Case example

Dr. Adams is an emergency physician on duty during the early morning hours this Sunday in the Emergency Department (ED) of a community hospital in a small Midwestern city. The ED receptionist informs Dr. Adams that a woman is on the telephone anxiously inquiring whether her 20-year-old daughter Alice, an undergraduate student at the local university, is a patient in the ED. The woman reports that her daughter's roommate has informed her that Alice has not returned to her room as expected; the roommate does not know where Alice is or what has happened to her. The caller adds that she has attempted to contact Alice by cell phone, but her calls have not been answered.

Alice was, in fact, transported to the ED several hours earlier by friends after she fell at a party and could not get up. When Dr. Adams first saw her, she was tearful and unsteady. When he asked what happened, she said, “I drank way too much and took some pills. I am so ashamed; please don't tell anyone about this, especially my mom!” Shortly thereafter she lost consciousness, and she is now receiving initial evaluation and treatment for acute alcohol poisoning or a drug overdose. The receptionist asks Dr. Adams to speak with the caller. Should he do so? If he does speak with her, what, if anything, should he tell her about Alice?

Ancient origins, contemporary significance

Protection of patient confidentiality is among the most ancient of the moral responsibilities embraced by health care professionals. The famous medical oath attributed to Hippocrates, for example, includes this pledge: “What I may see or hear in the course of treatment or even outside of treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.” Unlike several of the other injunctions contained in the Hippocratic Oath, however, this commitment to protect patient confidentiality is not just a matter of historical interest. Rather, it remains a staple of contemporary medical oaths and codes of ethics of health care professional associations world wide.