Confidentiality of medical records in pediatric cancer care. Myths, perceptions, and reality.

Confidentiality is a complex requirement and impossible to enforce within the scientific-medical setting. Legal constraints include a patchwork of federal, state, and local laws and regulations. The setting of the teaching hospital brings its own multifaceted breaches in confidentiality. Insurance and third party payment claims necessitate opening of the patient's records. But research medicine in particular broadly disseminates large amounts of detailed information about patients, creating a situation in which it is not possible to avoid revealing the patient's identity. A distinction must be made between the breach of confidentiality in connection with dissemination of the label of the diagnosis, and breach of confidentiality in relation to details of care and clinical investigation. The problem in relation to confidentiality of diagnosis is intimately entwined with the patient's self-concept. The problem in connection with details of care and clinical investigation is the consequence of the antipathy between the physician-scientist-investigator and the physician-healer-priest. These two roles are not truly compatible and, therefore, the problem of confidentiality could be greatly alleviated if the records for those two separate roles (clinical investigator and personal physician) were kept separately.