Confidentiality, Student Records, and Mandatory Reporting

Reader’s Question

I am a medical student, and I have a concern about seeking some counseling therapy. My school offers counselors for us, so my concern is the confidentiality of the sessions. In other words, if someone goes in and talks about their depression or talks about their personality traits, etc. and then the therpaist decides to tell someone at the med school that they shouldn’t be practicing medicine (becasue the patient is very ill, distressed, etc.). Do you know if this could happen? What are the “rules” so to speak, about keeping medical student information confidential? What are the grounds for reporting something?

Our Consulting Clinical Psychologist’s Reply

Every country has different guidelines regarding confidentiality, release of information, and mandatory reporting. In most countries, a therapist can violate confidentiality under the following circumstances:

• Patient is a danger to self and/or others (suicidal or homicidal). This applies if the patient has made a significant threat to harm others — called “duty to warn”.
• Patient has reported a situation involving child abuse.
• Patient reports or is suspected of elder abuse.

Some areas of the USA include other options such as

1. Danger to national security
2. Danger to personal property
3. Witness to physical violence in home/family
4. If the patient has been charged with a crime and is under investigation

Some professions have additional mandatory reporting requirements. Physicians may be required to report driving impairment to the Dept of Motor Vehicles to remove driving privileges from an individual clinically judged to be incompetent to drive safely.

In your situation however, your counselor should not report information about your reasonse for counseling unless one or more of the above situations are present. If you have a good therapist, however, they should address any issues that might impair your ability to practice medicine and/or participate in your education.

When counseling services are offered by a university, access to counseling records, diagnosis, and client information should be separate from university records. Your professors should not have access to your treatment history or related information.

If you want to ensure confidentiality, you may want to seek a counselor outside the university.