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Benefits and Dangers of Discussing Patients
Anthony Rudine -- I read a story today about a medical student who wrote an article about an autopsy he witnessed and was expelled from school for breach of confidentiality. While I do not know the specifics of the case, I did read the student’s article and found no problems with anything that was written. Of course, the student sued the school for breach of his first amendment right to free speech, and the courts agreed with his position.
As a medical student who likes to write and is encouraged to write about patient contacts, this article disturbed me very much. At what point does my first amendment right end and the confidentiality of a patient begin? Is there a clear line?
In business school, we are taught about the legal aspects of HIPPA and patient confidentiality and told that we should never reveal anything that would allow the public to identify the person in a line-up. However, I'm also concerned that the fear of litigation will make me hesitant to write about patient encounters that could provide insight to other healthcare workers.
I do not want to give the wrong impression here; I think that patient confidentiality is an absolute must, and it has nothing to do with the first amendment. However, when speech about unidentified patients becomes litigious, I feel the first amendment is being trampled on.
I am a big proponent of the first amendment, and I want it to be protected to the fullest extent. However, because I am not in the law field, I do not fully understand where the first amendment ends and HIPPA begins. I know I am not the only one who feels this way, and I would enjoy hearing what others think. For that matter, does the law present other problems that you think need to be changed?
June 12, 2006 | Permalink
Comments
When HIPPA were first instituted at our hospital, I was told, when I called the lab for test results on my patients, that they couldn't give the information out! And it gets messy when family members call me for information, if it hasn't been made clear by the patient who can and cannot receive info. It's well-intended, and generally works out ok. But there are times when it's downright annoying.
Posted by: Sid Schwab | Jun 12, 2006 4:45:26 PM
I think you definitely have to be careful discussing anything to do with patients in an article. While you may not be identifying a patient by name; if you discuss certain aspects of the patients case and it is detailed enough that the patient himself or his family could identify themselves in the article; then I believe you violated the patients right to privacy. What if a patient was dying and didn't tell their children and an article in the paper discussed the medical condition in such a way that the patients teenage children could tell it was talking about their parent. Although the article may have been meant as a discussion to physicians; it instead harmed the sick patient's children. Better to err on the side of caution........and not on the writer's first amendment rights.....the patient's privacy rights should trump all.
Posted by: vonna rae | Jun 12, 2006 10:58:34 PM
I'm sure if you ask Law2Doc on SDN you could get some good answers.
Posted by: | Jun 13, 2006 9:43:00 AM
I commend Anthony's enthusiasm for writing about patient encounters for the sake of increasing the knowledge we have about patients' experiences. But the patients' rights do trump all, as law2doc pointed out. I believe this gets to the even broader and deeper question of, "if and when does the greater good ever trump an individual patient's well-being". Organized medicine and the profession itself have not clearly declared the answer to this crucial question, and frankly, we will continue doing circles about a number of issues in healthcare until society determines which is in fact the more noble goal...an issue much more likely to be decided in the courtroom.
Just a pet-peeve note: It's HIPAA, it stands for the Health Insurance Portability and Accountability Act...not initially designed for the sake of confidentiality, although many wouldn't know this given all the HIPAA training we have these days.
Posted by: Joe | Jun 13, 2006 11:00:26 PM
Hi,dis is 1 time i m on dis site from a smal city n smal yet grt.nation i m from smmal medcolg welli think pts information shud b kept conf.that will b gud 4 the pt n his family also take it on ur own U wud never like ur friends n family to know abt ur any major illness so thinking 4 dat angle i suppose pts records shud b kept conf .which wud prevent them 4 more mental trauma n aiso their families specially 4 ds with public stigma with it like aids no!!bt as med studts it may annoy somrtimes bt dat wil b ok isnt it!
Posted by: chhavi singh | Jun 17, 2006 11:56:37 AM
Hey Joe, thanks for clearing up the spelling. HIPAA. I've been doing it wrong since the beginning.
Blogwise, I just change every possible thing I can except what is the heart of the story when it comes to patients. I may or may not change sex, decade it occurred, hospital location (ICU or ER), patient age, occupation, ethnicity and most of the time my stories are composites of many people.
Having 28 years of experience at multiple facilities allows me to do this because I have many, many experiences to draw from.
I always say, if you think you recognize someone on my blog, you don't, because it is probably five different people put together! : )
Posted by: Kim | Jun 18, 2006 3:19:53 AM
i blog about my encounters with patients almost everyday when i was still studying, of course without revealing their identities. i think that should be the demarcation line. i intend to continue that when i start my internship.
Posted by: sharon | Jun 19, 2006 10:51:37 PM
First, I def. think that individual patient rights trump all. Period. Their privacy is more important than the advancement of medical knowledge, convenience, or a physician's/student's right to exercise his/her first amendment rights.
That being said, it's very simple to dedramatize (I know, that's not a real word) this whole situation. When writing about or discussing a patient, just make sure that all identifying details of the case are left out. Most of it is not relevant anyway.
Posted by: rita | Jun 23, 2006 8:04:41 PM
