Patient story in PS- violate HIPAA?

[MDOnlyWillDo]

I have a patient case that I'd like to write about in my PS. I won't be using any patient identifiers at all, or hospital info, etc, just giving basic details about the disease. But it might not be hard for the readers of the PS to figure out which hospital I was at with this patient, and the timeframe will be in the date section of the experience box. To complicate matters, the case is a bit unusual- its not a common ailment. For example, if I'm talking about an eye surgery involving a worm in the eye, and in my shadowing experience I followed an opthamologist during Nov and Dec, they could put 2 and 2 together.

So if I were to talk about this case (not even the patient, just describe the visuals and my experience) would that be a HIPAA violation?

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[NickNaylor]

Leave out as many details as possible. They might be able to put two and two together, but I don't think they'll be too worried about it. They have to expect that most people will talk about their clinical experiences to some degree in their PS.

You could also not talk about this specific encounter unless it was absolutely essential to your decision to become a physician.

 

[vballer]

I did this for a similar scenario and was very vague on details. Worked out fine, no problems whatsoever.

 

[MDOnlyWillDo]

Thanks for the advice. I think it is essential, as it applies specifically to my interests, to explain why I'd be more interested in emergent eye surgery to save the sight rather than routine eye surgery.

But how vague? How vague can you be about a worm in the eye? (That's obviously not the case, but it shows how difficult it can be to be vague in an unusual case.)

 

[whoknows2012]

its not a HIPAA violation so long as you dont give identifying details. Otherwise every case study we do in small groups/lectures in med school would be a violation. Now OTOH I wouldn't go crazily in depth in terms of details of the case, but thats mostly because its probably unnecessary in terms of the point your trying make. Either way your fine.

 

[whoknows2012]

.

 

[RingTailedDoc]

Thanks for the advice. I think it is essential, as it applies specifically to my interests, to explain why I'd be more interested in emergent eye surgery to save the sight rather than routine eye surgery.

But how vague? How vague can you be about a worm in the eye? (That's obviously not the case, but it shows how difficult it can be to be vague in an unusual case.)

You could say you encountered a patient that had a rare medical condition. Instead of treating the condition with conventional means, the surgeon took a risk and opted for an emergent surgery that ultimately paid off/impressed you/made you want to be a doctor. You don't need to go too much further into detail, as it will eat up some of your characters that you could use to describe you want to be and why you would be a good doctor instead of trying to explain why the doctor you shadowed makes a good doctor.

Also, be wary of saying things like "i want to be on the cutting edge, etc., that's why I want to be a doctor". Yes, you will probably experience interesting things while practicing, but the majority of your time will be spent doing routine exams, procedures, etc. Make sure you're not coming off as somewhat ignorant of what a career in medicine would actually be like in describing your unique experience

 

[music2doc]

I always combine multiple cases into one. Instead of not providing pt identifiers, I give them a pt that doesn't exist and make the details all work together. It allows me to talk about individual situations without any possibility the pt I'm talking about could be "found" (because they literally don't exist -- at least not in one person).

 

[rhesuspieces]

I always combine multiple cases into one. Instead of not providing pt identifiers, I give them a pt that doesn't exist and make the details all work together. It allows me to talk about individual situations without any possibility the pt I'm talking about could be "found" (because they literally don't exist -- at least not in one person).

This is what authors like Gawande do too. OP, you need to alter the details of the case to protect the patient while preserving the "take home message" of the experience. You might consider finding another condition that would require emergency eye surgery and altering your story accordingly.

 

[Syqers]

You could also change details about the patient, like the gender, age, etc. You could use a name like "John Doe" so the school knows you are being conscious of privacy laws.

 

[szhao42]

I mentioned something something similar to this in my PS, though I didn't say anything about specific symptoms. It was quite brief (just a sentence), talking about a couple people who came in the ED (cardiac arrest, mental health). I did mention the age / gender, but I made sure to change it so they couldn't be identified. For example: 65 year old man who came in for cardiac arrest. As long as it has impacted you in a significant way, and doesn't give out obvious details like the name, race, dates, etc, there shouldn't be any issues. The adcoms read plenty of these "unique" patient experiences / interactions and understand for some people it is worth mentioning. Just stick with general info, change it up a little if necessary, and your good.

 

[LizzyM]

Be careful that you don't change a detail that is crucial to the story. Stating that a patient arrived from British Columbia with Chagas disease is not as plausible as a patient with Chagas from Colombia.

Here's what the Yale U site says about HIPAA and Personal Health Information (PHI) (it is the first one that popped up on google)

Data are "individually identifiable" if they include any of the 18 types of identifiers, listed below, for an individual or for the individual's employer or family member, or if the provider or researcher is aware that the information could be used, either alone or in combination with other information, to identify an individual:
■Name
■Address (all geographic subdivisions smaller than state, including street address, city, county, zip code)
■All elements (except years) of dates related to an individual (including birth date, admission date, discharge date, date of death and exact age if over 89)
■Telephone numbers
■Fax number
■Email address
■Social Security number
■Medical record number
■Health plan beneficiary number
■Account number
■Certificate/license number
■Any vehicle or other device serial number
■Device identifiers or serial numbers
■Web URL
■Internet Protocol (IP) address numbers
■Finger or voice prints
■Photographic images
■Any other characteristic that could uniquely identify the individual

Instead of removing the data, sometimes making the information more general is sufficient for de–identification; for example, replacing birth date with an age range.

 

[Ride Big Sky]

Including an experience like this can really add to a PS if done correctly. Just don't include many specifics and you'll be all set.

 

[pkwraith]

Outside of the basic identifiers, I just wanted to add one more comments. You said that this "worm in eye" was fairly unique.

JCAHO interpretation of HIPPA make account for certain rare, specific chief complaints and illnesses as identifiers, especially in smaller cities. However, that regulations is typically only applied to public display of information in EDs/hospitals.

However, without a second identifier, you should be fine, as I doubt "worm in the rare" would be that unique enough to be a primary identifier.

 

[Alejandro]

I'd say that you wouldn't want to include a LOT of info because i think it really speaks little to your clinical experience. For example, the person's name, DOB, location, for starters...is pretty useless and is just excess fluff for your PS, when you should be devoting it to how that exp has influenced you. I had the same thing, and then i realized that i only needed one short sentence to describe what the patient did: ate razor blades, toothbrushes, and pencils and was in jail. And i only included them just because it was relevant for describing the story and how I was involved (why he was suicidal, motivation to talk with him, the impact i had on him and vice versa). Otherwise, yeah...names and too many specifics, etc...really doesn't do much for your PS, frankly speaking.