people involved in providing medical care to an individual has been more than paralleled by the growing number of those involved in paying for that care. The payment trails from office and hospital practice through insurance company and employer all make extensive use of information technologies.


Privacy has been a part of medical practice since the 4th century B.C. The classical version of the Hippocratic oath for physicians states, “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.”1

It is not surprising that medical practice requires privacy. The patient is the source of much of the information that relates to his or her health, and if the physician (or more generally, the caregiver) is to obtain the information needed to make good medical decisions about the patient, the patient must be persuaded to provide it. Put differently, patient candor is an essential element of health care and depends heavily on the patient’s confidence that the information provided will indeed be kept private. Patient cooperation is also needed for laboratory testing and analysis and for treatment, particularly when treatment is ongoing.

From the patient’s perspective, medical information is often the most privacy-sensitive personal information that they provide. For these reasons, protecting medical privacy has long been recognized as an essential element of any regulatory system in health care.

As a point of departure, consider the issue of privacy as it relates to certain medical issues. Using the anchoring vignette approach described in Section 2.4 (see Box 2.2), a possible survey question might be, To what degree does [your/ “Name’s”] doctor respect [your/his/her] privacy? Here are a number of possible vignettes:

  1. [Renée] is ill and goes to the hospital to consult with the doctor. After she steps into the consultation room, the doctor closes the door and tells her that everything she says is confidential.

  2. [Alioune] is ill and goes to the hospital to consult with the doctor. While he is in the consultation room, a nurse opens the door several times


The modern version reads as follows: “I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.” For both versions, see

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