Annas G J
J Occup Med. 1976 Aug;18(8):537-40. doi: 10.1097/00043764-197608000-00006.
The law of confidentiality of medical information in the occupational setting is undeveloped and subject to change. Nevertheless, when a physician-patient relationship is established, all of the traditional trappings, including the duty to maintain confidences, go along with it. In other settings, such as preemployment physicals, examinees implicitly consent for their "fitness' for the job to be disclosed, but do not assume that specific findings will be disclosed without their informed and written consent. To promote physician automony and worker confidence in the occupational physician, an explicit policy of confidentiality should be developed and agreed to by both management and workers. This policy should spell out the conditions under which specific information will be made available to the employer and should guarantee the confidentiality of all other medical information. Workers should also be given routine access to their medical files, and offered the chance to refute and have amended information in them that they can demonstrate is inaccurate. In short, workers in the occupational setting should, in general, be treated like private patients. Such a policy will satisfy both the law and the ethical standards of physicians, and will promote worker trust in the occupational physician.
职业环境中医疗信息保密法尚不完善且可能会发生变化。然而，一旦建立医患关系，所有传统的相关要求，包括保密义务，都会随之而来。在其他情况下，如入职前体检，受检者默示同意披露其工作“适应性”情况，但不要认为未经其知情且书面同意就会披露具体检查结果。为了增强医生的自主性以及员工对职业医生的信任，应制定一项明确的保密政策，并由管理层和员工共同认可。该政策应详细说明在何种情况下会向雇主提供特定信息，并应保证所有其他医疗信息的保密性。还应让员工能够定期查阅自己的医疗档案，并有机会反驳和修改其中他们能证明不准确的信息。简而言之，职业环境中的员工总体上应被当作普通患者来对待。这样的政策将既符合法律要求，又符合医生的道德标准，还能增进员工对职业医生的信任。
