How to respond to identity suspicions at work?

leaf

I know a lot of you have a lot  better social skills than I have, so I'd really appreciate potential responses.

I work at the hospital where I am going to have an outpatient procedure (with anesthesia) later this month.  Because I have had confidentiality breaches in the past (essentially a male stranger, a radiology clerk, told me the night  before my breast excision  that he 'recommended that I have bilateral mastectomies because his co-worker had LCIS and that's what she did.'), I now have an alias for my health care at work.  My real name is a common first name, and an unusual last name.  I chose as my alias my same  first name (so that if a health provider says my first name when I come out of anesthesia I will respond correctly), and a relatively common last name.

Unfortunately, I have a rather distinct facial features,  so several of them have seen me and many of the nurses that will take care of me will likely recognize my voice.  I also have a PTSD-like syndrome, which may, or may not, get triggered.

If I get questions/statements such as "You're <leaf> who works in Department X upstairs, aren't you?" or even "How come your last name is different than the one I know?", how would you recommend that I respond?

If I say nothing, then that looks suspicious.  I can't really say, like some celebrities do, "Lots of people say I look like <name of celebrity>." ,  because of course I'm not a celebrity. If I say no, I am lying, which I'd rather not do, but I will if I have to in order to protect myself.  I don't know how to respond to the second.

All suggestions welcome.

Beesie

Tough situation. My suggestion would be that if anyone identifies you or questions you about your identify, rather than deny who you are, you could say that you were hoping for anonymity and that's why you registered under a different name.  You could even say that the last time you were in hospital some of your personal medical information was passed around unprofessionally so this time you were trying for anonymity so that it wouldn't happen again.  If nothing else, that would hopefully stop anyone who recognizes you from spreading it around.

Good luck with the procedure, and with the politics! 

KEW

Um...this would fall under a serious breach of HIPAA.  At my university, we have to "break the glass" in medical records to view an employees records.  It is a big deal, both HIPAA and confidentiality have been broken here and you have not been shown professional courtsey.  I would report it, with vigor. Sounds like a new round of training is in order. So sorry you had to go through this. 

KEW

barbe1958

Leaf, if you don't follow the advice above, you could always say "Shhh, I'm incognito today!" and laugh gently and walk away. If they pursue that, then throw them under the bus!

jan508

I like Barbe's suggestion

Jan

HantaYo

Namaste!

Leaf:  I am an RN and work in Pre-op and Recovery.  It is not unusual to be in the situation of caring for a co-worker or someone familiar from another department.  Everyone deserves and has the legal right to absolute privacy of themselves and information about themselves and only those who have a "need to know" in order to provide care should have access to the individual or information.  All health information is sensitive but some even especially so.  I am the guardian of my patient and I take that role seriously from all perspectives.  My hospital also takes the responsibility of privacy very seriously.  Any breach means immediate loss of job.  No second chance. This breach could be a comment in the cafeteria, an electronic peek when there is no need to know, or leaving a document in an area where it is vulnerable to being seen by unauthorized individuals.  One strike and you are out.  I know of specific individuals who have lost their job because of a breach.

You could ask your computer department to put a tag/something on your electronic record to track any inappropriate access.  When admitted you can ask the admitting department to put a "no info" or VIP or what ever label your health system uses to ID those that need special protection from breaches.  Our IT department does random checks and specific checks on "patients of public interest".  Also we have had patients who are aquainted (either positive or negative) with some staff members and have asked to make sure these individuals have no care responsibilites and no electronic access.

At the time of my BC DX and surgery I was Staff Development Nurse for the Pre op and Recovery areas and had a working relationship with every single staff member (about 90) in our department as well as patient staff care on all the floors  and knew quite well everyone's strengths and weaknesses.  Also every anesthesia provider, radiology tech, etc, etc.  I did not reveal my DX or upcoming OR to anyone other than my manager and a fellow educator untill a few days before surgery (about 6 weeks of incognito time).  I then sent a group e-mail to my 90 staff with a very brief explanataion of my DX and OR and set boundaries for personal interactions with me.  I wanted their support but not their curiosity and detailed what was or was not acceptable. I let them be my guardians and advocates and role models for other areas.  They were angels.  Although there was no way I could be incognito I only received very caring responses to my wishes for privacy.

I agree with barbe1958.  A little bit of humor can get a serious message across and if it doesn't work, throw them under the bus.  Privacy is the law! 

Karla

Leah_S

Leaf, you've gotten a lot of good suggestions here.

If someone asks, "Aren't you Leaf?" and you realize they know you can then request privacy - in other words, request that they say nothing and gently mention HIPAA. If they're not sure, then you can say, "A lot of people say I look like Leaf". It's not a lie, darlin, you do look like Leaf, after all.

Best of luck with your surgery.

Leah

molly52

Then there is the line "if I told you, I would have to kill you"

molly52

Seriously though, I think if anybody asks you questions about if you are really leaf - they are already violating your boundaries.  If they are not your personal friends, questioning you is out of order.  Therefore, I don't know if you "owe" them an answer.  Depending on your personality and relationships at work - ignoring them and changing the subject, or "why do you ask?" or remind them of HIPPA with an onimous frown. A while back there were some southern ladies sharing their "expressions", they had some pretty good put downs.

Honestly, you shouldn't have to be put through this.  Your privacy is your entitlement.  If you had a lawyer write a letter to your employer - they would be forced to improve their security.  Don't know if you want to go there or not.

leaf

Thank you so much, all!  Bessie, KEW, barbe1958, Jan and Karla, molly, !

Barbe, you came through once again!

When my radiology clerk incident happened (5 years ago; my reply to that comment was, "Well, that takes audacity"), I wrote an incident report.  Of course, the radiology clerk got a slap on the wrist.  He *certainly* was not fired and I've taken the opportunity of glaring at him whenever I've seen him (when I had to have my radiology information transmitted).  The co-worker who communicated the radiology clerk's comment to me, later told me, "I can't believe you wrote an incident report about that." (!!))

I know the laws, of course. But lots of people in my department are not sensitive to them.  I keep on telling others : would you really want all your co-workers to know if you, say, had AIDS, or was raped, or had a mental illness, or were incontinent or had athlete's foot.

While the HIPAA officer has said patient info is on a 'need to know' basis, and that any unauthorized access is subject to termination, (I have been told *I* need to sign a consent form to access my *own* medical information), I know the hospital culture has been different than this, and I want to be prepared. (I could relate other incidents, but I don't think I will.)

Thank you all again! You have really helped me.

hymil

Different surname, yeah so What's it to you who i maried at the weekend? Great time for Mr Right to show up....  one situation where it's easer for women to bluff it out than men....

or, I just met my amazing birth mother...

or, seems like Nobody in this darn town can spell Smith, so I went back to Erykksohn

or, who's this Leaf girl? I told you, I'm Queen Victoria! (this could get you heavily medicated, however)

or, You really think I look like that beautiful Leaf? Oh, Thank you SO much, you just made my day! (remember not to laugh out loud or sound sarcastic, it's a real compliment. You DO look very like her)

or, no actually I am the director of security, come to do the annual mystery inspection, (so you all best behave yourself!!) And your name is - ??  (so i can report you!)

One warning, then violence or legal action.  And that email you sent round, that was the one warning.

jenn3

a question with a question.........

"are you leaf"

"who's leaf"

"you look like leaf"

"is she good looking"

or ignore the question completely and turn the other way  - that would send a message.

Honestly, I can't believe that they violate the HIPPA policies the way that they do and am sorry that you put in such a bad position. 

AnneW

Leaf, this is major HIPAA stuff! I agree with what everyone else said. What happened to you 5 years ago was no incidental disclosure, it was a major breech. Hanta Yo had great advice.

Best of luck,

Anne

hymil

What about dark glasses and a wig? I'm sure the celebs do that when they want to look...er, i was going to say normal, but it wouldnt be quite my idea of normal...  If you focus on the bright pink wig, it might confuse a few, and embarass several others. Stunned silence would be probably better than intrusive questionning! Maybe don't use the false beard and the glass eye though!

Joke: He: Is it true that you always answer a question with another question? She: Who told you that, then?

leaf

That is hilarious - "If I told you, I'd have to kill you." in a deep, dark voice.   I'll have to practice to make sure they know I'm playing with them.

I just hope they wouldn't put me in a straight jacket!  (I have a PTSD-like diagnosis, but I do cringing and, when severe, gasping/trouble breathing.  I don't do commando-type stances, luckily.    I don't look forward to telling them about THAT. I have enough problems just *criticizing* my own psychotherapist.)

I'm keeping ALL of these responses in my armamentarium.  I do have electronic surveillance on my electronic records.  

I'm afraid I may need these techniques; my late friend, a postop RN, worked with all these women, and many of them took turns in taking care of my friend at my friend's home before she died of pancreatic cancer.  Since I saw my friend very, very regularly, most of them know me.

I know you SHOULDN'T have to be concerned about this. 

I had the following conversation when a co-worker had a baby. (The co-worker had a  baby shower so it was obvious she was pregnant, and her absence was described as maternity leave.)  Him:"Well, did she have her baby?"  Me:  "Yes."   Him: "Did she have a C section or a vaginal delivery?"  Me: "I have no idea."  Him: "But wouldn't you want to know?"  Me: "No, not unless she chose to tell me herself.  Of course, I hope both mother and baby are doing fine."

Another co-worker as I entered for work: "Eeck, XX is in the hospital!"  (An employee.)   I told him he just breached confidentiality.

When another co-worker got  prostate cancer, he told everyone personally "because they deserve to know".  But he didn't have the experience of people telling him he should be castrated the night before surgery.

About a month after my breast excision in 2006, another coworker (who I had not had any direct conversations with) said to me, "I must be the last one to know about your breast problems, but good luck on your breast conditions."  I either said nothing or Thank you. I was so taken aback.

Thank you all so much again!

ktym

I've used this one:

  "Are you ----  who works in ----?"

Total blank stare as you reply "Who?" 

It worked well along the lines of "why is/was your hair so short, did you have chemo"  "What?"  or "Why would you think that/"

The answer back is usually "never mind".  You didn't lie or deny, but, most people won't put themselves out there enough to ask a second time,kind of like asking someone in the grocery store you haven't seen in years if they are so and so and then being embarressed to find out they aren't.  Some are too rude, are just plain nosey and nasty, and need threat of firing, bodily harm including under the bus, but this deters a wide variety of the only mildly curious.

Hugs Leaf. Will be thinking about you, 

leaf

Thanks so much, kmmd.  I think I'll start with 'Who?' with blank stare, escalate to 'If I told you, I'd have to kill you", then, if I get anything more, it will be incident report/legal time.

My procedure isn't until Jan 25 (assuming it all gets OKed by insurance, etc.)  I'll post what happened (or didn't.)

I *really* appreciate the time and creativity all of you have taken to help me with this problem!!!

flash

Leaf- everyone's beaten me to the punch with great ideas.  I just wanted to say good luck on the upcoming surgery.

hymil

I did meet a choir-friend from previous church when i was in rads, he was in his white coat and he kind of looked at me as if to say, What are you doing here, well it was fairly obvious what i was doing there, I wasn't waiting for a bus and I wasn't dresssed for an interview to work there. Clearly then I must have been waiting for treatment, and I could see him mentally struggling with, Could it be the same woman? I would have forgiven him for going to look at the list to spot my name, and I would have been quite happy for him to admit he had recognised me and waste two minutes of his precious time to come over and wish me luck. But he didn't.

leaf

Thank you, flash and hymil.  

Hymil: I had a similar experience at the Cancer Center.  I found it upsetting that when health professionals walked through the large waiting room, they NEVER looked at any of the patients, never smiled or nodded, never acknowledged their existence.  I used to/currently work with two of the pharmacists there, but this happened even when I was at the Cancer Center almost every weekday for 3 months (taking my late friend with pancreatic cancer). I didn't mind for my sake, but I would have felt even more isolated had I had a bad prognosis, like my late friend.

You don't have to know someone to smile and nod your head and acknowledge their existence.  It felt like there was a big line in the sand between them and us, the patients in the waiting room or their caregivers.  It felt like they were saying nonverbally, "because you are a patient or caregiver, you have coodies, and cancer will never happen to us or any of our family or friends."

While I don't want my colleagues or supervisor to know my medical diagnoses, I think it is only human to want to be acknowledged.

barbe1958

Ah, now you're asking for what you don't want. You dont' WANT to be acknowledged....I thought.

leaf

Oh yes, Barbe - I want it both ways!

Well, I got another suggestion from my therapist. (I think I'll start with "Huh?")

To reply to "Are you <leaf> from Department X upstairs?"

"This is an inappropriate question."  or, more forcefully, "I find this question offensive."

To reply to: "How come you changed your last name?"

"To avoid questions like this."

Note: I doubt if many of the pre/postop nurses know my last name.

To those of you who are nurses: Would you be hurt by these replies?  How would you feel and respond?  Do you think they are appropriate?

barbe1958

I would find it offensive, which is why gentle humour could ease the moment...shh, I'm incognito today!

hymil

"My armband matches my consent form, the operating list and my x-rays, big black arrow on the correct bit of my chest, i had nothing to eat or drink since last night not even gum, and I have discussed my allergies, blood group and potential issues with PTSD and intraoperative-drugs with the anaesthetist. That's your job done, What's it to you who I really am?"

How ever do they manage when the President has to have surgery, or the royal family girls have thier babies? I'm liking the therapist's take on it, and her solutions. I think the forthcoming (Yeah right!) BCO book could easily make a whole chapter on this issue.

leaf

Thank you,both hymil and Barbe.  If anyone else has any more comments, I'd love to hear them.

leaf

My pre-op appointment was on Wed.  I was so nervous.  My pre-op nurse was a co-worker of my late friend (who died in 2008).  I had met my pre-op nurse several times during this time.

First I filled out a written questionaire. Luckily, there were no questions about mental health. (Yes, I will tell my nurse about my PTSD when I have the procedure.)

My pre-op nurse greeted me after calling my <alias> name with,

"You're a familiar face, aren't you?" as I was getting up from the chair.   I didn't expect this so early in the interview, for some nutty reason.

I wasn't resourceful enough for Barbe's good suggestion, and I went with 'I think that's an inappropriate question."  

She asked again, "But I know you from somewhere, don't I?"  

I replied, "I think that's an offensive question."

She apologized, and said she only intended the best.  I was, of course, very scared how this was going to go, so I spoke in a monotone for the next several minutes.

I then realized I was speaking in a monotone, and I was highly aware the preop nurse was probably hurt and puzzled by my answer.  So later in the interview, I said, "I have had my confidentiality breached in the past."  

That allowed her to relax somewhat.  Since I had had several surgeries there in the past, she asked about anesthesiologists.  I said I had thought all my anesthesiologists were good; I just didn't like it when I didn't have one. (Thinking of my traumatic wire insertion.)  She asked if I had a preference.   I replied with the names of the two anesthesiologists I had before; neither of whom would be working that day.  She said she only wants me to be comfortable.  I requested a female anesthesiologist if possible and said I totally understood if there wasn't one available.  (I'm having another D+C on tamoxifen- I know my uterus is hard to visualize because  its all folded up. On my last D+C my gyn was doing it blind.)

When I had my blood drawn, because in a 'former life' I had to draw blood from mice for research and was very bad at that, I talked about how much I admired people who could draw blood from humans.  He asked what I did now, which made me afraid again, but I said something very weak like, "Oh, this and that."  But what I liked is that he accepted this and didn't press. 

If I'm less nervous, at the procedure I will try the 'I'm going incognito today', but I don't know if I will be too afraid to remember.  I sure don't want to hurt or alienate my nurses, but I do want my confidentiality intact.

I'll post how the procedure goes next Tuesday.  I appreciate so much that you are reading this and providing your input.  It really helps so much.

barbe1958

Leaf, I'm pretty sure you won't hurt anyone's feelings. Typically, I try to add humour to my procedures and make THEM feel at ease. Why should I? They are just doing their job. They probably would think that you are nervous. That's all. You done good!

leaf

Thank you so much for your encouragement, Barbe!  It means so much to me!

ebarnes48

when I was in the RAF I was known by a nickname, and nobody knew my real name.Another girl who was a dental nurse, who wasn't allowed to reveal anything on my medical charts. started telling everyone my real name and how many teeth I had filled etc. she almost got herself dismissed from the  RAF. this insident was 30 yrs ago. then and now workers shouldnt be  revealing any information on your charts or telling anyone your medical history.

leaf

I know they aren't SUPPOSED to. But I am still concerned when a fellow employee is concerned.

When my late friend got pancreatic cancer  3 years ago (an RN who worked for 5-10 years down in this pre- and post-op surgery dept), I asked her about how she she felt about confidentiality about her diagnosis:  "Even if I wanted it to be confidential it wouldn't be." That makes me concerned. My friend had one doc who she worked with (not one of her own docs) who she found intrusive.   She dreaded his calls. He was calling her every week or two at  her home until she died.  But my friend had a hard time with boundaries.

We (in the hospital) got an email from the HIPAA officer that it was overheard that a group of nurses were considering looking up fellow nurses' medical records - 2 of their nurse co-workers have a very serious, often fatal  illness.  The nurses had been asked to contribute to their COBRA fund.  The HIPAA officer assured them that if they look it up, they would be subject to termination (but didn't say it this clearly IMO in his email.)

The radiology clerk who recommended that I have bilateral mastectomies was NOT terminated.  I have not heard of anyone who was terminated for confidentiality breaches.  

When I had my alias set up, they said, "We can track when people look up your info, but we can't track when people talk, and we can't prevent people from recognizing you."

 At my procedure, if I am clever enough, I hope to start with 'Ah, I'm going incognito today."  If they persist,  I plan, "I feel that is an inappropriate question."  If they still persist, I plan 'I feel that question is offensive."  If they still persist, I'll tell them "I have had confidentiality breaches in the past, and that question is offensive to me."  If I haven't already, I'll tell them my confidentiality was breached in the past. If they still persist, I plan to either repeat this or ask for a HIPAA liason.

I am so glad I had some sort of strategy, and with your help, I have one.  I feel I needed it last Wednesday.  I don't know if my Wed pre-op nurse would have revealed my medical information to anyone. But it definitely made me nervous when my late friend said she was confident that her medical information spread through her department like wildfire.  That's why I want to have a strategy in place, and don't reveal information to people who don't have a NEED to know (such as my anesthesiologist, immediate care nurses.) I have a PTSD-like condition, and I may cringe.  I have a mild lung condition that may be relevant to the anesthesiologist.  It is from a rare condition that has a variable outcome, but can be fatal.

I know some people in my department would have a field day with my information.They would remember it, since they work with me.  After my LCIS excision, I had a co-worker come up to me and say, "I must be the last person to know about your breast condition, but you have my best wishes...."  Gee, that made me feel good-not.

barbe1958

The day I was having my double mast (cancer already confirmed) the volunteer came back into the green room where family could still sit with us gowned-up patients and said very loudly "Who was it I told to take their underwear off? You can keep it on. Oh, there you are!" Then she stood in front of me and told me that she "had what you have and here I am 22 years later!!". I'm sure everyone is wondering what I "had". My room-mate the first night was in the room at the same time and everyone was SOOOOOOO embarrassed for me and thought I acted with such class. I guess I was just too stunned to respond!