THE DISCUSSION WAS:
A physical therapist receives a phone call from a woman demanding to know when her daughter-in-law’s next appointment is. The therapist tells the woman that she cannot disclose any information, and the woman becomes very angry and abusive, threatening to make a complaint. After the phone call, the therapist logs into the electronic medical record system to make a note about the conversation. However, since the two women share the same last name, the therapist accidentally accesses the woman’s record instead of the daughter-in-law’s record. The therapist realizes the mistake, but not before spotting that the woman suffers from a serious mental health disorder, which might explain her behavior on the phone. The therapist mentions to her supervisor the possibility of a complaint being brought and also mentions that the woman has a history of mental health problems. Do you feel that there has been a breach of confidentiality? Why or why not? How should the supervisor handle this situation? Should the patient be notified?
BUT NOW WE DO:
In your responses to your peers, indicate whether you agree with them about the way the situation was handled, and explain why or why not.
I WILL PUT WHAT I SAID FOR THE DISCUSSION IN THE FILES
HERE IS WHAT THE PEER SAID:
The situation described involves potential breaches of confidentiality in the handling of patient information, warranting a comprehensive analysis of ethical considerations as well as operating procedures to ensure that all PHI is safeguarded and only accessed by those who need it. Sensitive medical information and history should not be able to see sensitive information readily. There should be several technical and digital barriers to ensure this information is not readily seen upon opening a patient chart.
Firstly, the physical therapist’s refusal to disclose appointment information over the phone demonstrates an initial commitment to confidentiality, aligning with the ethical principle of patient privacy. However, the inadvertent access of the wrong patient’s record during subsequent documentation introduces a significant concern. The therapist should not be accessing a patient’s chart with whom they are not involved.
The therapist should have informed their supervisor of the threatening and aggressive interaction and allowed supervision to make any notes on the patient’s charts. Accessing a file for a patient you are not involved with is a breach. I would argue that this was an intentional breach as the therapist intended to access a patient’s file with whom she was unfamiliar. Further, what steps did the therapist take to ensure she accessed the correct file before opening it? I have a common last name; you should always verify the correct patient before opening anything.
The breach of confidentiality occurs when the therapist accesses the woman’s medical record instead of her daughter-in-law’s. The therapist then gained access to sensitive information about the woman’s mental health disorder. Then, when the therapist discloses this information to someone else, ethical concerns are raised, as it goes beyond the scope of the therapist’s professional duties and constitutes an unauthorized breach of the patient’s privacy.
After becoming aware of breaches, the supervisor should adopt a measured and ethical approach to address the situation. If I were the supervisor, this is what I would do:
Immediate Correction of Documentation
The supervisor should ensure that the incorrect documentation in the electronic medical record system is promptly corrected or removed. This action is crucial to mitigate any potential harm caused by the inadvertent access of the wrong patient’s record and to align with the organization’s commitment to maintaining accurate and confidential patient information.
Private Discussion with the Therapist
Schedule a private and confidential discussion with the therapist to understand the circumstances surrounding the breaches. Encourage open communication to ascertain whether the access to the patient’s record was unintentional and if there were contributing factors, such as system issues or lack of training, that need to be addressed. This discussion allows the supervisor to gather relevant information before making any decisions.
Reinforcement of Confidentiality Policies
Reinforce the importance of confidentiality policies and ethical obligations in healthcare. Provide additional training if necessary to ensure that the therapist understands the gravity of breaching patient confidentiality and the potential consequences. Emphasize the need for strict adherence to privacy regulations and organizational protocols.
Addressing the Secondary Breach
Discuss the disclosure of the patient’s mental health history to the supervisor. If the therapist intends to seek guidance regarding potential complaints, clarify the appropriate channels for addressing such concerns without compromising patient confidentiality. Reinforce the understanding that discussing patient information, even in the context of potential complaints, must adhere to strict privacy guidelines.
Consideration of Disciplinary Action
Depending on the severity of the breaches and the therapist’s overall professional conduct, the supervisor should consider appropriate disciplinary actions. Termination should be a last resort and only considered if there is evidence of repeated, intentional, or gross negligence in maintaining patient confidentiality. Prioritize fair and proportionate responses to the specific circumstances.
Notification and Apology to the Patient
If deemed necessary and in consultation with legal and ethical guidelines, consider notifying the patient involved in the breach. An open and transparent apology and assurances of corrective actions may be warranted to maintain patient trust. Ensure that the notification process respects the patient’s dignity and privacy.
Documentation of Corrective Measures
Document all corrective measures taken, including additional training provided, discussions with the therapist, and any changes in organizational protocols. This documentation records the organization’s commitment to addressing breaches and reinforces its dedication to maintaining patient confidentiality.
The therapist’s communication with the supervisor about the possibility of a complaint and the mention of the woman’s mental health history further compounded the ethical dilemma. The disclosure of a patient’s mental health status, even in the context of expressing concerns about potential complaints, represents a secondary breach of confidentiality. Such revelations compromise the principle of patient autonomy and may contribute to stigmatization.
Required Resources:
Textbook: Medical Law and Ethics, Chapters 9 and 10
Chapter 9 guiding questions:
1. What are the main purposes of the medical record?
2. What are the requirements for maintaining a medical record?
3. What are the confidentiality obligations when using electronic medical record-keeping?
Chapter 10 guiding questions:
1. What are the problems associated with patient confidentiality?
2. What is the purpose of HIPAA?
3. What are the Privacy Rule and the privacy standards?
https://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsggo&AN=edsgcl.730600901&site=eds-live&scope=site
Read this Shapiro Library article to understand the U.S. medical privacy provisions, the HIPAA Privacy and Security Rules, which provide patients with important protections and place obligations on providers but with limitations.
https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
This webpage offers a series short videos on patient confidentiality.
https://www.ama-assn.org/practice-management/hipaa/hipaa-violations-enforcement
Review this webpage from the American Medical Association (AMA) about the consequences of not complying with HIPAA.
Additional Support (Optional):
Video: https://www.youtube.com/watch?v=QO03vlOyGco
1:51
This video includes information on the proper use of social media, email, texting, and faxing as pertaining to HIPAA law.
NEEDED BY SATURDAY AFTERNOON PLEASE. DONT FORGET TO LOOK IN THE FILES FOR WHAT I PUT AS MY DISCUSSION POST
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