We all expect confidentiality when we go to the doctor, after all that is part of the Hippocratic Oath. We expect our medical records, diagnoses, and treatments to be kept private by our doctor.
What is the dilemma
Doctors can be in a real dilemma when it comes to sexually transmitted diseases. The medical records of the patient are confidential but what about the problem of public safety?
Let’s say a doctor has both a husband and wife as patients, one of them gets a sexually transmitted disease or infection, that person expects confidentiality; however what about the other partner? For this instance we will say the husband had a new sexual partner and was infected with an infection that was passed sexually and he doesn’t want to inform his wife of his infidelity should the doctor be able to tell the wife or should he keep his patients’ (the husband) information private? The reason for telling the wife would be for her to get treatment not disclose the affair yet if the doctor tells the wife and she is tested and it comes back negative for her she will know her husband was unfaithful. What about public safety?
As you can see this issue can be a real problem for doctors, especially if the patient is well known in the community. They have to weigh the privacy of one patient against the health of another patient as well as the many people in the public. Should they keep one patient confidential if it allows an outbreak or epidemic in the community?
What about the law concerning notification to partners?
While most states have laws that require the person infected with HIV, Gonorrhea, or Syphilis to notify all sexual partners that they have had a positive test those diseases, other diseases are not listed and do not require notification. Until the law changes and requires all sexually transmitted diseases and infections require partner notification it is up to the doctors to figure out what is best either provide privacy or make sure people get treatment so they do not have worse problems such as becoming infertile or other health related risk and the possibility of an epidemic in the community.
How can a doctor make the decision to break privacy or not?
There are a few things the doctor should take into consideration at this point.
- How much damage is there
- What is the expectation of damage
- How many people can be identified as potential victims of the damage
- Is the patient the patient zero of the damaging infection or one of the victims
- Can breaking privacy stop an outbreak and cause less harm
Those are just a few things for the doctor to wrestle with when making the decision of breaking privacy for one patient or keeping it. Does the damage possible to the community outweigh the needs of the privacy of one patient? Does breaking that privacy mean getting the infection under control faster causing less damage to the community?