Have you ever found yourself walking down a passage in a hospital or public setting discussing a patients’ diagnosis, treatment, reactions or anything along the line with another colleague? Have you ever stopped to notice how loud you might have discussed that patients details or if any other bystanders might have heard anything you have said, possibly even the patients’ personal details?
If you answered “yes” to my first question its most likely that your answer would be “no” to my second question. Innocent actions I am sure, but a hospital visitor or public stranger may overhear a provider’s confidential conversation with another provider or a patient, or may glimpse a patient’s information on a sign-in sheet or nursing station whiteboard. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule is not intended to impede these customary and essential communications and practices and, thus, does not require that all risk of incidental use or disclosure be eliminated to satisfy its standards. Rather, the Privacy Rule permits certain incidental uses and disclosures of protected health information to occur when the covered entity has in place reasonable safeguards and minimum necessary policies and procedures to protect an individual’s privacy (Privacy, 2002).
The minimum necessary standard requires that a covered entity limit who within the entity has access to protected health information, based on who needs access to perform their job duties. If a hospital employee is allowed to have routine, unimpeded access to patients’ medical records, where such access is not necessary for the hospital employee to do his job, the hospital is not applying the minimum necessary standard. Therefore, any incidental use or disclosure that results from this practice, such as another worker overhearing the hospital employee’s conversation about a patient’s condition, would be an unlawful use or disclosure under the Privacy Rule (Rule, 2013).
I found myself discussing patient details with another student and other colleagues frequently. Either it was to seek assistance or assurance or it was just to brag about a special interesting condition I have never treated before. whatever the case may be, excitement or judgement, I never stopped to think about patients privacy rights that might be violated or if other sensitive details where discussed loudly and other patients also over heard. I recently walked past a couple discussing a patient and playing a game of “ching chong cha” to decide who would treat this patient- unethical for sure. It was obvious neither of them where interested in the complete well being of this patient and they just wanted to do the bear minimum necessary to be able to ‘tick’ off the patient and add their name to their statistics for the day. After I over heard their challenge it really got me thinking about all the times I publicly discussed a patient and the possible harm I could have caused, and rearranging my patient load according to the ones I really like to see down to the ones I didn’t really feel like seeing. However this doesn’t always happen, it becomes difficult to handle the patient load on days you have a lot going on, for instance supervision days, exams, tutorials, clinician feedback sessions, etc. Some days I even had multiple of these learning sessions making my time spent in the wards with patients limited. Especially during these days I found myself discussing patients in loud areas and agreeing to minimal treatment necessary.
Some examples of minimum safeguards that should be implemented at large facilities to ensure maximum effort of obliging to privacy safe keeping:
- By speaking quietly when discussing a patient’s condition in a waiting room or other public area;
- By avoiding using patients’ names in public hallways and elevators, and posting signs to remind employees to protect patient confidentiality;
- By isolating or locking file cabinets or records rooms; or
- By providing additional security, such as passwords, on computers maintaining personal information.
References
Privacy, O. H. (2002, December 3). Incidental Uses and Disclosures. Retrieved from HHS.gov: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/incidental-uses-and-disclosures/index.html
Rule, S. o. (2013, July 26). Office for Civil Rights (OCR). Retrieved from HHS.gov: https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
4 thoughts on “The Walls have ears and the Door eyes”
Dear Wiana. This writing piece made me think about a lot of things I also do in the clinical settings. We often find ourselves discussing interesting patient cases, patient treatment or just any situation of a patient with other students. We don’t always look around for who is watching or listening. I like then how you bring the privacy rule into your piece as this makes your argument stronger on what the rights of the patient is as well.
Furthermore, in your last paragraph you discuss the couple who was playing a game to see who wins and who has to go see a specific patient. I think this is not very professional of them and maybe you can include how professionals in the workplace should have handled the situation. Here is a link that you may find helpful to include professionalism in your writing as well.
https://www.linkedin.com/pulse/what-professionalism-does-mean-you-daniel-w-porcupile
This will help make your argument stronger as you can provide more conclusions as to how we can handle the situation as professionals.
Clinical practice:
You have the incorporated nice examples of your own experience as well as other’s experiences towards the topic discussed. This makes your writing stronger as a lot of us as students and clinicians can relate to the situation.
Art:
Consider adding a picture that illustrates that the windows have eyes and the walls ears. Otherwise if not possible consider adding professionals talking loudly in a hallway.
Evidence:
Appropriate use f literature to support your claims in the reflection. In your reference list add the date your retrieved the information.
Eg. Privacy, O. H. (2002, December 3). Incidental Uses and Disclosures. Retrieved 10 April, 2019, from
HHS.gov: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/incidental-uses-and-disclosures/index.html
Language:
Reflection is well written. To make the piece more easy to follow consider linking words such as; however, furthermore, moreover etc. between paragraphs.
Digital literacy:
Consider using hyperlinks in your reference list as this will allow the reader to read up further on your topics discussed and make them understand the topics better. Also consider using tags such as; privacy, patient rights, professionalism.
Thank you for sharing
Agatha
Unfortunately I can answer “yes” to your opening question in paragraph 1 and I am sure many of the other students could do the same. As students we like to seek assurance from our colleagues by hearing their opinion on treatment and management with a patient and to do so we need to share personal information about the patient. This topic is therefore relevant to clinical practice and is common among students in a clinical setting. I however agree that we are not as aware as we should be that our casual conversations in the hall ways are breaching the privacy of patient’s and their personal information. I liked how you started paragraph 1 with a rhetorical question and get the reader to reflect on their own actions in a clinical setting. The writing is well structured, the argument is clear and easy to follow. I would suggest in order to strengthen your writing, adding a component that looks at this dilemma from a patient’s point of view. How would the patient feel knowing that their personal information is being discussed out of their presence? You talk about “After I over heard their challenge it really got me thinking about all the times I publicly discussed a patient and the possible harm I could have caused” at the end of paragraph 4, maybe expand on what you mean by “harm” you could have caused.
Your references are relevant and support your argument however bringing in more ethical content covered in class such as human rights and the patient’s rights could further strengthen your argument.
I liked how you ended with suggestions to reducing the occurrence of public patient discussions.
Paragraph 4, line 6:
“where” should be changed to “were”
“just wanted to the bear minimum” add “do”
Thank you for sharing your piece of writing, I enjoyed reading it. Keep up the good work going forward!
Hi Wiana,
Thank you for your writing piece. I have a few suggestions to improve your writing piece. If my understanding is correct you are referring to confidentiality? I think you are not introducing the topic, I think if you give us a definition or explain what you are writing about. Check the link below, i think it will help you to differentiate between confidentiality and anonymity.
https://us.sagepub.com/sites/default/files/upm-binaries/89170_Part_3_Protecting_Privacy_and_Confidentiality.pdf
I suggest you also explain how the the ethical principle was violated, I think a clear link between what you are writing about the ethical principle will be helpful to strengthen your piece.
“Entity” are you referring to a patient? I do not understand this.
Try making your sentences shorter, they are very long and it is making it difficult to understand what you are trying to say.
I liked how you added the suggestions on how maintain privacy, it is informative.
Your referencing is clear and up to date.
Thank you, all the best with the final.
Saschia.
If you have any questions, please feel free to contact me.
Thank you.