a court or other agency as a condition of parole, etc. and therefore your records about said patient could get tapped. Usually though, I’ve just had to write summaries about the patient’s progress and can thus report judiciously. I won’t enable a patient by covering up things, but I’m not going to report that their urine screen was positive for opiates, when the confirmatory mass spectrometer analysis clearly demonstrated it was from poppy seeds.


You might be concerned if she is pregnant and smokeing crack.

Legislation in some states declares crack use during pregnacy “child abuse”, and users are treated accordingly. There have been some cases of women being arrested and hauled away within minutes of birth.

I can’t see why a doctor would run a drug screen for a respiratory infection, but I think it might be useful if your girlfriend mentioned that she smokes - it may be relevant.

While patient confidentiality may be the legal rule, and the ethical rule, I know that in the town in Washinton state where I grew up doctor often called in parents (if parents came to the office with their child) so they could all “have a talk” about problems like drug use. I think they simply forgot about the ethical issues involved. If it were me in your situation, I might make sure to say to the doc’s face “Thank you for your advice and help. It may be rude of me to bring this up, but I would like to make sure you consider my health issues confidential, especially with regards to my parents.” Just a polite reminder, so they don’t do anything thoughtless.

Doctors might find this a bit offensive, but I know that it has made the difference for me when dealing with health problems I didn’t want my parents knowing about. The doctor simply wasn’t thinking, and assumed that my parents would be involved in the treatment I needed. They weren’t, and they still don’t know.

Whenever I see a doctor, I let him know about all the illegal drugs I use - I don’t want him to prescribe something that might interact badly without giving me warning. I’ve never gotten any warnings more stern than ‘You know you should probably quit’, but I’m not a minor.

If you’re talking the US, a case re: that practice went to SCOTUS, and they struck down the law. Giving a urine specimin to your doctor was not considered to be giving them permission to release the test results to the state in order to prosecute you.

It doesn’t sound that worrying yet. I’d recommend not taking it more than about once a month - partly because it keeps you awake, so if you take it too often you’re not getting a chance to catch up on the lost sleep, and not getting enough sleep can seriously affect performance in school/work and health. If she feels like she’s worn out, or not quite “with it”, she should have a break for a couple of months. I assume you know all the usual safety precautions like drinking the right amount of water, being careful who you buy stuff from, not drinking alcohol when you take it, having regular breaks from dancing and never using it if you’re on prozac or a similar antidepressant. You’ve probably also noticed it can strongly suppress the appetite. She’s not going to want to eat when she’s high, but she should do when she’s coming down - even if she can only handle a yogurt that’s better than nothing - it’ll ease the comedown and replace some of the energy she’s used when she was high. As long as you’re careful, it should be OK.

I wouldn’t worry too much about marijuana, unless she seems to be getting too dependent on it.

here’s the case re: pregnant women and drug testing

Her drug abuse almost certainly will become known if she reveals it (or if it otherwise becomes known) to her physician.

Should she reveal it and later apply for life insurance or certain health coverage, her complete medical files are become fair game to whatever insurer wants to root through them. And once that insurer gets wind of her drug abuse–past or present–(s)he is obligated to relay that information to the Medical Information Bureau in Boston.
The MIB keeps a huge database of persons with varied medical conditions that might be of interest to its vast membership of insurance companies. The most likely scenario in this case is that the insurer would photocopy the entire medical file, then relay keep conditions to MIB. BTW, if she wants insurance sometime in her life, the precondition is that she must agree to a full release of medical record. Should she try to limit it to a partial release, as some “experts” recommend, the prospective insurer won’t stand for it. And drug abuse like you cite is a definite red flag to insurers.

Another problem: once an HMO or other insurer discovers this condition, it is quite possible her employer (present or future) could, too. In the age of managed care, computerized records (and hackers), one’s medical history is usually not private. Her physician may want it to be, but it isn’t. Another problem: a disreputable person can get medical records from the MIB, with a little cash under the table.

This explains why some people go to another physician, use aliases, and pay cash.


"Should she reveal it and later apply for life insurance or certain health coverage, her complete medical files are become fair game to whatever insurer wants to root through them. And once that insurer gets wind of her drug abuse–past or present–THE INSURER is obligated to relay that information to the Medical Information Bureau in Boston. The MIB keeps a huge database of persons with varied medical conditions that might be of interest to its vast membership of insurance companies. The most likely scenario in this case is that the insurer would photocopy the entire medical file, then relay KEY conditions to MIB.

I didn’t know whether to start a new thread or just post to this one since it’s the same topic, different circumstances so I’ll try here first…

I am 16 years old and I’m sexually active, I’ve seen too many of my friends end up getting abortions or ruining their lives by having kids too young to want to do that to myself so I went to a Planned Parenthood and I started taking birth control pills on Sunday.

I have a doctor’s appointment tomorrow as a follow up to a kidney infection I had about a month ago.

First: Will anything show up in the urine analysis?
Second: If it does do I have a right to keep the fact that I am on the pill from my parents?
Third: If I request to not have my mother go into the examining room with me can they deny me that right?

Any help would be greatly appreciated