When practicing becomes policing: Physicians balance patient privacy with society's right to know

Doctors worry that laws requiring them to report issues from underage sex to poor driving may keep patients from seeking care.

By Damon Adams, AMNews staff. March 26, 2007.

Some physicians liken it to swapping a stethoscope for a badge. Increasingly, doctors are being called on to serve a policing role by screening their patients for society's ills. Laws have long required health professionals to report injuries from weapons and child abuse, but in recent years doctors have been asked to extend that reach to other areas.

Six states require physicians to report patients who may be unfit to drive, such as seniors hindered by illness. And although unsuccessful after public outcry, federal lawmakers tried to get doctors to notify authorities if they treated illegal immigrants.

Physician organizations have responded by giving doctors guidance on how to detect and report problems such as domestic abuse and unfit drivers, at the same time informing them about their ethical obligations and patient confidentiality. While there is overwhelming support for reporting child abuse, physicians are less comfortable turning in patients who might lose their driver's licenses due to medical conditions, and they oppose efforts to document immigrants who come for treatment.

Some physicians fear the demands on them to diagnose and report society's problems will only continue to increase.

"It's been evolving at a rate more than I would have liked over the past 10 years," said Sheldon Zinberg, MD, a California gastroenterologist. "It puts the physician in the policeman's uniform."

Each state has laws that require reporting of child abuse, including sexual abuse, according to the American Academy of Family Physicians. Most states have toll-free telephone numbers for receiving abuse reports, according to the Child Welfare Information Gateway, a national service that promotes child safety. Through mid-2003, 46 states had enacted laws specifying penalties for mandated reporters, including doctors, who fail to notify authorities of child abuse or neglect.