Privacy in Private Practice

To change, people often need to let go of a part of themselves. To have this happen in therapy, you need to create a sense of safety and a sense of trust. Privacy is crucial. Part of the ethical duty of any psychiatrist is to protect their patient by not revealing or releasing any information they learn in the doctor-patient relationship. Unfortunately, this is not always possible given the presence of society's interests. These interests are codified in a myriad of laws which specify when information can and cannot be kept private. In California, the California Civil Code, sections 56-56.37 (also know as the Confidentiality of Medical Information Act) describes when medical information can be released without a patient's consent. National regulations include the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The HIPAA privacy rule was released on December 28, 2000 although compliance was not required until April 14, 2003. It applies to "covered entities" who use electronic means for communicating information.

In addition to controlling access of others to your medical record, there are laws that protect your access to your medical record. In California, the California Health and Safety Code, sections 123110-123149.5 (also known as the Patient Access to Medical Records Act) describes these patient rights. These are federally extended by HIPAA.

To help my patients understand these rules and some of their implications, I have a privacy policy I give them describing some of the privacy situations I am concerned about. I'm not a lawyer, and I feel it isn't possible to predict everything, but open discussion of expectations and establishment of a mutual understanding is one of the best tools for building and maintaining trust. This is becoming more and more important as our society becomes more technologically oriented and more complex.