Rant: I have a bone to pick with patient privacy laws (HIPPA) and power of decision

[mattpegher]

All family members can be told any information regarding their relatives. HIPAA just restricts who outside of the family can have access to the patient info. With that said, I make sure the person I'm talking to is actually family by either asking my patient or hospital staff. Last thing I want to do is get myself hit with HIPAA violation lawsuit.

Not true.
Hippa states that a patient has the right to restrict access to his or her information. The Patient or if incapable, the next of kin, have the right to designate who has access to the information. Parents, siblings and even children can be restricted from information if it is the wish of the patient or the POA. Often release of information is implied, but it is usually best to determine to whom you may speak, to minimize the risk of a violation.

As for overriding family wishes, a physician can refuse to participate in certain parts of care that he/she feels are unsafe, or not in the patient best interest. But for most proceedures, going against the will of the patient is not done, and can be considered assault.

If I need to start an antibiotic, do a CT, certain labs, I will discuss this with the patient, but they are allowed to decline, I document this, and may try to convince the patient that this is in their best interest. However, I will never go against the explicit instruction of a patient or POA.

 

[Kaervak]

Not true.
Hippa states that a patient has the right to restrict access to his or her information. The Patient or if incapable, the next of kin, have the right to designate who has access to the information. Parents, siblings and even children can be restricted from information if it is the wish of the patient or the POA. Often release of information is implied, but it is usually best to determine to whom you may speak, to minimize the risk of a violation.

As for overriding family wishes, a physician can refuse to participate in certain parts of care that he/she feels are unsafe, or not in the patient best interest. But for most proceedures, going against the will of the patient is not done, and can be considered assault.

If I need to start an antibiotic, do a CT, certain labs, I will discuss this with the patient, but they are allowed to decline, I document this, and may try to convince the patient that this is in their best interest. However, I will never go against the explicit instruction of a patient or POA.

Honestly, I've never had an issue talking to family about what has gone on/is going on with the PT. With that said, by the time I get involved (EMT, pre-hospital care) with the PT they're usually already in the nursing home and the family knows everything that's gone on or being discharged from the hospital and the family knows more than I do. We're rarely involved with continuing care.

 

[MotionMan]

Honestly, I've never had an issue talking to family about what has gone on/is going on with the PT. With that said, by the time I get involved (EMT, pre-hospital care) with the PT they're usually already in the nursing home and the family knows everything that's gone on or being discharged from the hospital and the family knows more than I do. We're rarely involved with continuing care.

Still, it appears that your duty and the law requires that you not share such information without authorization from the patient or the authorized rep of the patient.

You are probably playing with fire without any upside.

MotionMan (<---- Formerly defended medical malpractice lawsuits (right before and after the time HIPAA was enacted).)

 

[Pliablemoose]

My biggest problem with patient confidentiality is when I assess/interact with patients in an "open ward" setting, there is simply no way to comply with privacy rules, laws with the way hospitals are constructed.

One of the current trends is to rename ER's Emergency Areas "EA" because we treat patients in the flipping hallways now.

I can't wait till we rename them emergency vestibules, and emergency driveways...

 

[mattpegher]

Well most of our beds are in private rooms, but some only have a curtain. Walls inbetween but sound does carry. It can embarrassing when a hard of hearing patient tells you about her bowel movements at the top of her voice.
Generally we try to maintain privacy while adviseing patients and families how they can get information. With alert patients we often just ask if we can talk to said person. I dont know of any case law but if a patient says that we can talk to family then later says that they didnt say so, I guess were screwed.
What a lot of people dont realize is that in submitting the bill to your insurance company you automatically allow us to give them some information and they inturn have permission to give the same information to who ever the primary is on the insurance. Ie, if you are a teen with an STD, and you are seen in the ER. I cant tell your parents that I treated you for STD, but you parents will get a copy of the bill, if you submit it through the insurance. This may include names of tests like gonnorhea and chlamydia, pregnancy tests, and alcohol tests, etc. They will likely have some idea not only that you were seen but why.