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Doctor-Patient confidentiality: Is it Truly bulletproof?

Updated: Jan 31

Have you ever shared a secret only to discover that everyone found out about it? It is a common experience, and not only do you have to handle the consequences, but you also grapple with feelings of anger and betrayal.

Of course we have all all been there and we learned some valuable lessons. Ideally, you become more careful and selective when confiding in someone. Fast forward a few years, and here you are talking to a psychiatrist. Not only are you dealing with an impartial professional, but your communication is also protected by doctor-patient confidentiality and HIPAA. What does that exactly mean, and can you trust your doctor with your darkest secrets? Will it remain confidential or come back to haunt you someday?

With many years in mental health and experience across various settings, including forensic settings, I've worked with individuals involved in murder, rape and other serious crimes, people who used or suffered dependency related to pretty much any illicit substance that can be found underneath the sun, people who survived one or more suicide attempts, people who encountered incomprehensible trauma, debilitating medical conditions, exotic or commonly seen STD's..... and everything above combined so I hope you trust me when I tell you that It would take a lot for me to raise an eyebrow, and most importantly, that I will never judge you. !

In the field of mental health, dealing with sensitive information is routine. Despite clear privacy regulations and legal protections we still must consider the slight possibility of a breach or handing over records due to a subpoena. That is why as an experienced psychiatrist, I document what's necessary for clinical decision-making and risk assessment while being mindful of the low probability that these documents will ever be disclosed. For instance, I might discuss feelings of guilt or shame without recording any intimate details of the events and thoughts that resulted in those feelings. I could also make a note in the record indicating that we spent 45 minutes focusing on family dynamics to justify the billing but I will stop there as there is no merit in recording sexually intimate or other sensitive details we just discussed. On rare occasions, a psychiatrist might create private, non-medical record-related psychotherapy process notes. However, this documentation is for individual use only and cannot be obtained by subpoena or any other means.

I plan in advance how to manage risk and vast majority of difficult topics and sensitive information out there I previously dealt with in one form or another while prioritizing my patient's well being and keeping it confidential with out compromises.

Still there are limits to confidentiality. You need to know that me as well as any other doctor will be required to act and disclose information when there is a concern of danger to yourself and/or others. Reporting instances of child or elderly abuse is also mandatory. Other than that, we are obligated to maintain confidentiality and we can be held liable for breaching it. In clinical practice, if you use insurance, your information and details of your treatment may be shared with the payer for payment purposes. Courts can subpoena parts or the entire medical record, excluding psychotherapy notes.

Technically, third parties are also bound by confidentiality, so while your insurance can request information for payment purposes, the information itself must remain confidential.

I hope this reassures you, and I look forward to our conversation.

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