What are doctors required to report?

Gunshot wounds and child molestation come to mind, but does anyone know of an online source with details?

I overheard a conversation at my gym where one of the members was expressing his concern over admitting to his doctor that he took anabolic steroids. One look at this guy and it’s pretty obvious that he’s on gear, but it got me wondering if his concerns are legally valid. Then I started to wonder about all the people out there buying all kinds of meds without a prescription from off-shore sources. I’m not asking about the importation issues, I’m just wondering about the after the fact business of telling your doctor what you’re doing. Self-medicating is stupid on many levels, but can it get you thrown in jail if you tell your doctor about it? What sorts of things is he or she required by law to report? Does it change from state to state?

My neighbor once went to see his physician drunk. His physician asked him how he got to his office. My neighbor replied that he had driven himself. His doctor confiscated his car keys and called the police.

Lotsa stuff. Just off the top of my head, I can think of HIV, Hep A, B, C, D, E, gonorrhea, syphilis, chlamydia, pertussis, rubella, smallpox, rabies, polio, measles, Tuberculosis, anthrax, cholera, legionella, genital herpes (1st infection only), trichinosis, tularemia, leprosy, …

CDC has a site devoted to what’s reportable: http://www.cdc.gov/epo/dphsi/nndsshis.htm

Campylobacter. When I had it, an investigation into a certain grocery store was launched.

I believe that any time a woman shows up in an ER with any sort of blunt force trauma, the doctor has the option to call the police. Even if she claims that she was clumsy and fell down some stairs.

IANAD. but I’m pretty sure they have to report anything that raises even a suspision of child abuse. And they are protected by law if it turns out that wasn’t the case.

Reported how, Qadgop? Do you mean to the CDC, or somewhere else?

We report it to our state health department.

Thanks for the link! Very interesting, but it only mentions infectious diseases. Are there reportable behaviors ( for lack of a better word)? Any guidelines for doctor-patient confidentiality?

Usually the way disease stuff works is that “notifiable” diseases are reported to county then state health departments, and are compiled at each level, and they get up to CDC where they are compiled nationally. We estimate a lot of drop off in that process. (doesn’t get reported by MD to county, doesn’t get reported by county to state … etc) so the numbers represent what is reported, nor the true level of disease. But reporting should be proportionate to disease.

Something really bad (SARS …) would probably get state and CDC involved immediately, if not sooner.

There is also stuff that doctors have to report about other doctors if they find out about it- that comes under the category of behavior. Substance use at work, drug diversion, writing bad prescriptions … Not pretty.

Just to clarify, that generally doesn’t get reported with any identifying information, does it?

Having just had a seizure for the first (and hopefully only) time, I found out that doctors are required in some states to report seizures to the DMV. So they can take away your license.

Presumably like a lot of other reporting laws, this is controversial, since it leads to patient under-reporting of potentially dangerous health problems. (My dad, for instance, has had what he believes are minor seizures for decades - but since California will take away your license for a year if you have any type of seizure at all, he decided to live with it rather than try to get it treated.)

What about illegal drug use? I gave my doc the straight dope about what I had been using, and he didn’t report me to anybody (that I know of).

I did a search for “doctor patient confidentiality” and came across this interesting site: http://law.enotes.com/everyday-law-encyclopedia/doctor-patient-confidentiality . It looks like there are some federal guidelines but there are also variations by state.

threats of violence to self or others.

I think it depends on your jurisdiction, and the local regulatory body for physicians likely has information/resources available for physicians that explains their rights/obligations.

In my location (Alberta, Canada), the provincial College of Physicians and Surgeons has guidelines for physicians on this topic:

(PDF file) Release of Medical Information. The list I’ve typed below has each main item, and the document supplies details about each item and the relevant legislation regarding each.

From the link, doctors (in this jurisdiction) must report:[ul][li]specified communicable diseases (see Public Health Act)[/li][li]suspected child abuse[/li][li]suspected abuse of a “person in care”[/li][li]animal bites (if rabies is reasonably suspected)[/li][li]deaths under certain conditions[/li][li]results of blood alcohol testing (if drawn for that purpose at the request of a Peace Officer)[/li][li]medical conditions that are a hazard to aviation safety[/li][li]medical conditions that are a hazard in railway workers[/li][li]patients with a “notifiable disease” for occupational health and safety[/li][li]all pathology reports indicating the presence of malignant cells must be reported to the nearest cancer clinic[/ul]A physician must provide information upon the request of:[ul][]a patient[/li][li]court order[/li][li]any third party when accompanied by authorization to release[/li][li]a patient’s legal guardian[/li][li]a patient’s parent, if the patient is under the age of consent[/li][li]a patient’s parent, if the parent has custody and the patient is under the age of consent[/li][li]the executor of the estate for a deceased person[/li][li]the College of Physicians and Surgeons, pursuant to an investigation under the Medical Professions Act[/li][li]order of a Statutory Board[/li][li]the Workers Compensation Board, regarding an injured worker[/li][li]the Therapeutic Products Directorate, Health Canada, re: narcotic drugs[/li][li]an agent of the Federal Minister of Health who is undertaking an investigation related to narcotic prescriptions[/li][li]a radiation medical officer, relating to radiation health or safety of workers and the public[/li][li]a Director under the Child, Youth and Family Enhancement Act who has custody of a child, when the guardian is unable or unavailable to consent to the treatment[/li][li]the Alberta Cancer Board[/li][li]other individuals in defined circumstances (e.g. the Mental Health Act or the Hospitals Act)[/ul]A physician may report:[ul][]persons medically unfit to drive[/li][li]patients who, the physician believes, present a clear and present danger to society[/li][li]patients treated for mental illness associated with violence or threatened or attempted violence on the part of the patient against any person[/li][li]under the circumstances outlined in the Mental Health Act a physician may disclose health information relating to a person receiving diagnostic and treatment services in a centre designated under the Act[/li][li]under circumstances outlined in the Health Information Act, physicians may disclose individually identifying diagnostic treatment and care information without consent[/ul]A physician need not report:[ul]gun shot wounds[/li][li]stabbings[/li][li]admitted use of illegal drugs[/li][li]injuries sustained during the commission of a crime[/li]
Note: “This is an area where there is often a misconception of the law. Although legislation is being advocated requiring such reporting, a physician is not required to provide any information to a police officer, even to the extent that a physician has treated a certain named person. Any information of that type should only be obtained through a judicially authorized search warrant.”[/ul]
The College of Physicians and Surgeons of Alberta also has a guideline regarding Reporting Unfit Drivers.

The Alberta Motor Vehicle Administration Act states that:

From the College policy:

Oh yes, identifying information is necessary. It’s a matter of public health.

It is confidentially held, but other health professionals who need to know have access to the information.

Lists of notifiable diseases and conditions vary by state. Of course many are reportable in all states, but still. You can call your state health department epidemiology division to get a list for your state.

Generally speaking, diseases reported to the state health department are not shared with other health providers or anyone else.

On the veterinary side, my state has a list of zoonoses and exotic diseases that I am required to report. Zoonoses are disease that people can acquire from animals, such as rabies and psittacosis. Exotic diseases are those thought to be absent from this country, such as Rhinderpest, Rift Valley Fever, Bluetongue, African Horse Sickness.

I have reported a few rabies and psittacosis cases, but have never seen (or at least recognized) an exotic disease.