Confidentiality vs. Privileged Communication

[BSWdavid]

Can anyone describe the basic difference between privileged communication vs. confidentiality? Also, are students legally obligated to maintain such obligations? I am getting some conflicting information regarding these topics. As a practicum student, I would like to ensure I am upholding my duty to my clients, but until I really understand these concepts, I am not sure I can do so.

Thanks!

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[erg923]

First, you should NOT be seeing patients if you have confusion about basic issues of confidentiality. Didnt your program teach you this? How is ethical for them to send you on practicum without taking an ethics class?

This is s as supervior question, not an SDN question. Although confidentiality rules are nearly the same from site to site, each site has its own of set of procedures and required paperwork for patient data release and commmunication. A PRACTICUM SITE SHOULD NEVER SEND YOU TO SEE CLIENTS IF YOU ARE NOT INFORMED ABOUT THESE SITE SPECIFIC ISSUES.

The one thing I can say for certian is that yes, of couse you are obligated to uphold the same laws of confidentiality as everyone else. Why would you not? Obvioulsy, you should be telling your patient about the limits of confidentiality before they even open their mouths AND explictly stating that you are a student-in-training and that their case will be discussed in detail with your supervior. They should be provided with the name and contact info of your supervior as well. Again, all things that need to be (should have been) covered by your supervior so that there are no misunderstanding by you or your patients.

 

[edieb]

Can anyone describe the basic difference between privileged communication vs. confidentiality? Also, are students legally obligated to maintain such obligations? I am getting some conflicting information regarding these topics. As a practicum student, I would like to ensure I am upholding my duty to my clients, but until I really understand these concepts, I am not sure I can do so.

Thanks!

If you are talking about the term privilege, this is a legal term, not an ethical one. Privilege refers to the right of a patient to not have information he/she discloses to you revealed, particlarly in a court of law (e.g., a subpoena for assessment records, etc)

Confidentiality is an ethical term referring to the fact that a therapist cannot reveal information, except in certain situations, a patient tells you in-session

 

[stigmata]

Man if you don't know you better get clear on this quickly, and do via your supervisor not here. It is your supervisor's license at risk. I have to say that I am more than astounded someone can make it to a clinical practicum, even at the social work level without knowing this and knowing it well.

 

[BSWdavid]

I do understand the issue of confidentiality. What I was confused about was the difference between confidentiality and privilege. In other words, if I were to have to go to court, would I still be able to argue privilege even though I am not licensed?

Just to note: I always explain to my patients that what they share with me is confidential; however, I am legally obligate to report suspected instances of abuse, homicide, or suicide. Again, I was just curious what the difference is between privileged communication and confidentiality and how this relates to myself as a student. Certainly I would always uphold ethical standards.

 

[BSWdavid]

It amazes me how this board can go from being helpful and supportive to downright rude and offensive. I was simply asking the difference between confidentiality and privilege...

 

[erg923]

I hope you explain that their case is discussed with your supervisor (since you are not a individually licensed provider), as well as with other students (if you have group supervision).

Law and rulings always supersedes APA ethics. You let your code be known, but if judge or law declares otherwise, you should not be going to jail for contempt...

If a patient initiates a tort against you, then that person has negated their confidentiality and given an green light on their records. Obviously, you would release only what is necessary...

 

[stigmata]

I assume you mean that I was rude by stating the truth. The fact that you don't know this very basic information is scary to me as we are dealing with people's lives, but in no way was meant as an offense towards you; someone or some others have not prepared you well. As you use the terms they are the same thing, but it is a little like asking 'what is the difference between an appendix and that that little useless thing on the end of your large intestine'?
Both terms are legal, and bound to practice law for every healthcare profession. Confidential referes to the nature of the information we receive, while privilege refers to who has the legal right to release or share such information. For example all info we receive in confidenital with exceptions like child abuse, imminent harm to self or others and sometimes gross inability to care for oneself or make decisions, but for adults privilege remains with the patient with the above. However, with adolescents privilege may be with the legal guardian or parent(s) which varies by state, and with kids it is always with the parent(s) or legal guardian. There are many other variations. Violation of these legal concepts is the number one reason for board actions and lawsuits.
I apologize for being blunt, but this is serious stuff.

 

[BSWdavid]

I hope you explain that their case is discussed with your supervisor (since you are not a individually licensed provider), as well as with other students (if you have group supervision).

Law and rulings always supersedes APA ethics. You let your code be known, but if judge or law declares otherwise, you should not be going to jail for contempt...

If a patient initiates a tort against you, then that person has negated their confidentiality and given an green light on their records. Obviously, you would release only what is necessary...

Well, the reason I didn't include an explanation that I am a student, is that they typically come in with this information already. Before I meet with them, they meet with my supervisor, who explains all this in detail. I always reiterate that point during the initial visit, but they all have this basic information ahead of time.

 

[BSWdavid]

I assume you mean that I was rude by stating the truth. The fact that you don't know this very basic information is scary to me as we are dealing with people's lives, but in no way was meant as an offense towards you; someone or some others have not prepared you well. As you use the terms they are the same thing, but it is a little like asking 'what is the difference between an appendix and that that little useless thing on the end of your large intestine'?
Both terms are legal, and bound to practice law for every healthcare profession. Confidential referes to the nature of the information we receive, while privilege refers to who has the legal right to release or share such information. For example all info we receive in confidenital with exceptions like child abuse, imminent harm to self or others and sometimes gross inability to care for oneself or make decisions, but for adults privilege remains with the patient with the above. However, with adolescents privilege may be with the legal guardian or parent(s) which varies by state, and with kids it is always with the parent(s) or legal guardian. There are many other variations. Violation of these legal concepts is the number one reason for board actions and lawsuits.
I apologize for being blunt, but this is serious stuff.

I absolutely agree that this is very important, and I have been taught "the basics" of confidentiality; however, I never really understood the difference between confidentiality vs. privilege. We have been trained quit well in ethics (based on the NASW Code of Ethics) but because privilege is a legal term, and not an ethical term, it hasn't really come up. Also, from what I understand, not all states offer privilege to social workers. My state is one that does, however.

I think when it comes to legality issues, most is learned during licensure preparation. Whether this is a good idea or not is an entirely different matter. I think the legal aspects of practice aren't emphasized nearly enough in clinical programs, but because the laws very so much between states, it can be particularly difficult to develop a curriculum that applies to most licensees (this is especially true in social work where licensure laws veru greatly between states).

 

[stigmata]

Hmmm. Privilege is with the patient or legal representative, and very rarely with the provider of services. Ethics is relative and secondary to law, but the law of confidentiality and who has privilege to release such information is very similar across America. Please get some clarification on this as it is clear you don't understand the terms, and what they mean in relation to practice. SDN is not the place to get this.

 

[BSWdavid]

Hmmm. Privilege is with the patient or legal representative, and very rarely with the provider of services. Ethics is relative and secondary to law, but the law of confidentiality and who has privilege to release such information is very similar across America. Please get some clarification on this as it is clear you don't understand the terms, and what they mean in relation to practice. SDN is not the place to get this.

I will certainly clarify. FYI: posted below is the Indiana code:

IC 25-23.6-6-1
Matters related in official capacity; exceptions to privilege
Sec. 1. Matters communicated to a counselor in the counselor's official capacity by a client are privileged information and may not be disclosed by the counselor to any person, except under the following circumstances:
(1) In a criminal proceeding involving a homicide if the disclosure relates directly to the fact or immediate circumstances of the homicide.
(2) If the communication reveals the contemplation or commission of a crime or a serious harmful act.
(3) If:
(A) the client is an unemancipated minor or an adult adjudicated to be incompetent; and
(B) the information communicated to the counselor indicates the client was the victim of abuse or a crime.
(4) In a proceeding to determine mental competency, or a proceeding in which a defense of mental incompetency is raised.
(5) In a civil or criminal malpractice action against the counselor.
(6) If the counselor has the express consent of:
(A) the client; or
(B) in the case of a client's death or disability, the express consent of the client's legal representative.
(7) To a physician if the physician is licensed under IC 25-22.5 and has established a physician-patient relationship with the client.
(8) Circumstances under which privileged communication is abrogated under Indiana law.

 

[zzzz2]

I will certainly clarify. FYI: posted below is the Indiana code:

IC 25-23.6-6-1
Matters related in official capacity; exceptions to privilege
Sec. 1. Matters communicated to a counselor in the counselor's official capacity by a client are privileged information and may not be disclosed by the counselor to any person, except under the following circumstances:
(1) In a criminal proceeding involving a homicide if the disclosure relates directly to the fact or immediate circumstances of the homicide.
(2) If the communication reveals the contemplation or commission of a crime or a serious harmful act.
(3) If:
(A) the client is an unemancipated minor or an adult adjudicated to be incompetent; and
(B) the information communicated to the counselor indicates the client was the victim of abuse or a crime.
(4) In a proceeding to determine mental competency, or a proceeding in which a defense of mental incompetency is raised.
(5) In a civil or criminal malpractice action against the counselor.
(6) If the counselor has the express consent of:
(A) the client; or
(B) in the case of a client's death or disability, the express consent of the client's legal representative.
(7) To a physician if the physician is licensed under IC 25-22.5 and has established a physician-patient relationship with the client.
(8) Circumstances under which privileged communication is abrogated under Indiana law.

Sounds like you already answered your own question. Sometimes doing a little research on our own or even googling for definitions is way more efficient than waiting for someone to respond here.

 

[stigmata]

So what this is saying is that privileged communication=confidentiality.