Emergency physicians have a duty to protect patient confidentiality, within the constraints of the law. It is an ethical and legal duty and serves to maintain patient trust and protects patients’ relationships, employment, and personal desire for confidentiality of medical information. There are specific circumstances where confidentiality should appropriately be breached, including judicial proceedings, public reporting statutes, and in cases where patients or other parties are endangered. Emergency physicians should avoid using social media for posting patient information, including de-identified images and comments. Transmission of patient information may be performed over secure electronic servers, for the purposes of patient treatment, with the patient’s consent. Protected health information may be appropriately used for educational purposes.