■ Professionalism and ethics:
Integrating professional duties, societal expectations and personal wellbeing
Treating members of the same family
Type of activity: Text case
This short text case describes a family physician's challenge: helping two patients resolve a family issue while maintaining patient confidentiality. The facilitation questions focus on helping learners to think about confidentiality issues when treating members of the same family and unintended breaches of privacy.
A 62-year-old woman presents to her family physician with complaints of insomnia and fatigue. She has been under considerable stress living with her sister's family with whom she has had a number of heated arguments. The family physician reviews the psychosocial context of her patient, and counsels her regarding stress management and behavioural management of her insomnia. They plan for a follow-up appointment.
Two days later, the sister, who is also a patient of the same family physician, presents with stress resulting from the family dispute.
The family physician believes she can help both sisters by attempting to mediate their dispute.
- Should the family physician discuss one sister's perception of the family dispute with the other sister?
- Under what circumstances might the family physician offer to counsel the sisters together?
- Do you think the family physician should continue to treat both sisters? What are the potential risks?
- What could a physician's office staff do to make a breach of confidentiality less likely when family members are patients of the same physician, or patients at the same clinic?
- How would you approach clinical documentation regarding inclusion of information about other family members in each chart?
Suggestions to faculty
Navigating privacy and confidentiality requirements becomes more difficult when treating patients who may not be able to consent independently. To more fully explore this topic, ask learners the following questions:
- Would the responsibilities of the family physician be any different if either of the sisters had cognitive impairment?
- Would the responsibilities of the family physician be any different if the cognitively impaired sister had a substitute decision-maker other than her sister?
- When would there exist mandatory reporting obligations around vulnerable seniors or adults in your area?