Patient Privacy & Outside Observers to the Clinical Encounter

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Individuals legitimately present during patient-physician encounters include those directly involved in the patient’s care, and can include other members of the health care team or employees of pharmaceutical or medical device companies when they are present to provide technical assistance, in keeping with ethics guidance.

When individuals who are not involved in providing care seek to observe patient-physician encounters, e.g., for educational purposes, physicians should safeguard patient privacy by permitting such observers to be present during a clinical encounter only when:

The patient has explicitly agreed to the presence of the observer(s). Outside observers should not be permitted when the patient lacks decision-making capacity, except in rare circumstances and with the consent of the parent, legal guardian, or authorized decision maker.
The presence of the observer will not compromise care.
The observer understands and has agreed to adhere to standards of medical privacy and confidentiality.
Under no circumstances should physicians accept payment from outside observers to allow those observers to be present during a clinical encounter.

AMA Principles of Medical Ethics: I, IV, VIII

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Opinion 3.1.1

Privacy in Health Care

Respecting patient privacy is a fundamental expression of respect for patient autonomy and a prerequisite for trust. Patient privacy includes personal space (physical privacy), personal data (informational privacy), personal choices, including cultural and religious affiliations (decisional privacy), and personal relationships with family members and other intimates (associational privacy). Physicians must seek to protect patient privacy in all settings to the greatest extent possible.

Opinion 3.1.3

Audio or Visual Recording Patients for Education in Health Care

Audio or visual recording of patients can be a valuable tool for educating health care professionals, but physicians must balance educational goals with patient privacy and confidentiality. Physicians also have an obligation to ensure that content is accurate and complete and that the process and product of recording uphold standards of professional conduct.

Opinion 3.1.4

Audio or Visual Recording of Patients for Public Education

Audio or visual recording of patient care for public broadcast is one way to help educate the public. However, physicians have an obligation to protect patient interests and ensure that professional standards are upheld. Physicians also have a responsibility to ensure that information conveyed to the public is complete and accurate.

Opinion 3.2.1

Confidentiality

Physicians have an ethical obligation to preserve the confidentiality of information gathered in association with the care of the patient. With rare exceptions, patients are entitled to decide whether and to whom their personal health information is disclosed.

Opinion 3.2.4

Access to Medical Records by Data Collection Companies

Information gathered and recorded in association with the care of a patient is confidential. Disclosing information to third parties for commercial purposes without consent undermines trust, violates principles of informed consent and confidentiality, and may harm the integrity of the patient-physician relationship.