Tuesday, January 24, 2012

It's All About the Privacy

A 31 year old female came in with a female friend for a sebaceous cyst, a nice big ripe one behind the ear.  It had obviously been brewing for some time, so Bobo elected to I&D it.  But first, Ativan, then  nice big does of Dilaudid.  She screamed such a string of obscenities so inconsistent with what he was doing that the usually unflappable Bobo was unnerved; he who as a general practice gives out Percocets like Pez and is not stingy with the lidocaine or giving it time to work.  He actually mouthed, "WTF" to me.  I had to dive under the table on that one.

Eventually I managed to scrape her off the ceiling, apply a dressing and send her off to the pharmacy to fill her antibiotic and narcotic prescriptions.

Two hours later (and the woman had been in the department at least 2 hours), I got a phone call. 

"Hi, I'm calling to see if my girlfriend is there".
Me: "I'm sorry, I'm not allowed to give out that kind of information, it is against privacy laws" (in other words, stupid, she's not here for me to ask her if she wants to take a call or have me take a message).
Idiot: "Well, I know she came there, and I know she needs a ride home so just tell me if she's there or not"
Me: "I can't give you any patient information.  Sorry".  (You could also be a stalker, maybe she has a restraining order on you, maybe you have a gun, and maybe you are crazy.  Or not, but I don't really care)
Idiot: "Listen, I just have to know if she was there, um, I mean, I just need to know if I need to pick her up.  You don't have to be a bitch about it"
Me: "I'm hanging up, have a nice day"
Idiot:: "I'll just come down and see for my-..."
Click.  Hey she came in with a friend, obviously she doesn't tell him everything.

We walk a fine line with the kind of patient information we give out over the phone.  Obviously, we want to do what's best for patients.  We talk to caregivers, and lots of times we talk with family members.  Do we try to ask for permission first? We do if it is a non-urgent problem.  Are we going to talk to three aunts, a cousin and a grandparent for someone with a minor laceration?  No.  Are we going to talk to family members who have been alerted by the nursing home  that their demented  elderly loved one has has been brought in with stroke symptoms or chest pain?  Hell yes. 

We don't leave messages on routine call-backs or for lab tests, but do suggest they call us.  Nor do we give information for  such requests as "I just wanted to see what my girlfriend's/boyfriend's STD test showed".  Sorry, you'll have to that information from her/him.  But if you are worried about that nasty discharge, come on down.

Once I had a director of nursing at a big hospital call me, the charge nurse, looking for information about her adult daughter.  She was being seen in my ER for a non-urgent problem.    I told Mom that I was sorry, but  giving her any information would be a patient privacy violation and that she would have to ask the daughter.  She thanked me and agreed that it was.  My next move was an immediate call to my boss to cover my ass.  Five minutes after I hung up with her my boss called me back to say the director had called her to praise me for protecting patient privacy and to congratulate my boss on training her charge nurses so well; she was embarrassed that she had been so careless about this issue.  You would think she would have known better, but the Suits and Clipboard Nurses who make policy rarely have any idea how these things work in the real world. 

Sometimes it is just a ridiculous game that puts us in the middle of family issues.  An example of this is a 25 year old with a minor laceration who was know to be an IV drug user.  It was not an injury that in any way, shape or form would have needed narcotics, so he left an unhappy camper and was quite nasty about it.  An hour later his mother called saying how much pain her son was in so could she please come down and get a prescription?  And his tooth was hurting too.  I said I couldn't discuss her son's care without his permission.  A short time later Sonny called and said we could give the prescription to his mother but we weren't allowed to give any details about his care or any part of his medical record.  Um, no. You are still not getting a narcotic prescription.  You have my permission to talk to your mother.