Medical confidentiality, as it has traditionally been understood by patients and doctors, no longer exists. This ancient medical principle, which has been included in every physician's oath and code of ethics since Hippocratic times, has become old, worn-out, and useless; it is a decrepit concept. Efforts to preserve it appear doomed to failure and often give rise to more problems than solutions. Psychiatrists have tacitly acknowledged the impossibility of ensuring the confidentiality of medical records by choosing to establish a separate, more secret record. The following case illustrates how the confidentiality principle is compromised systematically in the course of routine . . .