Schaler, J.A. (1997, November 16). Medical Security Risks.
The Washington Post, Letters to the Editor, p. C6

Absolute medical privacy is unlikely as long as third parties are involved in doctor-patient relationships ["Pursuing Medical Privacy," editorial, Nov. 3]. However, with its primary focus on electronic leaks, The Post -- as well as the Senate Labor and Human Resources Committee and Health and Human Services Secretary Donna Shalala -- seems to overlook a gaping hole in record security: secretaries and similar office personnel in private psychotherapy practices and substance-abuse treatment clinics.

The public should know that people holding such positions often are temporary employees. They have complete access to the most intimate details of client diagnosis and treatment. They handle telephone calls, type medical records, make insurance claims, etc. They take no Hippocratic oath or any equivalent, nor are they bound by any professional code of ethics. The worst that can happen to them is that they move on to another similar job.

The only way to ensure complete confidentiality, at least insofar as psychotherapy and substance-abuse clinics are concerned, is for clients to engage in a strictly contractual relationship with the provider. This means paying out of pocket for services and involving no third party whatsoever. If psychotherapists and the like have to drop their prices in order to survive, so be it. Clients also should make clear that they will hold their therapists responsible for any breach in security.

JEFFREY A. SCHALER
Silver Spring