When is it ok to violate doctor-patient confidentiality?

Question

Protect Doctor-Patient Confidentiality

Answer

As a therapist I have what is called "duty to warn". If a client makes threats towards a person, I MUST warn they may be in danger. This includes threat of death, maiming, harm to family members, and even pets.

There are a few key points. If the person is making an active threat which is imminent, they must be screened for commitment to a hospital. If they agree to go I can bring them myself, if they refuse police are called. I will also alert police what the person has said as well as make any effort to contact the other party. If the person is being screened, I still call the police/other party to ensure they are made aware of the threat in the case the client is deemed non-commitable.

We are protected by the duty to warn regulation. If a client were to sue me for breaking confidentiality, I must show I was acting in the best intersect of all parties involved and there was a possibility of harm. Most cases, the clinician is seen as doing the correct thing by warning.

Answer

The only time I understand the break of confidentiality is if the patient is at risk of harming themselves or at risk of harming others. It is always explained to me every time i went to counselling and in all honesty it is completely understandable.

Answer

I think, as a professional, a doctor should be able to decide if action needs to be taken in order to protect a possible victim. In the article, it did say that the patient hadn't made direct threats and had only admitted homicidal fantasies. Of course, his lack of action may be influenced by current laws, but I also think in that case, if the doctor felt as though the patient was not likely to commit the crime, he has no responsibility to anyone but his patient. He is a doctor, and most likely capable of making that assessment. But I think the laws need to make it possible for a doctor to also make the professional decision that breaking confidentiality may be in the best interest of the patient and potential victims. Although, I'll concede that this would only really be appropriate in a world where doctors could always be trusted to be ethical.

Answer

When you are a threat to others or yourself. I thought that was the policy anyways? Besides, I may be wrong, but as a mandated reporter, isn't homocidal fantasies something he would be required to report? I definitely feel as if he should have said something or tried to do a mandatory inpatient request.

Answer

I'm unsure what they mean by saying the doctor had a responsibility to warn "all foreseeable victims." Does that mean that the individual named specific victims surrounding his homicidal thoughts? If he did, the seriousness/intent/specicifity of his threats needed to be addressed and from there, this doctor had a duty to warn based on Tarasoff v. Regents. If he didn't follow this law, he does deserve to have action taken against him.

However, simply having a homicidal thought ("I'm so angry I could just kill someone") is not enough to go out and warn the masses. I have to follow Tarasoff duty to warn laws in my profession, and I inform everyone I see of my practice around this. My fear is that if duty to warn expands TOO much around what kinds of statements are actionable, it will discourage individuals from seeking help when they need it.

Regardless this is a tragedy. It's impossible to accurately predict someone's behavior regardless of what they are saying in a session. My heart hurts for this family.

Answer

Only time is if you become a threat to yourself or someone around you.

I told my therapist in middle school that my friend was coming to school with bruises all over from her step mom and you best believe she took action on that.

Answer

My therapist has said the only time he feels it's okay is if a patient poses a threat to their self. Obviously he's not a standard medical doctor but I know that's his policy.

Answer

When the patient has suicidal thoughts. I also wish that it would be mandatory to tell their partner that the patient is STD +. Since they are putting other people at risk. This is dangerous.

Answer

Also I might add that the psychiatrist stated that he made comments about homicide and he should have reported the patient even though he didn't think they would have been actual threats. Any threats should be reported.

Answer

I have such a fear of this kind of thing happening with one of my clients.  It is extremely difficult to judge if someone is an actual threat.  Often when I am dealing with people involved in relationship breakdown, there is a lot of anger.  People sometimes say quite scary things.

Whenever I have talked through things, I have never felt that anyone was in actual danger, hence I have not had to break confidentiality.

The idea of violating a clients trust in me makes me feel sick, it just feels so wrong and can be terribly damaging for a client.  I would need to be sure there was a definite risk.

That said, obviously if something as horrific as in the case cited happened, I would never get over the guilt I would feel.

It is scary as I just feel it is so easy to make the wrong call.  I hate this story!

When is it ok to violate doctor-patient confidentiality?

Let's Glow!

The Top Baby Tracker App: Embrace New Beginnings with Tender Care

The Top Fertility Tracker App: Your Path to Achieving Pregnancy

The Top Pregnancy App: Nurturing Your Journey to Motherhood

The Top Period Tracker for Empowering Your Menstrual Health Journey