Some patients refrain from seeking medical care or drop out of treatment in order to avoid any risk of disclosure. Some simply will not provide the full information necessary for successful treatment. At other times, physicians are approached by patients who ask us not to include certain information in their medical record for fear that it will be indiscriminately used or disclosed. The result of all these behaviors resulting from patients' reasonable concerns is unfortunate. More patients do not receive needed care, and medical records' data that we need for many purposes is regrettably tainted in ways that we often cannot measure.
Confidentiality is particularly critical for the effective treatment of mental illness.
The U.S. Supreme Court recognized the special status of mental health information in its 1996 Jaffee v. Redmond decision and ruled that additional protections for mental health information are essential for effective treatment. For this reason the mere possibility of disclosure may impede the development of the confidential relationship necessary for successful treatment. The 1999 U.S. Surgeon General s Report on Mental Health reinforced this decision. Of course a wide variety of medical conditions are sensitive and require the highest level of doctor-patient confidentiality. We need a high level of confidentiality protection for all medical records so that all patients receive the privacy necessary for high quality care.