3- The psychiatrist's obligation to maintain confidentiality may be waived in all the following circumstances EXCEPT:
a. involuntary committal
b. child abuse
c. medical emergency
d. venereal disease in a sexually active patient
e. a request for information by the patient's lawyer
I figure I should answer this since I'm in forensic training.
However its difficult to answer this (and I'm probably overanalyzing which is why I never do well on multiple choice exams) because there are varying degrees of confidentiality.
E.g. in choice a-the doctor will have to report information to the judge, defense attorney and the lawyer representing the mental health board. In the strictest sense that couuld be considered a breach, however the law does not consider it so because the judge and both lawyers are not supposed to give this information out, and in most jurisdictions the patient's information is kept confidential to the public. If that's the case is confidentiality truly breached? Yes in terms of the patient-doctor relationship, no in terms of leaking the information to the public.
b-same things as A. Yes if you suspect child abuse you have to report it, but those people you report it are state employees who must also not report this information to the public. If that's the case is confidentiality truly breached? Yes in terms of the patient-doctor relationship, no in terms of leaking the information to the public.
c-in most places, if there's a medical emergency and collateral information must be obtained, the doctor must try to obtain that collateral information even if it breaches confidentiality. E.g. someone overdosed, and you don't know the medication they were on, but perhaps the family does. In that case, the ER doc usually has to contact the family and ask them, which will breach confidentiality.
d-yes or no, depends on the venereal disease. If its something like Herpes, then no. If its HIV, then yes you have to report it in most jurisdictions because this could literally end up killing the other person.
e-problem here is if the patient's lawyer requests data, usually the patient gave the lawyer permission to obtain that data, in which case giving out the patient's data is not a breach. Of course that patient will have to give permission, and they will do so if the patient wanted their lawyer to have the data.
If I had to pick an answer, I'd pick E. It could only be a breach if the patient did not give permission, though I could very well see myself getting this answer wrong becuase I think its a badly worded question. Lawyers are supposed to keep their client's data confidential as well except in regards to the court and what their client allows, so I could see someone claiming this is not a breach. E.g. D-the answer depends on the disease. Choice A & B depend on the definition of confidentiality. In several people's opinions giving data to the judge and both lawyers is not a breach becuase they are supposed to keep the data confidential as well--just like a doctor telling a nurse what's going on in the patient's history.
(this is why I never do well on multiple choice exams. I usually know what's going on, but I also usually think the answers depend on circumstances the question didn't specify.)
