Ethics and Privacy
Ethics of Confidentiality and Disclosure
Should patients be informed before a history is taken about mandatory reporting requirements for partner, child and elder abuse? Most experts in the field believe this is ethically required, but some people disagree.
If you choose to inform the patient about the limits of confidentiality, a convenient time might be as part of new patient paperwork. Otherwise, you could do so verbally at the start of taking a history. "I just want you to know that everything we discuss here today is completely confidential, except a few things I am required by law to report ........."
Privacy issues to consider around the topic of abuse include:
- patient should be assured that the information she provides will not be revealed to her batterer
- do not ask partner to confirm or deny history given
- patients should be interviewed privately and alone or with a professional interpreter (do not use family or friends)
- if written screens are used, they should not be mailed to the house or filled out in the waiting room with the abuser present
- if patient is leaving abuser, do not write her new location in the records, which may be obtainable by partner's attorney consider alias for hospital admission
- do not list domestic abuse as a billing or discharge diagnosis if there is risk of abuser seeing bill; however note that patient legally may request insurance company to send EOB to alternative address
- do not record parent’s disclosure of personal abuse on child’s record, which may be obtainable by partner; however record if parent wishes to document abuse
- do not ask about abuse in the presence of children 3 or older, as the partner may question the child about the visit
- find out the safest way to communicate with patient outside of the visit
- who is the patient’s healthcare surrogate - what family members can be told about her healthcare issues?
Patient information needs
Some patients may not answer “yes” to abuse questions because they “don’t know what will happen next”. They have fears of deportation, children being taken away, etc. Providing information up front about the abuse screening and evaluation process, with hotline numbers to call, can help patients understand their situation more realistically. Perhaps they will confide in you the next time.