Confidentiality

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In California and most of the United States it is illegal for a health care worker to reveal any of your information to another person who is not involved in your health care. The only way around this is a court order.

Many laws govern this. You may recall that several people were fired when the hospital administration discovered that employees, including physicians, have looked at the paper chart or the computerized medical data of a celebrity without the permission of that celebrity. They have looked out of interest, curiosity, and sometimes have sold the information to a tabloid reporter for a large price.

16355831There are two forms we use in the hospital and medical offices: a form from this office to obtain information from another office or hospital and a form that we receive from another office to release our information on you to them. You must sign the form in order for anyone to legally release the information.

The forms usually have 3 lines you must initial: one for HIV related information, one for mental health information, and one for drug abuse information. These are called specific releases. If you do not initial these boxes and your medical record has information on these topics, then we would be in violation of the law in releasing that.
This may present a problem. Suppose you don’t mind if we release information on your back injury you experienced at work but don’t want us to release information on your HIV status. When you come into the hospital or clinic, we don’t write a note that separates the two problems, and the clerk who is copying the record doesn’t have the time to go through each page looking for HIV information which may be mixed with the back pain information. So my recommendation is not to copy the chart unless the 3 lines are approved by the patient. Maybe the patient should see a non-HIV specialist for the back pain to keep the information separate.

If I am in a clinic or hospital room and I mention that the patient has gonorrhea or HIV in front of someone else in the room besides the patient, I have broken the law unless the patient has given me permission to speak freely. We recently had a patient die who had not gotten checked for HIV before admission. She was awake the first couple of days I saw her and then in a coma the last couple of days. She didn’t want her family to know about the HIV besides the son. The physicians caring for her in the intensive care unit tried to answer questions as best they could but still withheld the information about the HIV. This is no easy task. When I was asked what my specialty was, I mentioned my general specialty: Internal Medicine. I didn’t mention why I was seeing her or my sub-specialty: HIV. I didn’t give them my card which mentions that I am the Medical Director for HIV Services. Spouses, friends, and employers will tell me things about their spouse, but I cannot volunteer information back to them without the patient’s permission.

In San Diego, I practiced there for 13 years as an HIV specialist, also seeing some Internal Medicine patients. It being a smaller metropolis, I was known as an HIV specialist, so if a patient said they were seeing me, then their friends might assume that HIV was involved. If I saw a patient in public, I wouldn’t acknowledge them unless they approached me since my being seen talking to them might cause others to question. I didn’t have this problem in Los Angeles since it had such a large population.

Revealing information is also restricted in casual conversations. I cannot discuss names with my spouse or friends. We health care workers should keep our voices down in the hallways and elevators.
Arrowhead Regional Medical Center, the county hospital for San Bernardino County, has a strict rule and software that prevents me from downloading information on patients to a thumb drive or pasting it in an email. I had to find a way within these restrictions to perform my billing sheets electronically.

When performing research on a patient there, we may take away on paper or in our laptop computers, information that is approved by a committee that makes sure that we are protecting patient safety and confidentiality as long as it doesn’t have patient identifying information on it: name, birth date, social security number, address, phone number, etc.

Whenever you enter a clinic or hospital, there is a phrase on the paperwork that states you will allow them to share your information with the government inspectors, those involved in your care now or in the future, and the insurance companies. Rest assured that I have never heard of a case where the police or the immigration officers requested information without a court order. If we give such information to them without the court order, we can be sued since we have broken the law.

So rest easy. You can trust us. Your secrets are safe with us. Tell us the truth.

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