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Asking this one for a friend located in the United States.

She's currently experiencing significant stress coming directly from her place of employment. All attempts to mediate this with her coworkers and boss have apparently failed and one of the benefits of her employment is a series of free optional visits to a psychiatrist hired by the company. She thinks this has the potential to help and might put her mind at ease until she can work out another place of employment.

I'm being told that, if she were to express herself openly and her grievances were to get back to management, she would almost surely be fired (and possible a couple other coworkers might get fired as well if she's taken seriously.)

Under normal circumstances I would cite standard doctor-patient confidentiality clauses that should at least guarantee nothing she says leaves the room and certainly doesn't get back to her boss. But I also know from experience, even from questions on this site, that confidentiality breaches happen all the time and don't tend to end well for the employee even if they're in the right.

Is it wise to trust psychiatrists employed by a business with business issues?

EDIT: I'm noticing there's some drift in the answers, so I'd like to clarify something: it's understood that it is illegal for the psychiatrist to lie about her confidentiality. That's known. What isn't known about this is how smart of a practical option this is.

As a trivial example, there are tons of questions about discovering fraud that would be trivial to answer if you assume that the laws will protect the employee. Based on the answers, that doesn't always work out.

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  • Are you in a occidental country ? Usually the doctor-patient confidentiality is really strict there, but this may be very different in others country.
    – Walfrat
    Dec 21, 2016 at 8:15
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    Is the psychiatrist an employee of the firm? Or is it simply an independent therapist that is paid by the company? That would alter the power dynamics considerably. An external therapist would be far more independent. However, he or she would also not be overly familiar with your friend's company.
    – Stephan Kolassa
    Dec 21, 2016 at 13:06
  • Given the comments and edit about not being able to trust the psychiatrist, it really looks like you're asking for justification to not trust them. I propose a bit of a compromise (which doesn't directly answer the question you're asking, that's why it's a comment): your friend could ask the psychiatrist to help them learn coping skills for stress without going into detail about what's causing the stress. Given the time of year, she could also use the holidays as an excuse to work on things like setting boundaries or asserting herself without even mentioning work if she didn't want to.
    – Mel Reams
    Dec 23, 2016 at 2:55

6 Answers 6

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Why are you asking us instead of she asking the psychiatrist point blank? "Are our conversations considered confidential and covered by the doctor-patient relationship? Will anything we discuss be reported back to my management?" The answer is either an unequivocal "yes" or an unequivocal "no" (*) and she takes it from there.

(*) And yes, the psychiatrist has to answer truthfully because not answering truthfully is at the minimum an actionable violation of professional ethics and it's a violation with extensive legal implications. References: Medical Privacy in the Workplace; American Psychological Association Note that the references are US-centric.

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  • @rath gnat explained why Caleb's answer is downvoted in comment; or at least why he did or considered downvoting, and I agree with that explanation. My answer is +3/-0 even though it also says "ask the doctor." I'm pretty clear that I believe but am not positive that this is protected and that this is what I personally would do, and I point out one associated risk. So far, this seems to be mildly striking the community as a constructive way to answer. (FTR I usually avoid DVing rival answers unless they have actively harmful advice, which these definitely don't.)
    – user42272
    Dec 21, 2016 at 15:47
  • Perhaps even visiting the company psychiatrist could raise red flags to management and the doctor in question wouldn't event have to breach confidentiality.
    – Zikato
    Dec 22, 2016 at 7:18
  • @Zikato - why don't you read the references I took the time and trouble to provide before you make another ignorant comment? From the second reference: "Will my employer know I saw a psychotherapist if I use my company's insurance? "Employers don't receive information about the health services an employee receives, even if he or she uses company insurance. (Cont)"
    – Vietnhi Phuvan
    Dec 22, 2016 at 7:56
  • "Some companies offer employee assistance programs (EAPs), which offer mental health services to employees. Usually, the company simply provides the service but doesn't receive information about how each employee uses it. However, if you have any questions about privacy and your organization's EAP, talk to a human resources representative for more details."
    – Vietnhi Phuvan
    Dec 22, 2016 at 7:56
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I believe the answer is yes, that the psychiatrist can be trusted and that this is legally enforced under doctor-patient confidentiality. I think the only exceptions a mental health professional makes are when one is in immediate danger of harming self or others or when ordered by a court (and I'm not sure what happens in the court situation. IANAL of course). I am U.S. based and can imagine this being locale specific.

My advice is to frankly ask this question to the psychiatrist, and I would expect the psychiatrist to provide a direct and honest answer that I would trust.

Note that the employee's use of the psychiatry section is likely, mostly, public (to management, for instance). I cannot speak as to how her manager will react if they are a malicious person with poor ethics or how to deal with that.

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There would be very little incentive for a psychological professional to violate patient confidentiality, risk getting sued for malpractice and lose his/her license to practice.

Most of the time, these professionals are contracted to the company through a third party and do not work exclusively for that company. They would have much business to lose from the publicity of a malpractice suit even if it eventually ruled in their favor (and it almost certainly would not be in the case of violating a patient's confidentiality).

So I would be fairly confident about this. However, if it is making the person nervous, then choose her own professional and let her health insurance pay for it or pay for it herself.

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There is no way to know unless you directly ask the psychiatrist. She is compelled to tell the truth by the Hippocratic Oath.

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    We're working on the assumption that the psychiatrist could lie, this doesn't really solve the original problem.
    – GGMG-he-him
    Dec 21, 2016 at 6:01
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    Except she couldn't lie about anything. Her lying to you is breaking her Hippocratic Oath and you can report her, and she will lose her license to practice.
    – Caleb
    Dec 21, 2016 at 6:03
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    without an explanation, this answer may become useless in case if someone else posts an opposite opinion. For example, if someone posts a claim like "There is no way to know even if you directly ask the psychiatrist. She is not compelled to tell the truth by the Hippocratic Oath. ", how would this answer help reader to pick of two opposing opinions? Consider editing it into a better shape, to meet How to Answer guidelines
    – gnat
    Dec 21, 2016 at 6:44
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    @gnat Fair point
    – rath
    Dec 21, 2016 at 10:24
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    So do I have to write a detailed description of the Hippocratic Oath? And then do I have to follow up with a detailed description of its origins because someone else could just write a BS answer that said the Hippocratic Oath is something else? And then I surely will have to give more detail on the causes that lead to the source of the Hippocratic Oath. Where does it end? My answer is self contained and sufficient.
    – Caleb
    Dec 21, 2016 at 16:46
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I believe we can take it as a given that any conversation she had as a patient would be covered under patient confidentiality regulations. I'm less sure of that reassuring your friend.

Your friend should instead ask herself what she has to say that would motivate the doctor to risk her career (and possible jail term for HIPPA viloations), in order to break that confidentiality.

She could certainly explore the doctor's relationship to the company and management--any relationship to management (spouse, sibling, same sports team, whatever), could possibly result in a deliberate or inadvertent disclosure.

But the idea that the company has an arrangement with the doctor in advance, to essentially use the doctor to spy on employees, is, uhm, unlikely.

Whatever she has to say probably isn't important enough for there to be a risk of deliberate disclosure.

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In such a situation, I would absolutely not trust someone who has ties to the company in question. While the psychiatrist's legal requirement to uphold confidentiality is true, if the psychiatrist violates it, there's no way to prove that. If managers at the company want to fire OP's friend, they can make up any sort of excuse to do so - they don't have to disclose that they received information from the psychiatrist.

I'm not trying to say all (or even many) psychiatrists would violate their oath / legal obligations but trusting the psychiatrist in this case is basically a gamble on one particular person's ethics who already has some ties to the company.

I'd personally look for a completely independent psychiatrist for help - this would, at least, lower the chance of details leaking back to the company.

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  • If management wanted to fire her, they can fire her with or without a reason since 49 of 50 of the states except for Montana implement employment-at-will. Management does not need to go through this psychiatry rigmarole to fire her. You are twisting yourself into knots and making complicated things out of straightforward stuff - I hate that.
    – Vietnhi Phuvan
    Dec 22, 2016 at 1:37
  • Psychiatrists have a very strong culture of upholding exactly those ethics. You don't have to bet on it if you don't want to, but it's a bit tinfoil hattish to worry about a corrupt company jumping through a needless hoop and working with a corrupt psychiatrist to no particular end, etc etc. Really, your life would be simpler if you took this risk and stopped eating raw cookie dough to cancel it out.
    – user42272
    Dec 22, 2016 at 4:14
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    @djechlin I don't question the ethics of any particular psychiatrist. I've seen instances of people getting fired because information got back to management through friends, etc. (Wasn't related to psychiatrists but some other company-provided service.) I think it's simply safe not to trust anything a company provides.
    – xxbbcc
    Dec 22, 2016 at 18:53
  • It's simply safe to trust a psychiatrist as well.
    – user42272
    Dec 22, 2016 at 19:28

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