Protecting patient confidentiality: What physicians can—and can’t—share with caregivers

By Naveed Saleh, MD, MS | Fact-checked by Jessica Wrubel
Published November 2, 2022

Key Takeaways

  • Physicians can share medical information with a caregiver when the patient agrees.

  • Agreement to share medical information can be tacit, but it is best to elicit explicit permission from the patient in private (ie, away from the caregiver).

  • It’s important to provide only as much information as is medically necessary to a caregiver.

Caregivers serve in various capacities, and depending on their status, can have full legal access to patient information.

There are, however, caregivers who have no special designations, privileges, or permissions. In these situations, it’s up to the physician what information is shared—and with whom.

Working with family and friends

Caregivers designated as personal representatives have the authority to act on the patient's behalf via healthcare advance directives, surrogate decision-making laws, and guardianship laws, according to A National Academies of Sciences, Engineering, and Medicine publication titled Families Caring for an Aging America.[]

A caregiver can also become privy to the patient’s healthcare information through HIPAA authorization. With this in place, the patient can determine what information is to be disclosed—and to whom.

Disclosure of patient information can fall under the nebulous category of “family and friends.” In these situations, the caregiver can hear patient information if the patient agrees to disclose it.

Either the patient is in the room and doesn’t object, or the caregiver is discussing the care without the patient present at the physician’s discretion. In the latter situation, the physician decides which information is shared with family, friends, or others based on their professional judgment.

If the person is not a friend or family member, the physician must be sure that the caregiver is involved in the patient’s care or payment. The healthcare professional (HCP) can only disclose information that is necessary for the patient’s care or payment, according to the US Department of Health and Human Services (HHS).[]

Examples of third-party disclosure include a surgeon providing guidance to a caregiver after surgery or a physician discussing dosages with a patient’s health aide, per the HHS.

When a friend, family member, or caregiver is on the phone with the physician, the doctor doesn’t need to see proof of their relationship when discussing care.

On a related note, a pharmacist can dispense medications on behalf of a patient to a caregiver.

What can be shared

The National Academies of Sciences, Engineering, and Medicine's Families Caring for an Aging America publication discussed the amount of information that can be disclosed to family, friends, and caregivers.

“How much information is shared is also a matter of professional judgment, based on the circumstances, but is to be limited to just the information that the person involved needs to know about the person's care or payment,” the authors wrote.

"When someone other than a friend or family member is involved, the health care provider must be reasonably sure that the person asked that individual to be involved in his or her care or payment for care."

National Academies of Sciences, Engineering, and Medicine

Advice on sharing

The Arizona Center on Aging offers tips to physicians regarding caregiver communication. First, it’s important to ask the patient in private (or away from the caregiver) who has permission to hear their medical information.[]

If a caregiver is named, they should receive only the information they need to know regarding legal status, treatments, or health history, according to the Arizona Center on Aging.

Keep in mind that permission from the patient need not be documented in the chart, although the HCP can take this step if they wish.

Tacit permission is given when an alert, awake, oriented patient doesn’t object to having another person in the room during information sharing. Nevertheless, explicit permission given in a private setting is best.

What this means for you

Caregivers play an important role in patient care and need a patient’s health information to help facilitate their treatment plans. Physicians can share information when the patient consents. It’s best to provide only as much information as necessary when speaking with caregivers and other family or friends who are involved in the patient’s care.

Read Next: Working with patients' families and caregivers
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