A Perspective on Confidentiality

The confidentiality of communications from psychiatric patients is threatened from many directions. The traditional stance of psychiatrists has been to proclaim total confidentiality as the principle and then to make exceptions. As third-party payers, peer review structures, and governmental agencies erode the exclusively dyadic doctor-patient relationship, the traditional stance no longer suffices. What is needed is a thorough understanding of the forces involved and a set of principles to help assess the real needs for confidentiality in a variety of psychiatrist-patient interactions.