Confidentiality

[Bub]

I recently spoke with a dialysis nurse about what I considered extremely confidential.  Before speaking I had her reassure me that she was professionally bound to confidentiality.  Saturday while speaking with a nurse practitioner at my center, he said something that left no doubt in my mind that she had repeated what I had said. Looking back now, I realize that it was not really that big of a deal, but my question is, "Are center employees bound by medical confidentiality rules, and do those rules apply equally to other staff at the center as opposed to Joe Blow walking down the street?" Perhaps our resident dialysis nurse who joined just recently could enlighten?

[paul.karen]

Good question.
I know that is standard for doctors not sure about nurses.  But even if it doesn't stand for nurses you asked her not to repeat it.  So at least you know one person not to confide in.

[willowtreewren]

I agree with Paul.

You told this nurse that what you were sharing was confidential, so it should not have been shared.

Having said that, though, is it possible that this confidentiality included something about your medical situation that might have put the nurse in a position of having to choose between your request for confidentiality and getting the best treatment for you?

I would love to hear more from medical proefessionals regarding this.
Aleta

[kellyt]

I'm not sure how the confidentiality law works within a health facility.  Good question.  I have worked for doctors my entire adult life and they discuss patients and their care with nurses (obviously), other physicians (sometimes out of office physicians), with billing staff (when it is related to their billing, etc.).  So the information does get passed on.  However, I would just assume that was okay.  Now, the doctor's I have worked for would NEVER give patient information to media, people outside the office i.e. friends, family members, coworkers of the patient, etc.

I really don't know the full law about confidentiality.  You might want to ask the person you told and find out what their reason was.  Maybe it was told in relation to helping you in some way or bettering the service provided at the clinic.    I really don't know.  If she never gave your name or gave any indication it could be YOU, then maybe she did protect your confidentiality.  Again, I don't know.  Doctors discuss patient "cases" all the time in meetings, discussion groups, etc. without ever revealing who the patient is or could be.

I'm sorry if you feel violated by this employee.  That's hard to deal with.  Good Luck.  Let us know what happens.   

[monrein]

It seems to me that a nurse might feel it necessary to share certain information with other members of your medical team and in fact some information probably ought to be shared if there could be medical consequences.  However, I feel that the nurse you confided in ought to have told you that she would have to share this information with others if that were the case.  You should really never be left feeling that your confidence has been betrayed and I would ask her about her definition of confidentiality.

When I worked as a family therapist, I would be very careful to go over with new clients what was meant by confidentiality, what the limits to it were, which types of things could never be kept strictly between us and so on.  I worked with a team and presented my cases to the team at regular intervals.  Clients could meet the team if they wished (they never really did) and I sometimes asked them if they had any general or specific questions for the team.  On occasion I was required by law to call the Child Services authorities (situations involving various forms of abuse) but would never do so behind clients backs so to speak.  I would give them the first opportunity to call themselves with my support if they wished, although I usually had to do it. 

If these issues aren't very clearly defined and understood, the possibility of establishing meaningful trust is limited at best.  The absolutely worst feeling for any client or patient, it seems to me, would be to feel that one is the subject of any kind of gossip.   That nurse ought to have told you she was going to reveal what you said to someone else, ideally BEFORE she did it but even afterwards would have been more respectful than you discovering it by accident.

[kellyt]

I think the word "gossip" is the key.  If what was repeated by the nurse was done as "gossip" that is unacceptable in any form.

Monrein, great information as always.   

[MandaMe1986]

Why is the HIPAA Privacy Rule needed?
Answer:
In enacting HIPAA, Congress mandated the establishment of Federal standards for the privacy of individually identifiable health information. When it comes to personal information that moves across hospitals, doctors’ offices, insurers or third party payers, and State lines, our country has relied on a patchwork of Federal and State laws. Under the patchwork of laws existing prior to adoption of HIPAA and the Privacy Rule, personal health information could be distributed—without either notice or authorization—for reasons that had nothing to do with a patient's medical treatment or health care reimbursement. For example, unless otherwise forbidden by State or local law, without the Privacy Rule patient information held by a health plan could, without the patient’s permission, be passed on to a lender who could then deny the patient's application for a home mortgage or a credit card, or to an employer who could use it in personnel decisions. The Privacy Rule establishes a Federal floor of safeguards to protect the confidentiality of medical information. State laws which provide stronger privacy protections will continue to apply over and above the new Federal privacy standards.

Health care providers have a strong tradition of safeguarding private health information. However, in today’s world, the old system of paper records in locked filing cabinets is not enough. With information broadly held and transmitted electronically, the Rule provides clear standards for the protection of personal health information.

For more detailed information about health privacy, you may want to visit our Medical Privacy: National Standards to Protect the Privacy of Personal Health Information site.



Generally, what does the HIPAA Privacy Rule require the average provider or health plan to do?
Answer:
 For the average health care provider or health plan, the Privacy Rule requires activities, such as:

Notifying patients about their privacy rights and how their information can be used.
Adopting and implementing privacy procedures for its practice, hospital, or plan.
Training employees so that they understand the privacy procedures.
Designating an individual to be responsible for seeing that the privacy procedures are adopted and followed.
Securing patient records containing individually identifiable health information so that they are not readily available to those who do not need them.
Responsible health care providers and businesses already take many of the kinds of steps required by the Rule to protect patients’ privacy. Covered entities of all types and sizes are required to comply with the Privacy Rule. To ease the burden of complying with the new requirements, the Privacy Rule gives needed flexibility for providers and plans to create their own privacy procedures, tailored to fit their size and needs. The scalability of the Rule provides a more efficient and appropriate means of safeguarding protected health information than would any single standard. For example,

The privacy official at a small physician practice may be the office manager, who will have other non-privacy related duties; the privacy official at a large health plan may be a full-time position, and may have the regular support and advice of a privacy staff or board.
The training requirement may be satisfied by a small physician practice’s providing each new member of the workforce with a copy of its privacy policies and documenting that new members have reviewed the policies; whereas a large health plan may provide training through live instruction, video presentations, or interactive software programs.
The policies and procedures of small providers may be more limited under the Rule than those of a large hospital or health plan, based on the volume of health information maintained and the number of interactions with those within and outside of the health care system.
For more detailed information about health privacy, you may want to visit our  Medical Privacy: National Standards to Protect the Privacy of Personal Health Information site.

 
http://www.hhs.gov/ocr/privacy/hipaa/faq/about/189.html

[jbeany]

Given that they discuss our entire medical history with us stuck in the chair, in earshot of all the patients in the room, I always thought the confidentiality thing was a crock anyhow.

Bub, I would demand an explanation from the blabbermouth.

[kellyt]

Given that they discuss our entire medical history with us stuck in the chair, in earshot of all the patients in the room, I always thought the confidentiality thing was a crock anyhow.

Bub, I would demand an explanation from the blabbermouth.

I've never been on dialysis, but now that you mention it when I'm sitting in the room at the doctor's office waiting (oh so long) for my doctor to come in, I can hear him talking to patients in other rooms, as well as with nurses in the hallway about other patients.  I've always wondered about that.  Surely, someone has said something about that to him.  I never do, but then again we're being seen for kidney stuff, blood pressure, peeing, etc.  If I was there for more personal reasons (sexually transmitted disease, etc.) I might be more inclined to speak up.  I probably should anyway...

You have a GOOD point, jbeany.

[twirl]

it should remain confidential - and if it has to be told to a nurse or tech - they should not be sharing the information or the fact that they know it --
my daughter complained to CPS about my niece not feeding her second son enough - he would get 4 ounces of watered down formula and that was it for about four hours - the poor child was sucking both fists and crying like crazy - he was 4 months old
we told her to feed him and she said he had plenty -
he was so thin -
she did the same thing to her first child - but he is two years and he gets more food -
they do not have much money and we would all buy her formula - to make it last she added too much water
when they went to my niece with the complanint they informed her that Stasie called -
they baby has gained weight and the older child is getting help with his speech-
Stasie did the right thing but it makes life uncomfortable
we are all going to complain

[Bub]

Thank you for your responses.  I read each and every one with great interest. As for confronting her, sadly I am not very confrontational ---- just feel I have learned a valuable lesson.  And to be fair, the practitioner who let the cat out of the bag probably did have a valid "medical" reason or need to know (or at least could justify it). But I still feel disappointed because I did ask for complete confidentiality and was promised it. She should have at least warned me that she could have the need to share with other staff in certain situations instead of giving me a blanket promise that should could never repeat or reveal any of the information.  I guess I am too old to be shocked or upset by this situation, but it does make me overall less willing to discuss any confidential or embarrassing problem or situation with anyone

[monrein]

"but it does make me overall less willing to discuss any confidential or embarrassing problem or situation with anyone."


And that's exactly what's wrong with this picture....because there could be something serious in the future that does need to be spoken about and now you're too spooked and feel betrayed to feel comfortable raising it.  If I were the social worker in your unit we'd be meeting as a staff group to review the total unacceptability of what happened, in an attempt to make sure it never happens again.  I don't enjoy confrontation either Bub but I dislike lack of professionalism even more. 

[peleroja]

I don't know how it's supposed to work, but when I was in center, I always heard the doctor talking with the patients around me  and sometimes across the row about their labs, etc. Any possibility someone else overheard and repeated it?

[Stacy Without An E]

I hope everyone realizes that privacy is a thing of the past in this country, like common courtesy and common sense.

When I go to pick up my medications, you're supposed to stand behind the red line for privacy reasons.  But you can hear everything the pharmacist is saying about everyone.  You could even sit in the chair to the side of the window and hear everyone's health issues all day long.

Stuck in a Dialysis chair and the doctor is talking full volume about you private health issues?  Nurses, techs and other patients know exactly what's going on.  Once again, NO PRIVACY.

Just wait until they try to put all of our medical records into digital files online so doctors anywhere can access the information.  Sounds like a good idea, right?  Lets just say a future employer you're trying to work for gets their grubby little fingers on the information...goodbye new job.

And every single day, more private information is shared without you even knowing it.

Eventually they'll take the word "privacy" (along with "freedom", "free speech" and "democracy" out of the dictionary because they will no longer exist.

Sigh.

[dialysisbiller]

I work in a CBO for billing (Corporate Business office) it seems the privacy laws are more practiced by business people rather than the nurses and doctors, where it should be. The only people in our office outside company employees are cleaning crews, a major reason for such security in our office, access to personal information on patients. All patient information is to be put away before people go home for the evenings and patient's names or other information is allowed to be left unattended on your desk. Managers keep watchful eyes out for anyone who leaves that information alone on their desk.

I worked in a Primary Care Physician office for 2 years, when the law came into effect. We had no glass seperating the waiting area with reception area, while answering the phone I realised patients waiting can hear me so I would not repeat alot of the things other patients would ask while I was on the phone. I had to remind the doctor he was NOT to use patient names when speaking to me regarding prescription refills and referals etc etc.... I'm more business minded than medical, so I kept the privacy law in mind daily where doctors and nurses may not always keep that in mind.

I can understand how you would feel, but it is YOUR RIGHT to privacy. It's not being confrontational to let someone know they were not obeying a law..... intent is the one thing you are missing, did she share the information to be informative or was she just talking to gossip about something?  I'm an optimist, I tend to believe someone to be good first, unless there is a history of bad.

If a doctor speaks to you in front of others regarding your medical information, you have the right to stop the doctor and remind him/her that you prefer to get your information in private and NOT in front of other patients. Doesn't matter if the doctor thinks it's not that big a deal to give you a lab result in front of someone, it's what YOU think.

[Rerun]

ALL Nephrologists..... come to the clinic and talk to us when we are 3 feet from one another!  I know all about Katherine's abuse of fluids and her depression and her bowel problem.  What the F's up with that?  I guess it is OK for some but not for others!!!!

Thanks for your help though         

[BigSky]

Im not sure there is individual confidentiality between medical staff of the same unit/hospital that is treating someone.

While people at these centers can be your friends, one must remember that they are medical personal first and anything told to them in the unit/hospital  usually is relayed to others within the place or put into your medical file.

I think the confidentiality issue applies that they cannot tell others outside of the medical unit/hospital setting or rely anything about you to other patients.

[Bub]

Well, my issue ended up being charted in my medical chart at my clinic.  I know this for a fact as I asked to review my chart and saw it noted by RN I had spoken to "confidentially".  Looking back now maybe it was not that big of a deal really, but I have learned not to say anything I would not put in the newsletter.