Confidentiality - when the patient is a health care provider
I am sure I am not the only person in this position. I am a pharmacist at a hospital (with 3 campuses), and my medical insurance covers best when I use my multi-campus health care system.
Perhaps someone will give me ideas about options I might have in my situation.
I have most of my health care at my hospital, or one of its campuses. If I go to another facility, it would mean I'd need to pay at least 20%. I only have LCIS and nothing worse, and I go to the cancer center on another campus. I have one immediate supervisor who works both at my campus, and in the cancer center as a pharmacist.
At my last oncology visit earlier this month, they asked me to update my meds and what they were for. I wrote this down, but since my supervisor was working that day (I saw her walk down the hall as I was registering), I wrote on the list I did not want my supervisor to see or enter this - that I only wanted persons to input this who didn't know me.
I told the technician who picked up my sheet I wanted my medical information confidential. He didn't respond, so unfortunately I upped the anty. I asked him how he would like it if his co-workers knew, for example, if he, say, had a gender change, or if he took a med to keep from killing people. Still no response. So I said, well, how would you feel if co-workers told you that you needed to have your genitals removed? (I had this happen to me 5 years ago; the radiology clerk, essentially a male stranger, told a co-worker to tell me that I needed bilateral mastectomies because he had a co-worker with LCIS and that's what she did. I had only told some people at work because I wanted them to understand that when I cried at work it was not anything they had done. When I cry my eyes turn red and puffy for the next 12-24 hours. So when I saw a person had been admitted that had metastatic breast cancer as a diagnosis on her orders, I burst into tears. I had one co-worker who said, 'I must be the last one to know about your breast problems.' I just stared at her.) I wrote an incident report about my confidentiality breach 5 years ago, and everyone got a stern lecture that 'confidentiality was important'. Later the co-worker who told me said she could not believe I wrote an incident report about that. I'm sure it doesn't help that I have a PTSD-like syndrome for childhood sexual issues,that I got diagnosed with a few months after this confidentiality breach 5 years ago.
My request (to not have my supervisor see my medical information) eventually 'upped' to the head HIPAA officer of the 3 campuses, and he said he cannot prevent care-takers from your medical information, and there is no way to track when people say things to each other. He said I should care at another facility. I don't want to do that because I have another serious diagnosis, which is quite rare, which has no treatment (except symptomatic), and has a very variable course but one 2003 paper gave a mean survival rate of about 11 years after diagnosis. (I get followed at a major institution for that because its so unusual. It can cause a lot of disability, at least when it progresses. I am in the early stages, and obviously I hope it doesn't progress.) Since my insurance has a lifetime cap, and I am my sole insurance provider, I'd rather not get care elsewhere, where it would be more expensive. He said he can put a tracker on who electronically accesses my medical information. Of course, that does not mean people won't talk. My immediate supervisor, and one other person, are the only pharmacists I know at the cancer center. The HIPAA officer said I can pick if I want 2 people to enter my info, but of course I don't know any of the pharmacists there, so I don't know who is trustworthy.
Lots of people in the pharmacy (including some pharmacists) don't understand that they may not want their co-workers and supervisors to know their entire medical history. I have a PTSD-like syndrome, and this potentially serious illness, and I want to be judged on my work. I know employers are not supposed to fire people because of their medical diagnoses, but I know this has happened; they find a way to let the person go.
My therapist said next time I get a request to list my medications and diagnoses to just say 'Patient refuses'. I would, of course, tell my doctors, but I don't want this to get to my supervisors or people in my department. On one of my procedures, the pharmacist who would get the list of the meds I was on said of a fellow employee who had a baby and whether she had a vaginal delivery or a C-section, said 'Well, wouldn't you want to know?' I replied, "No, not unless the person told me him/herself.
Does anyone have any other thoughts about what I might be able to do? The HIPAA officer refused to give me an alias, and said it messes up insurance billing. (I have an unusual name, so its not possible to hide behind a common name.)
Comments
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That's an excellent question. I work for a major pharmacy chain and our insurance only pays if we get our scripts filled at one of our locations. I havn't had a problem yet, but if I did, Human Resources would be the first place I would start. People get fired for discussing patient info. Our company has a zero tolerance policy when it comes to that. It looks like your hippa officer would have been more helpful, being a Rph you know how serious that is. Shame on them!
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leaf, I was going to suggest something, but then I changed my mind. So, I need to think about your situation a little longer. I imagine that it's fairly common for health care providers to find themselves in this same dilemma.
otter
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Leaf, I'm sending PM
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I've worked in a hospital ER for the past 10 years. While I hear your concerns and preference to keep your private medical information completely confidential, I'm afraid the only way you're going to ensure that this happens is to seek care elsewhere, despite having to pay more out of pocket. If it's that important to you, then it will money well spent. I know it shouldn't be necessary to do that, and if we lived in a perfect world it wouldn't be, but none of us live in such a place.
It's a very small world in the hospital environment, sometimes even with multiple campuses because people sometimes rotate among them. So just the mere fact that you're working so hard to keep everything hidden has likely already got the tongues wagging Even if they never actually find out exactly what it is you're trying to hide, they'll be wondering. If people get wind of you approaching the HIPPA officer and raising issues about confidentiality, there are going to be some who will do everything they can to avoid being your caregiver when you're there as a patient - and you certainly don't want the best and the brightest begging out of caring for you for fear of being blamed should some bit of information about you leak out, because it's the best and the brightest who will know enough to stay clear of you.
I know this is probably not going to make a bit of difference in how strongly you feel about maintaining your confidentiality, but I'm going to say it anyway. Assuming it's just your psychiatric history that you're fearful of being disclosed to the supervisor and co-workers - and unless this problem is negatively effecting your job performance - you might be surprised to find out that it wouldn't really make any difference to anyone in how they feel about you if they knew. .
Were I work, and I'm sure it's true just about anywhere, we have nurses on psych meds and many of us have one or more serious medical problems. We, and that includes the doctors and PA's as well, all know most everything about each others personal lives and medical histories - and nobody thinks any less of anyone else because of them. Our ER has a disporportionately high number of psych patients and many of the crisis counselors who come in to evalute these patients and make decisions on what plan of treatment best serves their needs have a psych history themselves. and are on many of the same medications as the people they're evaluating. They do their job exceptionally well and they're a vital part of the care provided to these patients. Nobody thinks any less of them because of their personal history and we admire them, highly value them and consider them an intregal part of out patient care team.
I assume you probably already know about FMLA, but if not here's a link -http://www.dol.gov/whd/fmla/index.htm
If you qualify, it will protect your job for up to 12 weeks straight or should you need to take days off here and there for medical reasons. We have 2 nurses who have serious medical problems on it. They have to call off a day here and there sometimes, but they can't be fired because of FMLA.
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I agree with going to HR. That HIPPA officer could himself be fired for treating you that way. A co-worker at the hospital I work for came within a whisker of getting fired for reading the chart of another co-worker's child she wasn't taking care of. The parent had gone home and the co-worker was nosy. It was ugly, but the co-worker parent asked that our fellow co-worker not be fired, although she was very upset that it happened. She's a better person than I am.
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leaf,
I have been there many a time. You do have the law at your side...something that has gotten better over the years. I have found my former co-workers to be wonderful as my caregivers, although I must say I am much more comfortable now that I do not work where I get my health care anymore. I have come a long way in being open about most things....no shame in my game! However, I feel quite differently about my former managers, and saw some very inappropriate behavior after a few surgeries (before BC.) I remember being pushed to get back to work and even was approached regarding skills testing while,in the PACU. My manager wanted me to remember my CBO's were due minutes after I was extubated after having my right ovary out. If I knew now what I know today regarding employer/employee legal boundaries...
so, there is no guarantee,which is incredibly sad.
I am wondering if you can split some of your care (and I am a strong advocate for keeping one's care in one place.)
OR
if you have a procedure, can you request your nurses/tech/PACU nurse? I have a treasured favorite PACU nurse who is the best who cares for me after an awful nurse experince. Here's where you can use your clout! You do not have to have any med students/residents etc...only those for your immediate care.
AND/OR perhaps reaching out to the many resources available through American Cancer Society? I worked with a wonderful cancer patient advocate and did receive some blessed financial assistance...If you wrote a bit about your story, and submitted with the help of a patient navigator, you may get enough help to justify going elsewhere..
I would also approach the outside hospital to see if you could negotiate your 20% co-pay...you do have insurance after all. I would include your insurance company in the negotiation process...any time they would consider another MD/hospital in network will be greatly helpful.
I would also ask for the outside providing hospital to consider using their charity monies to cover your 20%. Every hospital has money set aside for those who do not have insurance. If they even covered one or two surgeries...this would help.
Bills are very negotiable in hospitals...and I think all things are possible. If you had any other ongoing treatments (for example chemo...you would have better control over who saw your med lists in an outpatient setting. (or you should.)
I wish you the best...don't be afraid to ask for help. Your emotional well being is linked directly with your physical (as I am sure you know.)
I wish you the best,
Traci
o.k., those are my thoughts. I really do understand how complex this is, and can only say, you have to be comfortable and minimize your stress in order to heal.
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leaf - I know where from where you come in your concerns. I also am a health care provider as a Medical Technologist and work in a Blood Bank Transfusion service as well as part time in general laboratory. I tried having surgery at an alternate hospital where my insurance still pays. It was for my second breast biopsy and ductal excission. Fortunately it was outpatient and the experience was so negative for me that I chose to only go to the hospital in which I work for future surgeries.
I am a pretty open person about what is going on with me (much to the dismay of my rather prudish director) which I think helps to keep the gossip train in check. No one has to wonder what is happening. The other thing in my favor is that the electronic records and the computer system access to patient info is closely monitored by the IT department. People have been fired if they are found to be "snooping" in patient records that they have no business being in. We have access to a lot of patient information and we try to be very discreet and use it as need to know for treatment protocols. If someone has no blood bank work ordered, we best not be looking them up or we can be fired. We can't even look up our own lab results and such. I guess this helps keep some of the confidentiality.
In your shoes, if your supervisor doesn't know what meds you are taking, it could be trickier, but he/she should also be professional enough to keep any info that she comes into contact with confidential and treat you like any other patient. I know it is easier said than done. On the other hand, when you get a reputation as being a "whistle blower" it doesn't make life easier either. Sometimes it is a no win situation.
My boss is the opposite end of your situation. She is finding reasons I shouldn't come back to work too soon, even though they schedule me, and then gives me menial tasks as she doesn't think I can "mentally" handle my regular job. (Surgery only physically handicaps you, granted some anesthesia fog occurs, but I have never felt my patients in jeopardy after coming back to work). When you try to take a day off, they give you greif and won't give it to you unless you are one of the chosen few - I am not in this category as I don't believe in "brown nosing". I have also been told not to talk to sales persons, nurses on the floors and repair men about my surgery. (Like I'm going to show our favorite repair guy "My new boobs" LOL!).
Best of luck in figuring out your delima. We are certainly all in this journey together and only those of us who travel it really understand each other. The outside world certainly doesn't.
Nancy
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Leaf, patient privacy is a right, HIPPA is a law. Health care workers are supposed to live up to it, not find excuses for why they are just human and exempt from it.
I think the public needs to understand that health care workers are human and make mistakes at times, However, the public enters the health care system scared and vulnerable and expects that health care workers do their best to stive for not making those mistakes and expects those workers to hold themselves to very high professional standards. Certainly many are more open and dont' mind others knowing or talking about their experiences, and may actually find that therapeutic. That is their decision to make, not their boss or coworkers. My sincere hope for you is that you find someone at your institution who understands that and goes to bat for you and allows you to maintain your privacy and rights.
IMHO I know many will disagree, but you hit a sore spot with this subject
Edited to add: Just want to be clear all that I said above I meant to apply only to privacy and access to medical records and have no comment to make on any other professional behavior or standards.
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Thank you all for your thoughts and perspectives. Obviously I have a complicated situation. If you have other thoughts, I'd love to hear them. I'm glad I'm not alone in this.
One of the problems is that if my more serious illness gets worse, in the more lethal situations you are usually treated with very expensive medications, on the order of several thousand dollars a month, on a continual basis, or, in some rare situations, transplants, which have not been FDA approved so would not be covered by insurance.
For now, I'm going to try to find out what information billing requires, and inquire more. I will let people know how it goes.
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Hang in there. We'll be here to support you and listen.
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Leaf, I am a social worker at a VA hospital. I cannot receive care there as I am not a veteran, but my husband is and he receives his care there. Everyone has made some very good comments and I agree that the law is on your side. You should not be bullied/coerced to go somewhere else if this is where you want to get your care. Actually, I'm amazed your supervisor or any one who knows you do not immediately remove themselvesfrom knowing anything about your treatment or care.
When one of the people I supervise has to be out for awhile under family medical leave, I cannot even give the reason why to anyone else without permission. Get your care where you want it and be sure your healthcare info remains protected.
I was very very open about myself and my care to my co-workers, everyone, but that is just how I am. It was when and how I chose to tell them.
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Leaf - I also work at the hospital & clinic where are healthcare must occur or I have to pay "out of network" pricing. Your HIPAA officer needs to be reported. Your computerized and printed medical record are protected and you can ask your HIPAA officials for who has accessed (pulled up and looked at) your record. It is a very tricky situation and I also experienced a Director of another department ask me about a visit for a colonoscopy shortly after my BC dx. A fellow coworker has seen me being wheeled out in a wheelchair and discussed it with this director. Healthcare works need keep even the fact that you have an appointment, are seen as a specific area as a patient as confidential. For your HIPAA officer to say "you can't keep people from talking" is WRONG and absolutely their job to insure employees are educated - especially about VIP's from the community/area and co-workers. Your facility needs to know-even if you have to go to the CEO or Board of Directors. Sounds like your facility needs a new HIPAA officer.
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Thank you all again for your comments and suggestions. Today I may be able to find out what information people who do billing need to have, and what documents they access.
There is a person currently in our ICU who has the name of No, Info. (When she first got admitted, her nurse I guess thought it would make her name confidential if she spelled it instead of saying it. So if her name was Ann Brown, it would be confidential to say the patient's name was A-N-N B-R-O-W-N, lol.) Unfortunately, when we enter orders for No Info, we do get No Info as to her current admission, but her PAST admissions show her REAL name. So, all the pharmacists that enter her orders know her name. I'm sure she wouldn't appreciate this if she knew.
On my last outpatient procedure, I got them to change at least the name on my medication history (that gets sent to the pharmacy) to No, Info.
Now I don't know what billing people need to know for insurance purposes, but I'm sure there are a lot more people named Mary Smith than there are No Info patients. If you have a patient named Mary Smith, you will have to look at other identifying things anyway.
Its very hard to get people to change. I work the graveyard shift. Just last week, there was a new admit,<X>, and I told the next shift because I had ordered levels in an unusual manner on them. The reply from the day pharmacist was, "Is that our <X>?" (apparently a nurse who works the day shift.) I was so mad I could barely contain myself. I said, "I have no idea but it doesn't matter who it is at all." When a tech brought up the issue of confidentiality, and 'didn't seem to get it' - he is a friend to my notorious radiology clerk who advised I have bilateral mastectomies so I'm pretty sure he heard about my bc situation years ago - I asked, "If you had cancer of your genitals, would you like all your co-workers to know?" He did reply no, but I don't know how much impact that had. (In the past, when we had problems getting a blood factor product shipped halfway across the USA for a person who had hemophilia (even some of armed forces got involved) , he remarked, "Well, he probably didn't need it anyways." He doesn't have hardly any medical training - let alone being a doctor - let alone a hematologist.
The overall HIPAA officer frankly sounded uninterested. The cancer center HIPAA officer seemed more concerned.
We may be having TJC (the Joint commission) come this next week, so this is a bad week try to stir up the hive, but I will investigate further in the coming weeks.
Thank you again for your suggestions and support.
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Leaf,
I was a coder at a very high profile clinic... where the athletes go... and their charts were marked with red labels as was their computerized information. It was tracked daily and anyone that tapped into it that wasn't suppose to was fired. I know my coding manager would take employees charts or these high profile peoples' charts and code them herselft than send it on to the manager of billing. I am hoping your facility would show you the same respect if you called them and requested it. I don't know if you saw but somewhere out west-California?- a doctor was fired for just looking at the reason why the athlete was there.Big mistake. This is serious criminal stuff.
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Leaf,
sbmolee makes a very good point regarding the HIPAA officer. That person did Nothing to instill any confidence, and actually (I believe) only served to re-affirm your fears,
In life I do believe "there before the grace of God go I"... in that one can easily find themselves on the receiving end of their untoward actions some day.
This however may not help today, but I hope the support you will receive during these trials will be much greater and stronger than anyone with ill will or immaturity.
I know I had several good people on my side who looked out for me in my stays. I think a lot of health care workers do realize that they could easily be the one on the stretcher, and will try to go out of their way to protect you. This I hope for you. It used to be one of my greatest fears that I did have realized..and I made it though 9 surgeries.
Hang in there, you have all of our support and understanding. I'll send extra prayers of protection for you.
Traci
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Thank you again for your support. I will be pursuing this further, at least after The Joint Commission comes...
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Leaf, I think that the Joint Commission's visit would be a great time to pursue this! I am very angry to hear the lies your HIPPA officer told you. His job is to see that people do NOT talk about confidential patient info.
I'm in the same situation as you. Our institution sends reminder communications every so often that looking in employee's charts unless providing care is grounds for dismissal. I do wonder how much is really kept private. But if I had someone say to me the same crap as some of your co-workers said to you, I would report them gleefully.
If they continue to be weasels, as an RPh you could just leave them in the lurch and get another position elsewhere.
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Well, I just wanted to sort of update this. I got an email from the Cancer Center HIPAA officer (I got along with her the best), and she said I had misinterpreted what had gone on.
She DID let me form an alias (of my choice!) (I have an uncommon last name.) I Googled the most common last names in the decade of my birth in the US. I knew I wouldn't remember Smith or Lee (I'd get them mixed up), so I chose one I'd remember better. Its in the top 30 last names for that decade. I'm keeping my first name because it is in the top 10 for that decade, and I'd want to respond to the right thing if the doc calls me by my first name.
They haven't solved the problem of changing my real name on my previous admits, though. However, the list of my previous admits has shrunk to 2. (I have had many more than 2 procedures at my hospital.) Do they eliminate previous admits after insurance pays for them????
I think some people with very unusual names and/or very unusual spellings of their name might be in more trouble.
Anyway, I'm hoping the pharmacy doesn't ask me any questions on my fall/winter onc visit. When I need another procedure there, I guess I'll be registering under my alias.
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Leaf, thanks for the update. Happy to hear they are working with you and giving you an alias. Cracks me up about googling common names, I wouldn't have thought of that, I love it
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Thanks, kmmd. I'll try to post how this all turns out. A very smart friend of mine suggested the Google method. I found out that my (married female) cousin has a more uncommon last name than I do, even though I'm sure people have a LOT more trouble pronouncing my last name than hers. (Unpronouncable does NOT = uncommon.)
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