Does doctor-patient privilege extend to the nurse who’s also in the examining room? or doesn’t it apply to her? What if it’s just the patient and the nurse talking in the examining room?
The privilege applies to anyone who treats you. In EMT training we were taught that we were extensions of the emergency room physician, and thus subject to the privelege.
even as a receptionist, i was bound to secrecy.
the main rule was, if it ain’t your business to know (outside of work), SHUT THE HELL UP!
jb
Hang on there, folks. There are at least two distinct issues here.
The first is a general obligation of confidentiality, which is part of the Hippocratic Oath. Most U.S. states (and, I’d hazard a guess, most Western countries in general) have passed laws that provide greater detail about the obligation and extend it to other medical professions, such as technicians or nurses. Most also have confidentiality laws governing whole medical entities, like hospitals and clinics, in order to bind clerks, nosy janitors, and the like. In addition, most medical organizations enforce their own confidentiality rules that go beyond these laws, because they know patients expect it. I can also tell you entirely too much about federal medical-privacy rules slated to go into effect beginning next year.
The second is the peculiar legal concept of physicial-patient privilege, which is not nearly as universal. Law.com defines it as:
Those states that recognize this privilege often put additional limitations on it. For example, a physician who’s defending a malpractice suit can testify about the patient’s condition even if that information would normally be confidential–otherwise, the physician wouldn’t be able to defend herself.
I’m better versed in general medical privacy so I’m not really up on whether this legal privilege usually extends to other medical professions. It would seem to me that it must, if only because otherwise it’d be meaningless: a lawyer could get around it too easily by subpoenaing the nurse instead of the doctor.
But the moral is that in the U.S. this legal privilege is a creature of state law. There’s no federal physician-patient privilege - indeed, the Federal Rules of Evidence require federal judges to enforce the law of the applicable state. And there’s no consititutional right, either.
Oxy, Esq., editor of a medical privacy newsletter.
Privilege is not the same as an obligation to keep things confidential. The latter means that you must not divulge information unless compelled by a court. The former means that even a court is powerless to compel you.
The contours of the privilege all depend on the law of the jurisdiction. For instance, IIRC, there is NO doctor-patient privilege in the federal courts unless the doctor is a psychotherapist.
–Cliffy
Despite popular misconception about it, the physician-patient relationship is NOT immune to a court-ordered exposition. There are only three such relationahips that are immune: 1) client-attorney; 2) priest (or other clergy) and confessor; and 3) husband-wife.
To clarify, you might do a web search on HIPAA, which is a somewhat new law …Health Information Privacy Act (and another “A”, and I forget what it stands for right now).
How far does this privledge extent? My dentist once gave my name, address, and phone # to another patient who said i hit his car. And by the way, i didn’t, someone else parked next to me did! Was this legal?
“HIPAA,” believe it or not, stands for the “Health Insurance Portability and Accountability Act of 1996” (42 U.S.C. §1320d). It has a provision ordering the creation of health information privacy regulations.
When the law does recognise a doctor-patient privilege, the privilege belongs to the patient, not to the doctor.
There I went, dancing about this awful law, and now everybody goes and starts talking about the damn thing! 
If you’re really, really interested, the best website is probably HIPAAdvisory.com. It’s not an official government site, but unlike those, HIPAAdvisory has the complete regulatory language in HTML format. They’ve also got a bunch of nice overview articles.
Re: the question about dentists. I’m sorry I’m not a West Virginia lawyer, so I could give you real advice. What I can report is that my company considered starting a new records-privacy newsletter for dentists. Our market research dissuaded us, because it was pretty clear that most dentists either (a) knew so little about the law they wanted to bury their heads in the sand, or (b) didn’t care. Not encouraging.
I’m sure there are a lot of exceptions, mind you, but there seems to be widespread notion that most people really don’t much care if someone finds out they’ve had a cavity filled. That’s probably true. But from time to time that attitude may lead dental offices to release patient info in a way most physicians would find appalling.
I think HIPAA has more to do with the privacy of medical records, their provision to insurance companies minus patient identifiers, and encryption for electronically transmitted patient data. It doesn’t really address the classic “doctor-patient” privilege.
There are laws in most states which address the fact that medical records can’t be released without the patient’s consent (except by court order, and psychiatric records may have special rules) but do not really address the oral transmission of information being confidential. The AMAsays “the physician should not reveal confidential communications or information without the express consent of he patient, unless required to do so by law.”
This isn’t correct either – many states do recognize a doctor-patient privilege. And as I noted in my above post, the federal government recognizes a privilege between psychotherapists (whether they have an M.D. or not) and their patients. Out of all the areas of law that vary by jurisdiction, privilege law is one of the most diverse, possibly due in part to the fact that it is not governed by concrete rules at the federal level.
The most common privileges are the ones Neurodoc mentioned, but others such as doctor-patient, psychotherapist-patient, accountant-client, and the self-auditory privilege are recognized in some states. The federal government recognizes several privileges dealing with foreign dignataries such as diplomatic inviolability and the head of state privilege; since the federal government is supreme in the application of law to foreign affairs, it can (and does) force state governments to accept those privileges as well. Also, most jurisdictions actually recognize two spousal privileges; the spousal confidential communications privilege and the spousal testimonial privilege.
I find all this stuff pretty interesting, but it does nothing to answer the OP. That’s because privilege law is so dependant on the state at issue that we can’t even begin to address the question without knowing that piece of information. (Even then I wouldn’t hazard a guess because the law of each jurisdiction is so intiricate.)
–Cliffy, Esq.
Well, I love reading the answeres from those lawyer-types! I can’t offer anything as in depth, but as a nurse, I can tell you what my experience has been.
General medical info can be shared on a need to know basis only. (Which someone may have already said here) The guideline for defining those need to know people, is that they are involved w/ payment, treatment, or operations. Benefits, authoriztions, claims, quality improvement, risk management, teaching purposes, and the obvious-like direct pt care. There are times that some things may be overheard in the course of conversation. In a crowded hospital unit or office, you may overhear some things, but nurses are expected to take “reasonable effort” to safeguard your privacy. Limiting the use of names, speaking softly, discussing clinical issues in the clinical setting, you may still end up having some ‘incidental’ disclosure. Most nurses are sensitive to this.
Also, keep in mind the difference between confidential, and anonymous.
The nurse is expected to tell your doctor about anything clinically significant that you may discuss w/ him or her. Their is nothing wrong w/ saying…'Please don’t tell my wife/husband…" If you want to set your mind at rest. That is reasonable, and would probably be appreciated by the staff, if they have been sharing info all along w/ your previous approval. Make your concerns known!!