Am J Psychiatry 1996; 153:1250-1260
Copyright © 1996 by American Psychiatric Association
Confidentiality dilemmas in group psychotherapy with substance- dependent physicians
HB Roback, RF Moore, GJ Waterhouse and PR Martin
Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
OBJECTIVE: The purposes of this article are 1) to review federal and state
laws relevant to confidentiality in group therapy with impaired physicians
and 2) to provide empirical data concerning the actual confidentiality
practices and experiences of group therapists treating chemically impaired
physicians. METHOD: In the clinical research phase, 25 state medical
societies identified 45 rehabilitation centers as those to which the
societies preferentially referred chemically impaired physicians. Fifty-one
group leaders from 33 of these rehabilitation centers completed the survey
questionnaire employed in this project. RESULTS: Because of the risk of
potentially irreversible social and professional injury, physician patients
were exceedingly concerned about breaches of confidentiality. Co-members'
infractions most often involved the violator sharing with close friends and
family members the name and abuse history of a fellow physician. In
contrast, transgressors rarely leaked information about a co-member's drug-
related illegal behaviour. CONCLUSIONS: Chemically impaired physicians
would feel safer in sharing secrets in group therapy if more jurisdictions
adopted legislation making co-members liable for violating confidentiality.
Currently the pertinent body of law is confusing and inconsistent and
provides little protection to impaired physicians who enter group therapy.
The authors propose ideas for model legislation.
