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01/23/2013

Diagnosing the Famous Non-Patient

Jennifer Chevinksy, B.S.

The Philippine Medical Association (PMA) has recently denounced the actions of neurologist Dr. Rustico Jimenez who publicly commented on the health status of boxer and politician, Manny Pacquiao. If Dr. Jimenez had evaluated Mr. Pacquiao as a patient, performing a history and physical exam, certainly it would be inappropriate for him to share any related findings with the public since that would be a breach of the duty of confidentiality. However, Dr. Jimenez is not Mr. Pacquiao’s physician nor has Dr. Jimenez met or examined Mr. Pacquiao. Dr. Jimenez stated that from observing Mr. Pacquiao from afar and from his professional knowledge that boxers are more likely to suffer from neurological disease, the politician-boxer may be experiencing early signs of Parkinson’s disease. Dr. Jimenez has asserted that there is no physician-patient relationship protecting confidentiality since he has no connection to Mr. Pacquiao and has never conducted any medical exams on him. Thus, he should not be held to PMA’s high standards of confidentiality.

In America, celebrities and politicians face similar privacy issues, as doctors and healthcare workers are asked to evaluate and conjecture on such matters in the public domain. Any list of tabloid magazines includes headlines suggesting diagnoses of various ailments plaguing figures in the media. Perusing these articles (as med students sometimes do when we have that rare free moment) reveals real physicians discussing possible diseases or syndromes based on symptoms seen from a far distance.  Although no practitioner-patient relationship has been established between these celebrities and the commenting physicians, there is a glaring risk of violating these individuals’ privacy.

When a patient walks into the doctor’s office, there is a certain amount of anonymity and confidentiality that can be appropriately expected. In most large hospitals or medical institutions in the United States, doctors are required to undergo HIPPA (Health Insurance Portability and Accountability Act, 1996) training to learn about the rules and regulations surrounding privacy and confidentiality. Doctors familiar with HIPPA are aware of the limitations of sharing protected health information in order to preserve patient privacy. Only under very specific circumstances, enumerated by the act, are healthcare professionals allowed to divulge medical information about one of their patients. Do the standards apply to all individuals that the physician “diagnoses” or only to those patients with whom the physician has a defined physician-patient relationship? In other words, is it wrong for doctors to speculate about celebrities’ health?

Even though it may not directly conflict with HIPPA or other principles of medical privacy, medical professionals should be careful not to partake in such commentary. There is a lot one can learn about an individual’s health status solely by observing. The way individuals talk can reveal signs of a stroke, the way individuals walk can reveal signs of Parkinson’s disease, and the way individuals breathe can reveal signs of emphysema. Using their honed expertise, medical professionals can suggest multiple plausible diagnoses without having conducted a full examination. The moment medical professionals are looking at an individual for signs of disease or illness, they are forming a pseudo “practitioner-patient” relationship, and thus should be respectful of the related implications. This is a “patient” that has not consented to being in such a role or to being examined through a medical lens. Furthermore, if a physician takes on such a role, even from afar, does that provider then assume a responsibility to help treat, or in the case of Mr. Pacquiai, advise him to stop boxing, since it poses a threat to his health?

Mr. Pacquiao was displeased that his privacy was violated, just the same as many celebrities whose health information has been debated publicly. Medical professionals should be conscious to preserve privacy even for individuals who are not technically their “patients.” The Philippine Medical Association should be commended for taking this matter seriously and discouraging future privacy violations.

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