How Much Privacy do Health Care Providers and Health Care Leaders Deserve?

In today's Wall Street Journal, Harvey Silvergate takes on the SEC on the thorny issue of privacy regarding the health of Apple Corporation's Steve Jobs. The SEC Should Leave Steve Jobs Alone explores whether the right of investors to know and evaluate "material" information about company management trumps SJ's right to protect and manage his own heath information. Silvergate asks us to ponder whether withholding detailed information about a corporate principal's health constitutes a prosecutable fraud?

As health care leaders, we face the same dilemma in the context of both professionals and executives responsible for the well being of patients and health care operations in their trust. In the case of physicians, state licensing boards and hospital credentialing committees have struggled with creating a relatively bright line regarding suitability to practice even in the face of fairly profound "impairment" due to drug/alcohol dependency or major mental illness. Let alone making details regarding such information available to patients who might be in their care. Most of these serious health problems only come to institutional and/or licensure board awareness after complaints have been made by peers or patients. They are not voluntarily and preemptively disclosed.

In the case of hospital senior executives, program directors, nurses, ancillary therapists, or service area managers - who may deliver or oversee processes for the organization or delivery of care to thousands of patients - even fewer formalized methods of oversight exist. And disclosure of such health information in order to guide patients in deciding how much trust to place in an institution is unthinkable and considered an invasion of privacy.

Silvergate pragmatically concludes that "the notion that investors [are] entitled to every detail, when they [know] the CEO's health history and [see] his obvious weight loss, is ludicrous." Is it? And for investors, only money is at stake. What about patients whose health and lives may be at stake? Is it ethical to permit patients to choose doctors and health care facilities without knowledge of the potential personal health distractions and impairments of those responsible for safeguarding the environment? Could such information actually help inform patient choice? Is it conscionable to ask health care professionals to make such disclosures? And if so, how much, how often, and how publicly?