2008 Woodie Awards
Pocket Doc
Issue date: 12/4/06 Section: Pulse
- Page 1 of 1
Dr. George
Loyal readers of "Pocket Doc" will recall the column of 9/11/06 in which I answered queries of patient privacy. Somewhat irreverently, if you can imagine that, I indicted HIPAA as the basis for dilemmas we in emergency medicine face when caring for an unconscious, critical patient. Well, it turns out that I was wrong when I stated that it was illegal for hospital personnel to give information to families and other physicians.
The University has a Privacy Officer, Patricia Cunningham-Brooks, accordingly, she wrote the following response:
HIPAA Privacy Rules do not prohibit communications with family or medical providers in this scenario; it's actually quite the opposite. The medical provider or designee is allowed to contact the family and inform them of the patients' whereabouts and condition. The following information is not considered confidential in this scenario:
- Patient is in the hospital
- When patient came into the hospital
- General medical condition of the patient
The medical provider is also allowed to contact other medical providers to obtain medical history information. The attending physician can request information on behalf of the patient if the patient is not capable of signing an authorization. This is accomplished by having the attending physician sign the authorization. Another option is to have a family member sign an authorization to release medical information.
Unless a patient opts (sic) out of the hospital directory, medical providers can state that a patient is in the hospital.
In the scenario where a patient dies, HIPAA Privacy Rules do not prohibit communication to family members via telephone. Remember that the privacy rules were not designed to hinder the patient care process, so doing what is reasonable in a given situation is acceptable.
I don't doubt for a second that Mrs. Cunningham-Brooks knows her HIPAA. I would hope that she would have the same respect for my 28 years experience in emergency medicine regarding what reality is on my turf. Respectfully, I must disagree with her and state that HIPAA has interfered with the delivery of patient care. After years of the message that patient confidentiality must be protected, there is unquestionably a fear in the medical community that any lapses in that silence better be with knowledgeable, supportive documentation. HIPAA interferes when I, as an emergency physician, am unable to access psychiatric records of patients who present to the emergency department in a psychiatric crisis. And it interferes with the training and retention of doctors, nurses and paramedics who find themselves blocked from following the progress of a patient with whom they have become emotionally attached. So, although the purpose of the document was not to impede patient care, it has. Don't ask me. Ask other doctors and nurses (please, lose the providers).
On the other hand, I will grant that in many other cases HIPAA has sensitized us to patient privacy, something that we all can appreciate when it is our lost condom, venereal warts or pubic lice that is being laughed about among the staff. It isn't just about embarrassment either. Jobs, marriages, and insurability can all be lost as a failure to honor privacy. The potential to dramatically alter a person's future is in our hands and needs to be respected. So it seems that privacy, like everything else, comes with a price. Whether it is worth it or not just depends on whose positive pregnancy test, genital herpes or positive drug screen, we're talking about, doesn't it?
Dr. George is an emergency room physician with the University of Illinois at Chicago's Medical Center.
As with all medical advice, consult your physician before beginning any regimen or if symptoms persist for more than 5 days.
Send your anonymous questions to pulse@chicagoflame.com.
Loyal readers of "Pocket Doc" will recall the column of 9/11/06 in which I answered queries of patient privacy. Somewhat irreverently, if you can imagine that, I indicted HIPAA as the basis for dilemmas we in emergency medicine face when caring for an unconscious, critical patient. Well, it turns out that I was wrong when I stated that it was illegal for hospital personnel to give information to families and other physicians.
The University has a Privacy Officer, Patricia Cunningham-Brooks, accordingly, she wrote the following response:
HIPAA Privacy Rules do not prohibit communications with family or medical providers in this scenario; it's actually quite the opposite. The medical provider or designee is allowed to contact the family and inform them of the patients' whereabouts and condition. The following information is not considered confidential in this scenario:
- Patient is in the hospital
- When patient came into the hospital
- General medical condition of the patient
The medical provider is also allowed to contact other medical providers to obtain medical history information. The attending physician can request information on behalf of the patient if the patient is not capable of signing an authorization. This is accomplished by having the attending physician sign the authorization. Another option is to have a family member sign an authorization to release medical information.
Unless a patient opts (sic) out of the hospital directory, medical providers can state that a patient is in the hospital.
In the scenario where a patient dies, HIPAA Privacy Rules do not prohibit communication to family members via telephone. Remember that the privacy rules were not designed to hinder the patient care process, so doing what is reasonable in a given situation is acceptable.
I don't doubt for a second that Mrs. Cunningham-Brooks knows her HIPAA. I would hope that she would have the same respect for my 28 years experience in emergency medicine regarding what reality is on my turf. Respectfully, I must disagree with her and state that HIPAA has interfered with the delivery of patient care. After years of the message that patient confidentiality must be protected, there is unquestionably a fear in the medical community that any lapses in that silence better be with knowledgeable, supportive documentation. HIPAA interferes when I, as an emergency physician, am unable to access psychiatric records of patients who present to the emergency department in a psychiatric crisis. And it interferes with the training and retention of doctors, nurses and paramedics who find themselves blocked from following the progress of a patient with whom they have become emotionally attached. So, although the purpose of the document was not to impede patient care, it has. Don't ask me. Ask other doctors and nurses (please, lose the providers).
On the other hand, I will grant that in many other cases HIPAA has sensitized us to patient privacy, something that we all can appreciate when it is our lost condom, venereal warts or pubic lice that is being laughed about among the staff. It isn't just about embarrassment either. Jobs, marriages, and insurability can all be lost as a failure to honor privacy. The potential to dramatically alter a person's future is in our hands and needs to be respected. So it seems that privacy, like everything else, comes with a price. Whether it is worth it or not just depends on whose positive pregnancy test, genital herpes or positive drug screen, we're talking about, doesn't it?
Dr. George is an emergency room physician with the University of Illinois at Chicago's Medical Center.
As with all medical advice, consult your physician before beginning any regimen or if symptoms persist for more than 5 days.
Send your anonymous questions to pulse@chicagoflame.com.
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