How to respond to identity suspicions at work?

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.

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.

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?

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.

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

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.