Review Question - QID 210457

The Health Insurance Portability and Accountability Act (HIPAA) dictates that a physician may not share healthcare information without the patient's permission. It is appropriate to deny requests from family members when there is not an explicit understanding that information can be shared.

If there is no explicit permission obtained from a patient for a family member to be involved in the patient's care, then it is considered unethical to share information with the family member. One notable exception to this rule is that it is acceptable to share information with others (in the absence of patient permission) when the information directly endangers the family member/individual (such as a threat to kill an individual). Other instances where it is acceptable to breach confidentiality include situations where it is a legal requirement to report certain diseases/conditions or special situations (such as child/elder abuse). Otherwise, the plan and care should be discussed with the patient. If the patient is unable to discuss their care, then the plan can be discussed with their healthcare proxy.

Incorrect Answers:
Answer 1: Bring the cousin to the room and ask the patient if it is acceptable to disclose his course is inappropriate because it may put the patient under pressure to say yes in the presence of his cousin. Healthcare decision making should be discussed with the patient in private without any possible coercion.

Answer 2: Bring the cousin to the room and explain the plan to both the patient and cousin is inappropriate because the patient needs to explicitly state that it is appropriate to share this information prior to the cousin being informed.

Answer 4: Explain the plan to discharge the patient in the next few days is true but can only be conveyed once the patient has stated it is appropriate to share the information with the cousin.

Answer 5: Tell the cousin that you do not know the patient's course well is lying which is always inappropriate for the USMLE. You should merely explain the truth which is that the physician cannot disclose information about the patient at this time.

Bullet Summary:
Healthcare information cannot be discussed with anyone unless approved by the patient.