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Ask the Mental Health Expert Archives 2001-2004

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Confidentiality

Q. I have a 21-year-old husband. We have been married almost 2 years. He has bipolar disorder with suicidal tendencies and I had him admitted to the hospital. Regarding confidentiality, can his parents talk to the doctor about his condition without my being there? I thought the doctor couldn't talk to his parents, since he is a married adult. Can you offer me any help?

A. While confidentiality requirements may differ somewhat from state to state and hospital to hospital, the general rule of thumb is this: with respect to an adult patient, complete confidentiality applies to everybody--even parents and spouse!--unless the patient authorizes sharing of information.

This applies to what your husband's doctors and nurses can say to others, not what others can say to the medical staff. So, nothing prevents your husband's parents from talking to the doctor--with or without your being present. But confidentiality requirements do limit the doctor's right to talk back!

So, unless your husband authorized the doctor to communicate with his parents, the doctor could listen to your husband's parents' concerns, but not share information about your husband, without his permission.

Even a spouse can be excluded from receiving such information, if the patient so orders. There are, of course, exceptions to the confidentiality requirement. For example, if a patient says, in the doctor's office, "I am going to walk out of here right now, get in my car, and kill myself later tonight," the doctor ordinarily has the right to break confidentiality by notifying a spouse, parent, or law enforcement authority, for purposes of safeguarding and hospitalizing the patient. But once in the hospital, the rule is activated again, except in some cases of court-ordered evaluation.

You can learn more about the subtleties of confidentiality in Dr. Robert Simon's book, "Concise Guide to Psychiatry and the Law". But frankly, I wonder if there is a more personal issue between you and your husband--or his parents--that might benefit from some discussion.

If you are feeling left out or excluded, you can certainly communicate your feelings to your husband (if the treatment team permits it), his parents, or your husband's doctor. There's no rule that limits what you can say, or to whom. But I recommend saying it tactfully. I hope things work out for you and your husband in this difficult situation.

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January 2004

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