That is a good question to ask yourself when retelling a story, BUT it is absolutely not the legal or ethical standard that you need to meet. The legal and ethical standard have to do with whether someone else can recognize the patient. The actual patient may well recognize their own story because of the confidential data that they are a party to, such as the things you said or did.
Another thing to consider is whether the patient would want that story told. On more than one occasion, a patient has told me they hope I get into medical school while thanking me. Ask yourself: would the patient want to help you in this way, by being mentioned anonymously? You are legally allowed to talk about patients who hate you (with sufficient anonymity), but on ethical grounds I think it is better to tell stories about patients who like you and would want to help you get accepted to medical school. On a similar note, a story about gout is less sensitive than a story about gonorrhea, although the legal test is the same.
If a patient's family members were to recognize themselves in your anecdote, do you think that they would feel that their privacy was violated or not?
According to HIPAA, a patient's information is "deindentified" if the following are removed:
2)
(i) The following identifiers of the individual or of relatives, employers, or household members of the individual, are removed:
(A) Names;
(B) All geographic subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of the Censue:
(1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and
(2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.
(C) All elements of dates (except year) for dates directly related to an individual, including birth date, admission date,, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;
(D) Telephone numbers;
(E) Fax numbers;
(F) Electronic mail addresses;
(G) Social security numbers;
(H) Medical record numbers;
(I) Health plan beneficiary numbers;
(J) Account numbers;
(K) Certificate/license numbers;
(L) Vehicle identifiers and serial numbers, including license plate numbers;
(M) Device identifiers and serial numbers;
(N) Web Universal Resource Locators (URLs);
(O) Internet Protocol (IP) address numbers;
(P) Biometric identifiers, including finger and voice prints;
(Q) Full face photographic images and any comparable images; and
(R) Any other unique identifying number, characteristic, or code, except as permitted by paragraph (c) of this section;[related to making new code numbers for later identification]
