In previous columns, we have discussed the laws and regulations protecting the confidentiality of medical information, as well as the circumstances under which medical information can be disclosed.¹ As a general rule, physicians have an ethical and legal duty to keep confidential all information they learn from their patients. As the New York Supreme Court put it in the seminal case of Doe v. Roe:²

…a physician who enters into an agreement with a patient to provide medical attention, impliedly covenants to keep in confidence all disclosures made by the patient concerning the patient’s physical or mental condition as well as all matters discovered by the physician in the course of examination or treatment.

The rationale behind this protection is to encourage the patient to be completely forthcoming to the physician, secure in the knowledge that the physician will do the utmost to keep all such information confidential. As the American Medical Association puts it:

Full disclosure enables the physician to diagnose conditions properly and to treat the patient appropriately. In return for the patient’s honesty, the physician generally should not reveal confidential communications or information without the patient’s express consent unless required to disclose the information by law.³

Throughout the course of their careers, physicians face many difficult judgment calls in their relationships with their patients. One of the most challenging decisions they face is determining whether a patient’s statements or behavior indicate that he constitutes a threat to himself or others, and whether the physician is thereby justified in breaching patient-physician confidentiality by notifying law enforcement and/or the patient’s family members. A case that has been playing out in Kingston, N.Y., since 2004 provides a cautionary tale to physicians regarding when such a breach is permissible and when it is not.

_{1Serbaroli, “Medical Privacy: Rights and Remedies, Part 1,” NYLJ Jan. 30, 2008; Part II, March 31, 2008; Part III, May 30, 2008.}    

_{2 Doe v. Roe, 93 Misc.2d 201 (Sup. Ct. NY County 1977).}    

_{3 http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics.page?.}