Master the board step 3

Master the Boards: USMLE Step 3
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Members of law enforcement: You cannot release medical information to
courts or police without a court order or subpoena.
Hence, only a patient can obtain or ask for his or her medical information to
be released. A current physician cannot obtain a patient’s previous medical
records without her direct consent.
Breaking Confidentiality to Prevent Harm to Others
An exception to the privacy rule is in the circumstance of protecting other
people.
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If a patient has a transmissible disease, such as tuberculosis or HIV, the
physician can violate the patient’s confidentiality to protect innocent third
parties. If you have tuberculosis, for example, your doctor can contact your
close associates without your consent if they are at risk. If you have syphilis,
HIV, or gonorrhea, your doctor can safely inform others without your consent
that they may be at risk.
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The classic example is of a patient with a psychiatric illness who may be
planning to harm others. They physician has the right to break your confidentiality
to alert the person at risk to prevent harm.
This issue comes down entirely to whether another person may be harmed by
the patient’s illness or actions. If you have a dangerous disease and your doctor
does not inform the innocent third party at risk, then that physician is liable
for harm that befalls the innocent person.
End-of-Life Issues
Autonomy as applied to end-of-life issues is the most important subject for the
test and for patient autonomy.
Withholding and Withdrawing of Care
Withholding of care and withdrawing of care are considered indistinguishable
from the point of view of the test and of proper ethical behavior. An adult
with capacity can withhold or withdraw any form of therapy. If the patient
begins therapy, he or she has the right to withdraw that care. The reasons for
the withdrawal or withholding of care are not important.
Advance Directives
An advance directive is a set of instructions from an adult patient with
capacity directing the care of himself or herself prior to losing capacity.
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