There must be a bona fide “doctor-patient relationship” between individuals and a physician before any duty of confidentiality is created. Generally speaking, individuals must voluntarily seek advice or treatment from the doctor, and have an expectation that the communication will be held in confidence. This expectation of confidentiality does not need to be expressed. It is implied from the circumstances.

If individuals meet a doctor at a party, and in the course of “small-talk”conversation, they ask the doctor for an opinion regarding a medical question that relates to them, the doctor’s advice would most likely not be considered confidential, nor would the doctor be considered “the individuals doctor.” Likewise, if individuals send an e-mail to an “Ask the Doctor” website on the Internet, the communication would not be considered confidential, nor would the person who responded to the e-mail be considered he sender’s doctor. No doctor-patient relationship was established, and no duty is owed.

If individuals are examined by a physician at the request of a third party (such as an insurance company or their employer), no matter how thorough or extensive the examination, or how friendly the doctor, there is generally no physician-patient relationship and no duty of confidentiality is owed to the patients. This is because they did not seek the physician’s advice or treatment, and the relationship is at “arm’s-length.”

In many states, the privilege is limited to professional relationships between licensed doctors of medicine and their patients. Other states extend the privilege to chiropractors, psychologists, therapists, etc.