About HIPAA rules

[deleted158872]

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do a patient's family members or loved ones have the right to know about the patient's diagnosis, treatment plan or anything related to his illness that he didn't or doesn't want to disclose to them?
if a family member worries and comes to you and inquires about your patient's illness, while the patient has not signed a consent form to give out information, what would you tell them?

 

[Wordead]

No to all of the above. Tell them you cant discuss it with them.

You can with written authorization from the patient or if they're POA.

 

[Psai]

"I'm sorry, I know that you care a lot about Mr. whoever but I can't give out any information about them without their consent"

 

[deleted158872]

Thanks

 

[baxt1412]

if it's not on paper, it doesn't exist. (this goes for any field, essentially)

obviously a different caliber, but I went through the same thing with me being an RA for 3 years. Parents would call the dorm asking us to check on their kids - "they haven't called me back in days/weeks/months.... how are their grades doing (not that i even have access to that).... if i stop by can you let me into their room?... etc ad nauseum."

I just told them that I am legally obligated not to do any of the above (besides simply checking on the student and telling them that they should talk with their parents, but beyond that... yes) and that I can't break federal law no matter how bad they want to know some things. Same thing went for if a random student came in and wanted to know what room another student lived in.

Your hands are legally bound

 

[baxt1412]

This is incorrect. Verbal consent is routinely obtained for family members. Example: you come into a room for a patient encounter, wife is in the room. You say, "Is it okay if we discuss your results with your wife?" Patient says yes, move on. No need for a written consent.

i meant in the context of what I took OP's message to be, which was not in the presence of the patient who would likely give consent if they can and wanted to.

if a family member worries and comes to you

 

[baxt1412]

That's fair.

However, also worth noting that if the patient is incapacitated, and the aforementioned family member is their next of kin, they have a right to get all that info even in the absence of a signed consent. We've had cases of wives making decisions for men, even though they had been separated for some time.

how does medical power of attorney work? that would be only if the patient is incapacitated right? not if they appear lucid?

 

[baxt1412]

Exactly. When a patient has decision-making capacity, we are still required to obtain their consent to share their information, even if it is with the person who is their designated medical power of attorney. However, if the patient is incapcitated, the medical POA kicks in, and we share info with the designated person.

The problem arises when a person does not have a medical POA. In those cases, it defaults to the next of kin, or whatever is specified under state law and standard practice (sometimes, for example, there is no spouse and multiple children, so then things start to get sticky). We have seen multiple cases where the incapacitated person clearly would not have chosen their next of kin as their medical POA, but because there is no legal documentation, we listen to their next of kin.

And it can get ridiculous. I saw one case many years ago at an outside facility (not my home hospital) where a wife was coming into the hospital to sign papers and make decisions about a man's care, and the wife's boyfriend was with her to provide "support." The guy's siblings were going nuts over the situation, but nothing anyone could do about it.

yeah, all the more reason to have well-laid out decisions about your life and have your family know your wishes, no matter how hurtful it may seem to some of them.

you think that is bad, hopefully as physicians we will be leaving substantial wealth to our family upon our death (some people intentionally elect not to do that which is fine).... add millions on top of a sticky DNR, life support, etc decision and it gets even worse i'm sure.

 

[baxt1412]

Best is when multiple "wives" show up

HomerSimpsonBush.gif

 

[baxt1412]

Oh no, I've already told my kids that they're getting nothing. I'm going to spend every dime.

that's not an uncommon mindset for many people.

 

[Goro]

I had a great-aunt, quite well-to-do, who indeed "took it all with her". Pissed my mom off to no end.

Oh no, I've already told my kids that they're getting nothing. I'm going to spend every dime.

 

[deleted158872]

1/ Are physicians allowed to say general things like, "Don't worry, your spouse isn't at significant risk?"

2/ If a patient has HIV, should physician disclose the information when his spouse asks? Or do physicians have a duty to disclose it without being asked?

 

[hmockingbird]

1/ Are physicians allowed to say general things like, "Don't worry, your spouse isn't at significant risk?"

2/ If a patient has HIV, should physician disclose the information when his spouse asks? Or do physicians have a duty to disclose it without being asked?

1. No
2. I believe you have to report HIV patients to the health board. But you still can't tell anyone personally without the patient's consent (unless they are unconscious and need treatment as above).

 

[TraumaLlamaMD]

Oh no, I've already told my kids that they're getting nothing. I'm going to spend every dime.

That's exactly what mine told me, seems fair enough!

 

[TraumaLlamaMD]

I had a messy case once where a patient was deemed to lack capacity to refuse admission, so her mother (in Florida) served as her decision maker while she was treated in our part of the country. However, it was also determined that she did have capacity to refuse disclosure of her HIV status to that same decision maker, which seemed to complicate things greatly in terms of updating the mom, helping her with placement from afar, etc - given this patient was in the hospital solely due to HIV complications.

 

[giantswing]

Best is when multiple "wives" show up

Had someone show up, claiming to be the patient's bestest, dearest friend. Actually, they were having an affair w their spouse. Tho i suppose they really could have been both.

 

[deleted158872]

^ lol

 

[Kaustikos]

I'll also add that you should use common sense. If you're rounding with lots of people, have only the resident and intern come with you. I've seen how awkward it is to have a crowd of people staring. Especially when it causes a distraction and no one notices the wife in tears.