Correspondence

Confidentiality

N Engl J Med 1993; 328:1128-1129April 15, 1993

Article

To the Editor:

The professions make such a fuss about confidentiality and privileged information that the naive layperson invariably believes that lawyers, doctors, and members of the clergy would rather face any horror than breach the confidence of their clients. Theoretically, I do not doubt that this is often the case, but practically, medical confidentiality is not important.

I sit in a shared waiting room and the booming, clear voice of the telephoning receptionist informs me that she requires some demographic and personal information of A; question after question is clearly presented. Next, I learn that B is pregnant and has a history of seizures; and C must visit the hospital for an electroencephalogram. The names of these patients roll mellifluously off the woman's tongue. This no sooner ends than here are the doctor and a patient discussing some ocular malady: “Things will improve in two weeks,” we are all informed. I am bristling, but the receptionist is beckoning me to the safety of the examination room. The door closes behind me and I am safe from all these confidences that do not concern me. But not for long, for echoing clearly through the wall are the doctor and a patient discussing some personal misery that I want desperately to ignore. Now the doctor is in the hallway, continuing to talk, and I could ignore his words only if I had come equipped with earplugs. Next, I am at the receptionist's counter discussing costs, payments, bills, and photocopying, nothing I want the large audience to overhear, so I stay on the official side of the counter and speak quietly. As I leave, they all stare at me as if they know every secret I have carefully protected.

I am off to the pharmacy for some prescription drugs. The pharmacist stands behind a partition, far away, and asks me lots of questions. I must speak loudly so that he can hear name, address, date of birth, and other demographic details. Next, he wonders whether I am allergic to anything. I balk: “Not here in public,” I angrily reply, while an audience thinks me mad. “I just need to know for my records,” he clarifies helpfully. Does that warrant broadcasting my personal medical history to the winds?

Robert Hauptman, Ph.D.
St. Cloud State University, St. Cloud, MN 56301