New concepts of confidentiality in family practice.

Medical confidentiality protects the physician-patient relationship and ensures privacy so that intimate information can be exchanged to improve, preserve, and protect the health of the patient. The ethical and legal basis of confidentiality forms a conditional rather than absolute privilege, however, and numerous exceptions currently exist whereby third parties with a legitimate interest have access to patient information. Family medicine may now be another exception because its conceptual framework abandons the old model of treating just the individual and employs a more advanced model of treating both the individual and the family. Using the argument that the treatment of a diseased individual really means treatment of the diseased family, traditional limitations on the scope of confidentiality need expansion. Critical information may necessarily have to be sought outside these limits for diagnostic purposes as well as successful treatment of family disease. At the initial visit, therefore, patients need to be informed that limited portions of confidential information may need to be shared with other members of the family, but that only information necessary and relevant to the treatment of the problem will be shared.