Confidentiality in clinical psychiatry

A brief history of the central role of confidentiality in the doctor-patient relationship is presented. Emphasis is placed on the positions of the American Medical Association and World Medical Association. The dilemma posed by the requirement of balancing the rights of the patient against those of society is portrayed. Particular attention is paid to the role of technology and mass society in exacerbating this tension, and the differences between the rights of confidentiality and those of privilege are offered. Recent court cases are cited to illustrate five legal theories to which a patient can resort in alleging damages for the inappropriate disclosure of confidences, as are others in an effort to show the directions in which American courts are heading. Several suggestions are offered to the clinician in dealing with confidentiality.