MMI confidentiality questions and privacy scenarios

Patients tell physicians what they tell nobody else, and MMI confidentiality questions test the duty that makes that possible, using a sister, a coworker or a friend in place of a patient. Each scenario hands you information in confidence and then introduces someone with a reason to want it. Your answer has to say whether they get it, how much, and what you tell the person it belongs to.

What these questions test

Confidentiality is the duty to keep what a person shares with you from anyone they haven't agreed to share it with. Raters score whether you treat that duty as strong but not absolute and whether you can name the limit that would justify breaking it. In medicine the limits are set by law and professional codes. In many places they include a serious risk of harm to the person or to someone else, certain infectious diseases and suspected abuse of a child.

How to approach them

1. Say whose information it is and in what role you received it. A friend's secret, a coworker's diagnosis and a layoff list seen at work each carry a different duty, and the role sets how much you can do with it.
2. Test the limit. Ask whether anyone faces a serious risk of harm, whether a law or a policy requires disclosure, and whether the person would consent if asked. A 17-year-old sister seeing a boyfriend your parents have banned isn't at serious risk, and a tutoring student skipping sessions to stay out of a tense home may be.
3. Decline before you lie. When an employer or a parent asks you directly, you can refuse to discuss it and tell the person who confided that you've been asked. A falsehood told to protect them makes you a participant in the deception.
4. Share the least with the fewest. Where the limit is reached, tell the one person who can act, give only what they need, and where it's safe, give the person it belongs to the chance to disclose it themselves first.
5. Decide your breaking point before the MMI follow-ups arrive, because the interviewer will make a sister's boyfriend older or a coworker's illness worse to find where you'd break the confidence. For a privacy policy prompt, name the people who never consented. In the question on police searching ancestry DNA databases, the cousins of the person who mailed a sample never agreed to a search, so weigh their privacy against the murders solved.

Common mistakes

• Treating confidentiality as absolute leaves you unable to act when the person or someone else is in danger.
• Breaking a confidence at the first moment it becomes awkward tells the rater you'd do the same with a patient's record.
• Lying to the person who asked, instead of declining to answer, turns a kept confidence into a deception you own.
• Forgetting to go back to the person who confided in you leaves them to learn what you did from someone else.