Psychiatrist Questions Medical Ethics

Privacy and confidentiality with caregivers

I am a caregiver for a man in his older 50s with early-onset Alzheimer's. He will be seeing a psychiatrist soon. How much will I be able to know about this in terms of privacy and confidentiality? Will I be consulted in terms of any potential care measures?

21 Answers

It depends If you are considered patient's next of kin or you have power of attorney.
wWait until complete neuro-psychiatric evaluation
If he or his conservator signs permission
This will be best addressed if he is willing and able (competent) to give a power of attorney for medical decisions to you. You may want to discuss this with family and seek legal counsel. His psychiatrist may also be able to assist with the discussion. Good luck.
I'm sorry to hear about his diagnosis. Privacy and confidentiality should be approached the same way, however, as with any other patient. Just because he's been diagnosed with AD does not automatically render him incapable of informed decision-making, and he retains privilege with respect to his medical records and information. An adult of statutory age is presumed to be competent unless ruled otherwise by a judge. You can still participate in the treatment process, however, with his permission, and you can always communicate any concerns to his treating provider(s). I have found that most patients in this type of situation are comfortable and even prefer their caregiver's presence while being evaluated or treated.
If he has early onset of alzheimer's disease he may be able to give you permision to talk with the psychiatrist to obtain advice about your caregiving role.You may also want to obtain verbal or written permission from an involved,close family member.If you obtain permission ,encourage that person or persons to communicate that permission to the psychiatrist so he or she knows that permission has been granted and that the psychiatrist can share advice with you. Best of luck. Dr.L
This is going to depend on Which State or Province you live in. It will also depend on your relationship to the client and whether he has capacity or not and if he does, whether he consents to you knowing the content of discussions with the Physician. I would always ask if I can talk to a family member or appointed agent to get collateral information and provide feedback.

A rigid attitude toward confidentiality can prevent optimal care.
Unfortunately some psychiatrists adopt this practice. A call to this
psychiatrist expressing your desire to co-ordinate cares would reveal the
degree to which this may be possible.
Generally a patient can sign a release of information allowing the psychiatrist to discuss care and recommendations with a family member, other healthcare provider or caregiver. This case is more complicated because the gentleman you are taking care of may not have the cognitive capacity to provide consent.

If the gentleman you are caring for has a medical power of attorney, this individual would be able to facilitate communication needed between you and the psychiatrist by providing permission for the patient.

I hope this is helpful.

Doris C. Gundersen MD PC
You will need to inform the psychiatrist about the diagnosis, and request the ability to speak with him/her. If the patient can sign a release of information for the doctor to talk to you, that would be ideal.
If you are the primary caregiver, the psychiatrist will probably make sure you understand and agree to the confidentiality terms. You will be given instructions regarding his care including giving his medications and what you need to do in an emergency. You may have specific questions that you want to ask.
You will be able to request information about this patient's psychiatric
treatment plan by having the patient provide you with a written release of
information. The psychiatrist will also request release of information from
the patient so you will be able to communicate and collaborate with each
other. This would be the most comprehensive way to treat this patient.
Please let me know if you have additional questions.
Generally the clinician will ask the caregiver for information but not give
away any information unless the patient or guardian gives permission to
share things with the caregiver.

Be well,

Aron Tendler, MD, C.BSM
Diplomate of the American Board of Psychiatry and Neurology
General Psychiatry & Sleep Medicine

Advanced Mental Health Care Inc.
The patient decides if he/she is competent
If the patient is incompetent the Dr has no choice but to communicate with caregiver
IT's more of legal question than a psychiatric one. Get written
persmission to speak with the Doctors.
A psychiatrist has a confidential relationship with their patient. They may not be able to tell you much about the patient. If you can arrange a joint appointment with the patient's agreement, you might learn more. Doctors who are willing to listen can be given any observations or opinions that you wish to impart - this can be very helpful to the doctor. The doctor should be interested in hearing from anyone who is concerned about the patient.
The psychiatrist's office will likely require the patient to sign a verbal release of information for you to be present during the visit and involved in the patient's care. If the patient is unwilling to sign a release or unwilling to have you involved in his treatment, the psychiatrist must comply with these wishes. If there are mitigating circumstances such as safety issues, concern for poor self care, concern that the patient may not be able to make decisions in his own best interest, then the psychiatrist may recommend that you attempt to obtain legal guardianship for the patient. This is a determination made by the court. If you have legal guardianship, then you will be directly involved in treatment decisions and provide informed consent for the patient.
His family should communicate to you about possible suggestions set forth in a visit regarding his care or if you are present for the visit with him, you can be asked about his activities and etc.

Thanks so much for your question. If your patient has given written consent to the physician to release information to you, then you can receive the information. Also, if the patient's family has legal authority to give consent for release of information, then this would work as well. Please let me know if this answers your question or if you have any further concerns. Please have a good day.

Let me ask you a question about what kind of a caregiver are you? Certified, licensed or lay.
Discussion with the psychiatrist and with the patient is called for. A mutually agreed upon posture may be arrived at. Issues like the nature of your caregiver status (family or not), family concurrence, if you are not and state laws need to be considered. If property disposal and/or a will are at issue, legal consultation may be necessary.