Legal aspects of medical confidentiality in the occupational setting.

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.