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Disease Control and the Physician-Patient Relationship

Basic to all public health is the reporting of communicable diseases and hazardous conditions to the public health officer. This information is used for tracking the course of epidemics and for intervening to protect the public health.

Reporting duties transcend the patient's right of privacy and the physician's obligation to protect the patient's confidential information. For some diseases, physicians are required to report only the number of cases they see. Other diseases and conditions require physicians to provide identifying information, such as name, address, occupation, or birth date of the patient, as well as information on the disease. For many diseases, the health department will contact the affected person and obtain information about additional persons who may have been exposed to the disease.

CDC in Atlanta, Georgia, is the federal agency responsible for accepting disease reports and participating in national and international disease control efforts. It is the U.S. agency that participates in the World Health Organization and the Pan American Health Organization. CDC maintains many disease-specific programs, such as venereal disease control and tuberculosis control. It also stocks and distributes specialty drugs and biologicals either because these are not approved for distribution in the United States or because the need is limited. CDC maintains the Epidemic Investigation Service, which may be called in by a local health authority to assist with a difficult disease problem. Except for a few specific programs, the CDC does not accept disease reports directly. The programs work through state and territorial health departments.

All jurisdictions in the United States have laws that require the reporting of certain diseases to a local or state health officer.[121] The laws differ on which diseases are reportable, who must report, how the reports are made, and who accepts the reports, but the substance of the law changes little. Reportable conditions are infectious diseases or toxic exposures that endanger the community. All states require that physicians report these diseases and conditions, and many extend this requirement to include nurses, dentists, veterinarians, laboratories, school officials, administrators of institutions, and police officials. Failure to report a reportable disease may constitute a criminal offense, and it creates civil liability if someone is hurt by it. Required reporting is exempt from confidentiality limitations and physician-patient privilege. The patient's right of privacy gives way to the societal need to prevent the spread of disease. Physicians must not abuse this privilege and unnecessarily divulge a patient's medical information. (See Chapter 8.)

[121]Chorba TL; Berkelman RL; Safford SK; Gibbs NP; Hull HF: Mandatory reporting of infectious diseases by clinicians. JAMA 1989; 262:3018-26.


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