Breaching Patient Confidentiality: A Study of Physician Assistantsʼ Awareness and Attitudes

Abstract

INTRODUCTION All health care providers, including physician assistants (PAs), have a longstanding ethical obligation to maintain patient confidentiality, which dates back to the Hippocratic Oath and continues to be reflected in contemporary codes of ethics.1,2 The duty of confidentiality is grounded in the ethical principle of respect for autonomy and honors the patient’s right to decide with whom to share personal information. An implicit or explicit promise of confidentiality can also help build trust in the health care professional-patient relationship, which may affect the patient’s willingness to seek professional help, reveal relevant information, and adhere to treatment plans.1,3 Thus, the promise of confidentiality is essential for the health care professional to fulfill his or her fiduciary responsibility to protect and promote the patient’s health-related interests. In addition to an ethical obligation, health care professionals have a legal obligation to protect patient confidentiality. This legal duty can be found in both federal and state law. The privacy rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) sets a national floor for protecting patient confidentiality by restricting the ability of covered entities to use and disclose identifiable protected health information without written authorization. However, many state laws provide even greater protection than HIPAA. For example, according to the Texas Occupations Code, all written, verbal, or observed communications with the patient are generally held to be confidential and may not be disclosed to outside parties, unless an exception either requires or permits disclosure.4 These exceptions are explicitly listed in the statute and vary on a case-by-case basis. It is therefore important that all health care professionals are aware of what these exceptions are and how they apply in specific cases. In the state of Texas, all physicians are required to take and pass a Karmen Slabic was a PA student at the Baylor College of Medicine, Houston, Texas, when this research was conducted. Amy Maguire is an assistant professor of medicine and medical ethics at Baylor College of Medicine.