So Much for Confidentiality

The New York Times last week once again published Cornell psychiatrist Richard Friedman’s apparently real psychiatric cases with no mention of consent from the patients while the American Psychiatric Association does nothing. I fear that patients or even potential patients reading such material will wonder whether they can trust any of us to keep material about them out of the media.

Although the cases described in this article might appear anonymous at first read in my opinion knowing the name of the psychiatrist narrows the field, especially when the psychiatrist apparently holds a faculty position, likely limiting how many patients he can treat. I suspect the patients themselves, if not friends or family members, know the identity of the cases.

If we do not know the identity of the authoring psychiatrist fewer safeguards may be needed to protect the patient’s confidentiality. If the author has fabricated the cases, or if the author has obtained consent from a real patient, the author or publication should include a statement to that effect. The question remains, however, whether patients can freely consent to publication when they may worry about the effects of refusing on the treatment relationship.

We need to agree on a test for identifiability of openly published cases. The American Psychiatric Association has failed to adequately promote patient-psychiatrist confidentiality. Stop publishing real cases Dr. Friedman.

I wrote about this problem before here and here.

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