Torn between Patient Confidentiality and the “Right” Thing

Post from DSN User:

“Any thoughts…

I have a patient that I have been treating the past few years and she’s now 19 years old freshman in college. Yesterday she presented for treatment with fractured crowns number 8, 9 ,24 25. When I asked her what happened, she said this was confidential between myself and her that she was involved in an altercation with a boyfriend who punched her and broke those four front Teeth. Now her parents do not know about this / she told them some story about what happened. I really wanted to let mom know who brought her but that would be a HIPPA violation! I’m wondering if I should report this case as abuse? I gave her a number to call for battered women. I was just curious to see what folks think about this situation. How would you handle it? Thank you.”


What is one to do when reporting abuse can be a HIPPA violation but you fear for this patient’s safety and would want nothing more than to protect them? Do you stick to your morals and report the abuse and just apologize for breaking the law later? Or do you keep quiet because this patient trusted you enough to confide in you and you wouldn’t want to break that trust? This is one of those lose-lose situations. The kind of situation that leaves you with a pit in your stomach even after you’ve made your decision.

Luckily for this DSN User he is able to reach out and seek advice. He doesn’t have to dwell on the choice on his own. He’s apart of a Safe Place where everything is kept confidential. Here is what other DSN Users had to say in regards to this lamentable situation:




  • “I’d report it. She could have told you any story to move along the apt but she chose to mention the abuse. It means she trusts you a lot which is great. it’s definitely a hard decision either way.”
  • “What if this was your daughter? What if next time instead of breaking a few crowns he kills her? I would make a decision based on these questions. Could you live with your decision to report, or not to report?”
  • “She’s an adult and you don’t report domestic violence. If she was 17 that’s a different story. Telling her parents would be breaking her trust. If this is a serious domestic abuse case he could kill her if word got out in the wrong way. All you can do is ask her if she would like to report it and if she wants your help to do so. This is coming from my wife, a counselor, and sadly deals with this stuff all the time up in AK. Not to mention you would be breaking HIPPA laws.”
  • “I’d have a heart-to-heart with her and encourage her to report it to the police.”
  • Heartbreaking.. As a father of 2 precious daughters, my heart goes with Dr. George Sanchez. I would NEVER forgive someone for withholding such information. Unfortunately, I think Dr. Derek Green is correct regarding the law. Ask a cop friend, attorney friend for state specific law regarding this. Ask her to sign a HIPPA release “so her parents can pay for it”. IDK, worth a shot at staying legal. My least favorite good idea is an anonymous point blank letter to the parents (postmarked far away from your office, best if from her college town). I answer to the Good Lord and assume He will forgive me for breaking this law.”



As many of the DSN User’s have stated, ‘It’s a hard decision, regardless’, but it’s a decision that has to be made. Some users suggested reporting the abuse himself while other suggested encouraging the young girl to report it herself so that no laws are being broken. There are many elements to take into account when making such an impactful decision. Are there laws that will be violated if reported? Can you live with yourself if you don’t report it? Is it worth breaking the trust of your patient? Could it cause more harm in the long haul? What would you do?


But being apart of a community where you can weigh your options with others is valuable. If you’re looking for more actionable information like this, join DSN!