An inevitable logical starting-point is the hallowed medical privacy tradition dating back at least as far as Hippocrates—but one doesn't have to be cynical to surmise that even Dr. H's own receptionist may have gossiped about patients' foibles and maladies.... The precept of nondisclosure is an ideal. But it has been, and should still be, central to the patient–physician relationship, and to the similar relationship with nurses, pharmacists, health social workers, and other care-providers.
The assurance that revelations made within the healthcare relationship will be held confidential encourages people to seek care in the first place, and then to be open in the exchanges involved—divulging information truthfully, asking questions even though doing so may be awkward or embarrassing, cooperating with procedures, and generally nurturing mutual confidence in the relationship. This is essential to effective health care, including public-health surveys and many other activities beyond primary care.14
Thus there is the expectation, embodied in most medical licensing laws and in professional codes, that medical care is delivered within a "medical circle" supervised by physicians and performed within accredited clinics and other institutions. Nurses, pharmacists, physical therapists, laboratory technicians, orderlies, data clerks, and the rest of the "healthcare team" are bound by licensing, ethical obligations, and/or their employment contracts, to respect patients' privacy.
Given the unlikelihood of strict supervision and enforcement within complex, bustling healthcare organizations, institutional "cultures" that emphasize respectful ethical practice are at least as important for patients' privacy as legal rules are.
As will be mentioned repeatedly in this Report, a major problem is that today physicians' span of control simply does not extend to follow or protect data as they are examined by all the different parties who claim rights to access. New responsibilities and liabilities need to be delineated.
(13) An excellent general review is Lawrence O. Gostin, as cited in endnote (4).
(14) During the course of this study the author was dismayed at the number of people, encountered in passing, who mentioned that they have stopped going to their gynecologists, for instance, or mistrust screening or counseling programs, or are reluctant to ask reimbursement for health care, because they "know" that medical confidences will not be respected, or because they fear negative discrimination. Sad to say, their apprehensions may be justified.