Permissible Reasons for Accessing Confidential Patient Information
The physician may access confidential information from the Medicare record if it concerns a unique disease that requires the information for proper diagnosis, treatment, or prevention of serious harm, provided this serves the patient's medical care. 1
General Rule of Confidentiality
Medical information, including data from Medicare records, must be protected by the legal and ethical principle of confidentiality as a general rule. 1 Privacy rights in the medical context translate into protection of personal data, affirmation of confidentiality, and freedom of choice. 1
Exceptional Circumstances Permitting Disclosure or Access
While confidentiality is paramount, the principle is not absolute. 1 Ethical, legal, and statutory obligations may permit healthcare professionals to access or disclose otherwise confidential information in exceptional cases. 1
Legitimate reasons for accessing confidential information include:
Medical necessity for patient care: When the information is essential for diagnosis, treatment, or prevention of serious harm to the patient, particularly in cases involving unique or rare diseases where specialized knowledge is required. 1, 2
Administrative requests: Hospital administration may request information for legitimate healthcare operations, quality assurance, or compliance purposes. 1
Patient incapacity with family involvement: When a patient has neurological deficits or lacks capacity, and family members are appropriately involved in treatment decisions, information may be accessed to facilitate proper care discussions. 1
Key Considerations
The most ethically sound reason among the options presented is accessing information due to a unique disease (Option D), as this directly serves the patient's medical interests and represents a core professional responsibility. 1 Healthcare professionals have a duty to pursue appropriate diagnosis and treatment, which may require accessing comprehensive medical records. 2
Important caveats:
Simply because family requests a copy does not automatically justify physician access without proper authorization and legitimate medical purpose. 1
Neurological deficits alone do not justify accessing records unless this is necessary for the patient's care or involves appropriate surrogate decision-making. 1
Administrative requests must serve legitimate healthcare operations rather than inappropriate purposes. 1
The physician's primary obligation is to the patient's welfare, and accessing confidential information is justified when it serves serious medical needs, particularly in complex or unique disease presentations where comprehensive information is essential for proper care. 1