Confidentiality and HIPAA

Patients have a right to privacy and confidentiality. This encompasses many things, from protecting their dignity to maintaining the confidentiality of their medical history and present diagnosis. In examining a patient, and often in treating them as well, there will be a need for them to remove clothing. They have the right to not be exposed unnecessarily to anyone. They also have the right to discuss health care issues in confidence.

Health care professionals are expected to honor these rights at all times. There may be points at which information must be shared. For example, TB is a communicable disease that must be reported to public health officials, and in some instances to other individuals who may have been exposed. Sexually transmitted diseases must be reported to public health officials as well as to all potentially exposed partners. However, there are rules to follow in doing so in order to protect the rights of those involved.

There are laws governing confidentiality, and they vary greatly from state to state. For instance, in California, it is illegal to transmit any information on the HIV status of a patient. The diagnosis may not be coded on medical records but may be listed in the medical history.


In 1996, Congress passed legislation known as HIPAA. This is the Health Insurance Portability and Accountability Act. The original intent was to protect individuals from losing their health insurance or from having pre-existing clause limitations placed on their health insurance coverage if they left or changed jobs. The other intent was to provide the federal government with the power to intervene in issues of fraud and abuse in the health care industry.

It took five years for HIPAA to take effect, and two more years to become mandatory. As of April 2003, all health care facilities must comply with the rulings. You most likely have received notifications about your HIPAA rights, or have noticed changes in the way business is conducted. For instance, many pharmacies now have you stand way back from the counter when dropping off or picking up prescriptions so that you won't overhear information about another customer.

Another intention of HIPAA is to set in motion the process for establishing Electronic Health Records (EHR). This would create a national database of medical records that could be accessed by professionals when needed. The need for this type of access was recently pointed out in the aftermath of Hurricane Katrina, when masses of individuals were relocated without access to their medications, prescription information, and medical records. Patients didn't know their diagnoses and/or the names of their medications to even begin to assist in the process.

Confidentiality is an important aspect of health care. It's a challenge sometimes not to share the fact that you are treating a celebrity. It is also important to understand that you cannot share information about a patient with their family members or friends without the patient's consent. The ability to keep secrets and honor confidentiality is an important characteristic for all health care professionals.

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