Saturday, October 14, 2006

HIPAA-Crit

This post is not about suicide. Suicide is an important topic and there's been some good discussion here, but frankly it's getting to me a bit. I went out to dinner last night with a friend who had to identify her brother's body ten days after he killed himself. Then she had to clean up his blood soaked room. Then we had a suicide in our neighborhood a week or so ago, and my neighbor still hasn't been able to return to the house. So as far as the blog topic goes, my final word would be: Just Don't Do It (with apologies to Nike). It's a freakingly mean thing to do to your loved ones and friends.

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And now for something completely different:

I'm going to pose a problem to our readers and ask for advice---how's that for a switch? (Actually, I just needed an excuse to try out our new polling feature.)

Here's the situation:

I went to the bank this past Saturday. It's a rather small branch, and on weekends it's crowded. On this particular day the line for the teller curved around the perimeter of the lobby where two people were waiting to see a banker. The first person was a middle-aged woman and a young man with peach-fuzz cheeks (for future reference, Peach Fuzz Man). The woman was talking to Peach Fuzz as he tapped on his PDA. He appeared to be looking something up. I wasn't paying much attention until I heard Peach Fuzz say the phrase, "You definitely meet DSM." At that point my ears pricked up like Harold the Vampire Cat in front of a humming bird (but without the jumping at the window part). I heard some more mumbling and then I heard Peach Fuzz state quite authoritatively, "You need a full cardiac workup." Now, by this point I'm somewhere between amazed and aghast.

Every physician has been in a social situation where someone asks for clinical advice after they find out what you do for a living. I generally say something about not discussing individual cases in public, or I'll talk about a diagnosis in general terms without reference to any particular individual details. I think this situation takes the case as far as lack-of-privacy goes. I have no doubt that every person standing in line heard as much of that conversation as I did.

I'm making a lot of assumptions here, I know. I'm assuming they didn't know each other before they came to the bank, and that during casual conversation the woman found out what Peach Fuzz did for a living and asked for professional advice. I'm assuming Peach Fuzz has some medical training, although what happened sounded more like medical student or intern behavior. (Then again, there are faculty physicians around here these days who look pretty Bambi-ish.)

So there's the situation. My question for the blog is, what would you do if you heard a doctor discussing this woman's case in public? Unfortunately the poll doesn't let me ask questions about the voter, because I'd love to know if people had different advice based on whether they were health care providers or patients. Regardless, give it a shot and then see how others voted.

8 comments:

NeoNurseChic said...

I'm tryin to figure if it's really a HIPAA thing if she's asking him when it is more than obvious that other people are standing nearby. I really think that's her own problem, and to violate HIPAA, he'd have to be telling her the juicy details of the patient he saw yesterday, etc etc. I mean, sure...this takes away the privacy element, but she brought it up dead smack in the middle of a public place.

As for me, from a nursing standpoint, my family asks me things all the time. I will answer general information questions, or I will advise someone what doctor to go to. I will not cave into my grandma's constant asking for my opinion about her own and various other family and friend health issues. Not that she would, but family have been known to sue family for giving casual medical advice and then things go wrong.

I saw what happened in my ex-boyfriend's family. One request with return for a prescription of antibiotics, and now his family bothers him constantly! Once I have prescriptive authority, it stops at the door of the office I work at. I'm not giving my family prescriptions for their various meds. Go to your own physician, PA, or NP. I think once that gets started, you're screwed...

But then that's me...from the HCP standpoint since usually I blog here from the patient standpoint, but I like to remind once in awhile that I am also a HCP. :) (Especially since I was up well past 3am last night doing my endocrine case study for my advanced pharma class...and now I have a killer migraine! bleh...)

Take care!
Carrie :)

Dinah said...

clink, only you would care about such things. I toook the poll. Then I read it out loud to my husband and tried to register his vote (the first time we've EVER voted the same way) and it wouldn't let me vote again. damn computer.

ClinkShrink said...

I would love to be a fly on the wall when you try to use the new electronic voting machines next month. I can hear it now: "What's wrong with this damn machine? It won't let me vote twice!"

healthpsych said...

They could have been together and he could, of course, been simply looking up symptoms on the internet and not a medic at all. :)

jw said...

I'm glad people don't ask engineers questions in public places. Imagine "Hey bud, I've got a 6 point decending trend line on a 5 by X-bar-R. Ya think it's tool wear?" Such questions just do not happen.

Frankly I can't think of an answer to the pole or the problem.

Yet: Doesn't it seem that it is really rude to ask a Dr. questions in social settings? It seems that way to me. Thus, to me at any rate, giving really absurd answers may well be justified: "Oh definitely! It's mysamic humors in the liver. You need a good purge."

Anonymous said...

EEK, so far eighty three percent agree with me. When I worked in the field I heard MDs in the elevators of hospitals discussing patients loudly in front of anyone around. And the nurses and medics were just as bad if not worse. I wonder if anyone has ever beens sued over this. I love you abf

Roy said...

I agree with Carrie. She is giving explicit permission to discuss the case in earshot of others. It's *her* business if she cares not if others know her history. Of course, he still may have been more discreet, but perhaps she already said "I don't care" before you walked up.

40 people voted... not too shabby.

Mike said...

Under the HIPAA policy the woman should have visited her primary care physician or concern physician rather than directly asking for advise to any unknown person...and the worse thing the woman did was that she discussed these thing in public place...