Duty to warn: when should confidentiality be breached?

Family physicians may be confronted with the dilemma of when to breach a patient's confidentiality to warn an intended victim of specific threats of harm. The courts have consistently ruled that persons who have a therapeutic relationship with patients have a duty to protect society from specified and foreseeable danger, yet at the same time to act judiciously in guarding against unnecessarily violating a patient's confidentiality. The dilemma imposed by this dual obligation is illustrated by a case report. Guidelines for assessing dangerousness and determining a course of action are offered so physicians can respond to their patient's threats of violence.