Probation due to HIPAA violation

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Hello everyone

I am a 3rd year FM Resident about to be graduating in June. I had a pretty smooth sailing so far and even passed my ABFM board exam. So, earlier in May I got called by our GME director saying I was found to be guilty of HIPAA violation as I had accessed my wife's medical records. At that time, I did say that my wife knew about it and apologized profusely if it was a HIPAA violation. He then said they have a pretty strict hipaa violation policy due to a previous incident and that if I was an attending I would have been directly terminated but since I am a resident they are going to be putting me on probation for hipaa violation until end of my residency. I talked to my PD about it and he said he never had a situation where a resident was on probation for this and could not help in changing my probation to like a warning. Now, I have already signed a contract with another health system to work there back in April. We are currently in the process of credentialing and applying for my state license. I hope anyone can help in answering a few questions I have:
1- Should I inform my current employer or the credentialing dept about this new development?
2- How should I plead my case when I answer yes to the question about being on probation while during residency
3- Will this probation have an effect on my future job prospects?
4- I want to apply for medical license to the states of Ohio, Michigan and Texas as I intend to finally settle in one of those states. Will this probation have an affect on me getting a full unrestricted license.

I know I made a mistake by accessing my wifes record, I am really disappointed in myself and will never repeat such a mistake in the future. I have even stopped my colleagues since then from accessing records they are not taking care of. I hope any of you will help in answering my questions as I am really confused and have no idea how to proceed from here.

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Yeah, I know you want us to say "Oh this is no big deal, it'll probably go away," but I don't think any of us can confidently say that out of hand. This is bad, and it's happening at a very bad time as you transition from residency. As your current hospital said, if you were a current attending you would have been terminated, so it's absolutely conceivable that this could be a deal-breaker with your prospective employer--lots of places have had some sentinel event where they got raked over the coals for this exact scenario. So a lot will likely depend on your new place's hiring policy, and how desperate they are to get you.

Rather than taking random advice from people on the internet, you just need to read the relevant policies for your new employer and prospective state. So I'll address your specific questions, but "read the policy and do that, or talk with a lawyer" is the over-arching theme.

1--most places, I imagine, will have language in the contract that compels you to report if you have some sort of disciplinary action taken against you during the hiring process. So I'd read your contract and any other on-boarding documents you've gotten from HR to see what you need to do, but I suspect you'll need to let them know.
2-Basically as you have here, "I made a stupid mistake, I so sorry and I learned from it, and I'll never it do it again." Not sure what else you could realistically do.
3-Again, it'll totally be dependent on where you're looking to get hired and how far in the future we're talking. Assuming this doesn't scuttle your current hire and you go on to be a model employee for an extended period of time it'll probably eventually be rendered a footnote, but it may well cause you headaches in the short to medium future.
4-You'll definitely need to disclose it. Whether it'll prevent you from getting a license is probably state dependent.

I don't think these answers are what you want to hear, and I'm not trying to kick you while you're down. But I'm trying to give you an honest assessment. If anything is at all unclear from reading the relevant policies, you should get a lawyer to look them over on your behalf and get their advice.
 
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I sympathize with you. I think we have swung the pendulum so far, I think it’s stupid.

I agree with the above poster. With one little point to add. Are you joining a private practice or a large health care system? I’d venture to say most physicians will find this incident somewhat over-reaching and cringing, but not a deal breaker. Not long ago, I admitted a patient whose physician is his son, and POA is another son. If that’s not weird and violating ethical guidelines, I don’t know what is. However if you have to deal with a large health system who will not overlook anytime you are “written up....” then you need to start arming yourself up. Or look into if you can get this problem expunged if your wife says she actually knew you were looking in her record.
Good luck op.
 
I do not think it will affect you in the long term. It is such a stupid reason to be put on probation for. I always asserted that the greatest enemy of physicians are physicians.
 
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I think you are very lucky you weren’t dismissed. When you say your wife knew, you should emphasize not that she knows but that she asked you to look at it for her (because retroactive “permission” with your career on the line isn’t credible).

WRT disclosure, it will depend on your specific situation so you’ll have to sort through that. Might be worth paying for professional advice.

Our system has a process for preauthorizing me to access family member’s charts. She has to sign a notarized document giving me permission. We also can authorize each other access on the patient portal side.
 
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Yeah, I know you want us to say "Oh this is no big deal, it'll probably go away," but I don't think any of us can confidently say that out of hand. This is bad, and it's happening at a very bad time as you transition from residency. As your current hospital said, if you were a current attending you would have been terminated, so it's absolutely conceivable that this could be a deal-breaker with your prospective employer--lots of places have had some sentinel event where they got raked over the coals for this exact scenario. So a lot will likely depend on your new place's hiring policy, and how desperate they are to get you.

Rather than taking random advice from people on the internet, you just need to read the relevant policies for your new employer and prospective state. So I'll address your specific questions, but "read the policy and do that, or talk with a lawyer" is the over-arching theme.

1--most places, I imagine, will have language in the contract that compels you to report if you have some sort of disciplinary action taken against you during the hiring process. So I'd read your contract and any other on-boarding documents you've gotten from HR to see what you need to do, but I suspect you'll need to let them know.
2-Basically as you have here, "I made a stupid mistake, I so sorry and I learned from it, and I'll never it do it again." Not sure what else you could realistically do.
3-Again, it'll totally be dependent on where you're looking to get hired and how far in the future we're talking. Assuming this doesn't scuttle your current hire and you go on to be a model employee for an extended period of time it'll probably eventually be rendered a footnote, but it may well cause you headaches in the short to medium future.
4-You'll definitely need to disclose it. Whether it'll prevent you from getting a license is probably state dependent.

I don't think these answers are what you want to hear, and I'm not trying to kick you while you're down. But I'm trying to give you an honest assessment. If anything is at all unclear from reading the relevant policies, you should get a lawyer to look them over on your behalf and get their advice.

Thank you for the response. Yeah I am definitely going to talk to a lawyer about it as well, just wanted to get the forum's opinion too. Have you heard of people getting denied medical licenses by the medical board because they were placed on probation?
 
I sympathize with you. I think we have swung the pendulum so far, I think it’s stupid.

I agree with the above poster. With one little point to add. Are you joining a private practice or a large health care system? I’d venture to say most physicians will find this incident somewhat over-reaching and cringing, but not a deal breaker. Not long ago, I admitted a patient whose physician is his son, and POA is another son. If that’s not weird and violating ethical guidelines, I don’t know what is. However if you have to deal with a large health system who will not overlook anytime you are “written up....” then you need to start arming yourself up. Or look into if you can get this problem expunged if your wife says she actually knew you were looking in her record.
Good luck op.
So my wife knew I looked into her records as she was with me when we looked at it, that is why i kinda feel being put on probation is a bit excessive. I'll be joining a pretty large health system and when I interviewed at the place, the chief and I instantly clicked and I was wondering should I let him know or let the credentialing people do their job.
 
I think you are very lucky you weren’t dismissed. When you say your wife knew, you should emphasize not that she knows but that she asked you to look at it for her (because retroactive “permission” with your career on the line isn’t credible).

WRT disclosure, it will depend on your specific situation so you’ll have to sort through that. Might be worth paying for professional advice.

Our system has a process for preauthorizing me to access family member’s charts. She has to sign a notarized document giving me permission. We also can authorize each other access on the patient portal side.
That is a good point you brought up which is kinda the case. One moment of stupidness and this will follow with me through out my career. Sighs
 
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Thank you for the response. Yeah I am definitely going to talk to a lawyer about it as well, just wanted to get the forum's opinion too. Have you heard of people getting denied medical licenses by the medical board because they were placed on probation?
I haven't. If I had to guess, you'll wind up having to explain yourself, and it'll probably wind up being no big deal for the medical board. But I base that on no experience whatsoever.

I think the hiring/credentialing people are more likely to have an issue.
 
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I know of someone who failed to disclose a probation in residency to the medical board and therefore their licensure was done with a probation period which means the hospital where they sought credentialing did so provisionally meaning they will be reviewed more and have to renew sooner. Had they simply disclosed I doubt it would have been an issue. The probation was for a different reason and he had letters that demonstrated that reason was appropriately remediated which helped.
 
I think you are very lucky you weren’t dismissed. When you say your wife knew, you should emphasize not that she knows but that she asked you to look at it for her (because retroactive “permission” with your career on the line isn’t credible).

WRT disclosure, it will depend on your specific situation so you’ll have to sort through that. Might be worth paying for professional advice.

Our system has a process for preauthorizing me to access family member’s charts. She has to sign a notarized document giving me permission. We also can authorize each other access on the patient portal side.

I don't know about this honestly. When I was a resident in my initial advanced program, I had this really bizarre medical condition that literally popped up day of the incident, and some of the program's attendings had to help me medically ironically. It was so bizarre that I would say many if not most of my fellow colleagues looked at my imaging - obviously they violated my HIPAA rights countless times, and no one got fired or disciplined at all!!! I liked most of my colleagues so I did not make an issue of it, but it's not so cut and dry to be fired immediately. Ironically I got sent a letter that it was inappropriate for me to access my own records! But not a single one of my colleagues got disciplined and/or fired.

I think the probation at the end of residency is a little over the top. If wife knw about it, it's not really a HIPAA violation i don't think. So they are making a big deal out of nothing in my opinion. But yes OP will sadly have to report the probation - although this probation shouldn't be an overall as big an issue as if the OP was on acdemic probation or something like that.
 
I don't know about this honestly. When I was a resident in my initial advanced program, I had this really bizarre medical condition that literally popped up day of the incident, and some of the program's attendings had to help me medically ironically. It was so bizarre that I would say many if not most of my fellow colleagues looked at my imaging - obviously they violated my HIPAA rights countless times, and no one got fired or disciplined at all!!! I liked most of my colleagues so I did not make an issue of it, but it's not so cut and dry to be fired immediately. Ironically I got sent a letter that it was inappropriate for me to access my own records! But not a single one of my colleagues got disciplined and/or fired.

I think the probation at the end of residency is a little over the top. If wife knw about it, it's not really a HIPAA violation i don't think. So they are making a big deal out of nothing in my opinion. But yes OP will sadly have to report the probation - although this probation shouldn't be an overall as big an issue as if the OP was on acdemic probation or something like that.
Unless wife signed a records release it is still technically a violation.
 
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I don't know about this honestly. When I was a resident in my initial advanced program, I had this really bizarre medical condition that literally popped up day of the incident, and some of the program's attendings had to help me medically ironically. It was so bizarre that I would say many if not most of my fellow colleagues looked at my imaging - obviously they violated my HIPAA rights countless times, and no one got fired or disciplined at all!!! I liked most of my colleagues so I did not make an issue of it, but it's not so cut and dry to be fired immediately. Ironically I got sent a letter that it was inappropriate for me to access my own records! But not a single one of my colleagues got disciplined and/or fired.

I think the probation at the end of residency is a little over the top. If wife knw about it, it's not really a HIPAA violation i don't think. So they are making a big deal out of nothing in my opinion. But yes OP will sadly have to report the probation - although this probation shouldn't be an overall as big an issue as if the OP was on acdemic probation or something like that.
If wife knew about it it might not be a HIPAA violation - but it would still be a violation of hospital policy. Verbal consent is valid, but without proof of it it isn't much defense.

Different settings I've been in have had different rules for even looking at your *own* medical records. That is, I have every right as a patient to request copies of 100% of my medical record - but if I use my accesses as a physician to look at it from the front end, I might be breaking my employers policy. I think my current employer allows it, but I'm not 100% sure.

For looking at your family's medical records, it's ranged from outright forbidden to OK only if you have some form on file somewhere giving you permission.

Regardless though, if you break hospital policy, they can throw the book at you. Hospitals are paranoid.
 
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If wife knew about it it might not be a HIPAA violation - but it would still be a violation of hospital policy. Verbal consent is valid, but without proof of it it isn't much defense.

Different settings I've been in have had different rules for even looking at your *own* medical records. That is, I have every right as a patient to request copies of 100% of my medical record - but if I use my accesses as a physician to look at it from the front end, I might be breaking my employers policy. I think my current employer allows it, but I'm not 100% sure.

For looking at your family's medical records, it's ranged from outright forbidden to OK only if you have some form on file somewhere giving you permission.

Regardless though, if you break hospital policy, they can throw the book at you. Hospitals are paranoid.

Well how come none of my colleagues got disciplined when they looked at my records?
 
Well how come none of my colleagues got disciplined when they looked at my records?
Did you report it? Different places have different approaches to policing things. I have worked where someone got in trouble for looking at their own records so obviously that wasn't self reported but other places my only audit a small percent of charts so unless someone complains (or if they have a celebrity come through and they do extra checks on it) then violations might not get caught.
 
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Well how come none of my colleagues got disciplined when they looked at my records?
I can think of a few reasons

A) No one in an appropriate position ever found out about it. The EMR keeps logs of who looks at what when, but they're (most of the time) passive. Some systems have a higher standard for VIP charts (which can include but are not limited to employees, family members of employees, and anyone newsworthy) but many others just keep the log.

B) Your coworkers never actually pulled up your records. You mentioned that some of your own attendings were involved in your care - well, if they (who had every right to) pulled up your imaging and your coworkers saw it under *that* access, the system has no idea whose eyeballs are actually looking at the screen. You admit you had an interesting case, so if it was pulled up for purported education reasons, it may actually be legitimate.

C) The PACS system doesn't keep track of the same accesses as the rest of the EMR so no one has any idea who looks at what imaging (as opposed to notes). I've seen this in a few hospitals where the PACS system had a generic login - though not recently.

D) Your hospital doesn't care about privacy rights and is flirting with state/federal fines/sanctions as soon as it actually comes to light.

More than one of the above is possibly true.
 
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You need to find out if this is program level probation (I.e. somewhat informal) or institutional level probation (which if the GME Head called you in it probably is). These have different reporting requirements and also different adverse action policies when it comes to the ACGME. You need to find your hospitals adverse action policy and find out what it entails because most will have requirements for hearings to include the right to appeal for institutional level adverse actions that require future reporting.
 
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I can think of a few reasons

A) No one in an appropriate position ever found out about it. The EMR keeps logs of who looks at what when, but they're (most of the time) passive. Some systems have a higher standard for VIP charts (which can include but are not limited to employees, family members of employees, and anyone newsworthy) but many others just keep the log.

B) Your coworkers never actually pulled up your records. You mentioned that some of your own attendings were involved in your care - well, if they (who had every right to) pulled up your imaging and your coworkers saw it under *that* access, the system has no idea whose eyeballs are actually looking at the screen. You admit you had an interesting case, so if it was pulled up for purported education reasons, it may actually be legitimate.

C) The PACS system doesn't keep track of the same accesses as the rest of the EMR so no one has any idea who looks at what imaging (as opposed to notes). I've seen this in a few hospitals where the PACS system had a generic login - though not recently.

D) Your hospital doesn't care about privacy rights and is flirting with state/federal fines/sanctions as soon as it actually comes to light.

More than one of the above is possibly true.

2 attendings were involved in my care and yes they can pull up things, that's not the issue. The residents pulled up my imaging independently, outside of any attending involvement so yes they violated HIPAA. And each resident has an independent log on ID. I mean it's not an issue at this time obviously but I felt that if a bunch of co residents can violate my HIPAA rights a husband shouldn't be put on probation for viewing his wife's records.
 
2 attendings were involved in my care and yes they can pull up things, that's not the issue. The residents pulled up my imaging independently, outside of any attending involvement so yes they violated HIPAA. And each resident has an independent log on ID. I mean it's not an issue at this time obviously but I felt that if a bunch of co residents can violate my HIPAA rights a husband shouldn't be put on probation for viewing his wife's records.
The actual solution is everyone should be in trouble, you can bring up the inconsistency if you want that because that’s how the hospital will treat it
 
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The actual solution is everyone should be in trouble, you can bring up the inconsistency if you want that because that’s how the hospital will treat it

Well this was about 5 years ago so it's a non issue. My point is that OP is in a crummy situation when i don't think he did anything really bad. I wonder if he can bring a note or wife herself to say hey I'm ok with this. He is simply being made an example of.
 
Well this was about 5 years ago so it's a non issue. My point is that OP is in a crummy situation when i don't think he did anything really bad. I wonder if he can bring a note or wife herself to say hey I'm ok with this. He is simply being made an example of.
What everyone seems to be missing is the difference between patient level access and doctor level access

The wife can only grant the husband patient level access. The husband here used doctor level access which can only be used if part of the patient care team or if part of approved education/research. It’s kind of a big difference and despite lack of malicious intent, OP is extremely lucky to get probation
 
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Wife’s mental health notes, gyn notes, PCP notes could all contain information that she doesn’t want her husband to know (and even if further protected, there are appt dates, med rec, etc). Our spouses don’t lose their privacy by marriage. The fact that others have gotten away with worse is really irrelevant to the discussion. He’s lucky.

Which is why when he does discuss it, the story needs to be that they went in her chart together at her behest but obviously in hindsight, that was a poor choice.
 
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It’s pretty common to show/share interesting imaging cases on PACS amongst radiologists and radiology residents for educational purposes, even if they’re not directly interpreting the study or even offering input. Isn’t that considered a HIPAA exception? It’d be a huge impediment to education if it weren’t. Seems like if the illness in question were as bizarre as claimed, then there would educational value in reviewing the imaging, even for those not involved in the patient’s care.
 
It’s pretty common to show/share interesting imaging cases on PACS amongst radiologists and radiology residents for educational purposes, even if they’re not directly interpreting the study or even offering input. Isn’t that considered a HIPAA exception? It’d be a huge impediment to education if it weren’t. Seems like if the illness in question were as bizarre as claimed, then there would educational value in reviewing the imaging, even for those not involved in the patient’s care.

The HIPAA Privacy Rule allows use of PHI without a patient's written authorization for health care operations which includes "conduct of training programs in which students, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers."
 

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While that’s technically true, it’s not really appropriate when it’s someone everyone knows. This comes up in tumor board type situations as well. Just a question of being respectful
 
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So my wife knew I looked into her records as she was with me when we looked at it, that is why i kinda feel being put on probation is a bit excessive. I'll be joining a pretty large health system and when I interviewed at the place, the chief and I instantly clicked and I was wondering should I let him know or let the credentialing people do their job.


I just wanted to re-iterate that if I looked at my wife or 4yo record, I’d get fired.

It’s a big deal. Learn the lesson. You can think the pendulum has swung too far, don’t die fighting. It’s not worth it.
 
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The HIPAA Privacy Rule allows use of PHI without a patient's written authorization for health care operations which includes "conduct of training programs in which students, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers."

The "under supervision" is a big deal. This is for case conferences and the such, not for what the OP did.
 
The "under supervision" is a big deal. This is for case conferences and the such, not for what the OP did.

Oh yeah I was just commenting on the educational use component. Nothing to do with OP. Every hospital I worked for didn’t even let you look at your *own* records under employee access.
 
While that’s technically true, it’s not really appropriate when it’s someone everyone knows. This comes up in tumor board type situations as well. Just a question of being respectful

Not just that, but it's still a HIPAA violation in this case without a doubt. This was not "presented" by attendings at a conference in an ANONYMOUS way how tumor board, etc. is done. and no one asked my permission
 
Not just that, but it's still a HIPAA violation in this case without a doubt. This was not "presented" by attendings at a conference in an ANONYMOUS way how tumor board, etc. is done. and no one asked my permission
Did you report it?

If not, that's your answer. Clearly your hospital doesn't have automatic audits of employee charts, which many don't. Thus consequences only occur if it's reported.
 
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How is it at other facilities? Because at my hospital, I get told monthly that if I go into my chart or anyone I know without direct patient access, I will be fired. When I hear someone from my facility get in trouble for going into their chart or a friends chart, I have zero empathy because it is so hammered into us that I can't help but feel like it is their own fault. Is it not like that elsewhere?
 
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This is so stupid lol it wasn’t even a big deal you looked at your wife’s record while she was with you big deal.. I hope it doesn’t affect you long term and In a couple years you look back at this and laugh..good luck man
 
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How is it at other facilities? Because at my hospital, I get told monthly that if I go into my chart or anyone I know without direct patient access, I will be fired. When I hear someone from my facility get in trouble for going into their chart or a friends chart, I have zero empathy because it is so hammered into us that I can't help but feel like it is their own fault. Is it not like that elsewhere?
The UPMC policy is that I can look at my own charts, except for any psych, drug/EtOH, or HIV/AIDS counseling/work. I find that a little weird, because that stuff is still me (although I haven't had/don't have any of those things).
 
The UPMC policy is that I can look at my own charts, except for any psych, drug/EtOH, or HIV/AIDS counseling/work. I find that a little weird, because that stuff is still me (although I haven't had/don't have any of those things).

I have taken advantage of this UPMC policy only once, when I was applying for life insurance. I had spent 4 weeks in a turnaround with medical records during which they proved incapable of locating an EKG the insurance people wanted to see. Eventually I just went into the chart and printed the d*mn thing myself.

As a psychiatrist though I actually get why they don't want me looking at my psych or D&A records. Not that these are actually segregated anymore with our current EMR(s), so I'm not sure how well the can be enforced...
 
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I agree with everyone who’s says this SHOULDN’T be a huge deal, but clearly it is, both at the OPs program and at a lot of places. So the moral of the story is that unless there is an explicit policy explaining that it's kosher like UPMC, you should assume that you CAN'T without getting in big trouble.
 
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I have taken advantage of this UPMC policy only once, when I was applying for life insurance. I had spent 4 weeks in a turnaround with medical records during which they proved incapable of locating an EKG the insurance people wanted to see. Eventually I just went into the chart and printed the d*mn thing myself.

As a psychiatrist though I actually get why they don't want me looking at my psych or D&A records. Not that these are actually segregated anymore with our current EMR(s), so I'm not sure how well the can be enforced...

Explain why you can’t look at your own psych records
 
Explain why you can’t look at your own psych records

I write all my notes these days with the assumption that the patient could wind up reading it (also a jury) but in practice if one of my patients were to read their notes I would want to know this had happened so we could talk about it. This is important in psychiatry, meaning-making impacts the things we deal with far more than in many other specialties.
 
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Personally I think this is stupid, because he received verbal consent, but this is clearly in violation of the hospital's policies, which means they can punish him any way they want.

My hospital system allows viewing your own record. In addition, you can view that of a spouse/family member provided you document verbal consent in the chart (in the form of an event note or telephone encounter) and eventually provide a proper ROI form.
 
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Explain why you can’t look at your own psych records
If this is basically just once a month medication checks then I agree there isn't really any good reason for it. If these are talk therapy based sessions then there is *very* good reason why one shouldn't be able to access their own psych records. The therapist-patient relationship is meant to be a blank slate for the patient to project and transfer onto and in a manner that is largely uninfluenced by anything other than the patient's own thoughts/feelings. If the patient is reading notes from a therapist it could be quite damaging to that dynamic. It's less like like reading notes and more like letting a patient photoshop their radiology images. It could completely alter the course of treatment for better or (more likely) worse. This concept and the fact that HIPAA allows the patient the right to access their charts is why many private practice therapists don't even write notes beyond maybe a bare bones skeleton of info.
 
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If this is basically just once a month medication checks then I agree there isn't really any good reason for it. If these are talk therapy based sessions then there is *very* good reason why one shouldn't be able to access their own psych records. The therapist-patient relationship is meant to be a blank slate for the patient to project and transfer onto and in a manner that is largely uninfluenced by anything other than the patient's own thoughts/feelings. If the patient is reading notes from a therapist it could be quite damaging to that dynamic. It's less like like reading notes and more like letting a patient photoshop their radiology images. It could completely alter the course of treatment for better or (more likely) worse. This concept and the fact that HIPAA allows the patient the right to access their charts is why many private practice therapists don't even write notes beyond maybe a bare bones skeleton of info.

Additionally, imagine someone at their last appointment wanted stimulants and you did not prescribe them, and in your note you briefly mentioned why you did not think they had ADHD in terms of missing symptomatology/history/etc.

Guess what they're going to endorse at the next visit?
 
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It's a huge deal. What if sometime later his wife says that she didn't give verbal consent? Or that she was pressured into giving consent? Or she complains that this was part of a pattern of harassment? The HIPAA law will hold the institution responsible. In some cases, it might be fine. In a good number of them, it can be a catastrophe. Many institutions will give you a warning for looking at a random person's chart without permission, and will fire you for looking at a family member.

This is not a laughing matter, now nor in the future. Get written consent if you're going to do this. And even then, avoid it.
 
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Additionally, imagine someone at their last appointment wanted stimulants and you did not prescribe them, and in your note you briefly mentioned why you did not think they had ADHD in terms of missing symptomatology/history/etc.

Guess what they're going to endorse at the next visit?
Excellent point, although I don't think that's quite as unique to psych as the therapist-patient dynamic. Many other specialties prescribe drugs with abuse potential and you won't see the same protections on notes from medicine, neuro, ortho, PM&R, etc. I guess the counterargument is that those specialties have physical exam findings that are hard to fake, but most clinically validated psychometric testing has questions meant to detect dishonesty and something like muscle spasms isn't going to have much in the way of findings unless the patient is actively spasming in the office. I imagine a significant portion of the people prescribed muscle relaxants didn't have impressive exam findings at the time of the script.
 
Excellent point, although I don't think that's quite as unique to psych as the therapist-patient dynamic. Many other specialties prescribe drugs with abuse potential and you won't see the same protections on notes from medicine, neuro, ortho, PM&R, etc. I guess the counterargument is that those specialties have physical exam findings that are hard to fake, but most clinically validated psychometric testing has questions meant to detect dishonesty and something like muscle spasms isn't going to have much in the way of findings unless the patient is actively spasming in the office. I imagine a significant portion of the people prescribed muscle relaxants didn't have impressive exam findings at the time of the script.

Maybe your setting is very different from the ones I have experienced but ain't nobody diagnosing things with an MMPI in our general outpatient clinics.

Agreed that the therapist-patient dynamic is probably the more important point and if it is not at all operative in an ostensibly "med management" focused appointment I am not hopeful for great outcomes.
 
Thank you for the response. Yeah I am definitely going to talk to a lawyer about it as well, just wanted to get the forum's opinion too. Have you heard of people getting denied medical licenses by the medical board because they were placed on probation?
I was on probation in residency for “professionalism”. The only state that made a big deal of it was TX. The TMB is not a joke. I had to hire a lawyer for that and go in front of the board in Austin.

Other than that, a simple explanation suffices. I have gotten seven licenses and been credentialed at all places without problems.
 
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I was on probation in residency for “professionalism”. The only state that made a big deal of it was TX. The TMB is not a joke. I had to hire a lawyer for that and go in front of the board in Austin.

Other than that, a simple explanation suffices. I have gotten seven licenses and been credentialed at all places without problems.

Ironically I submitted a complaint for a highly unethical and shady physician in Tx to the Tx medical board - who has tons of complaints on Yelp, and the board did absolutely nothing. The dude is completely dubious. We had an attending who was fired from prior residency as a resident - then got some sort of "action" or probationary period with the Tx board, among other things that he would be professional, etc. HE terrorized most of us during residency, countless of complaints were filed about him on evals. Then the GME/ACGME got involved when complaint was filed, and he was eventually let go from the program as an attending. That did not seem to get the board's attention. The only other "sanction" or whatever he got was for not reporting some sort of domestic dispute for which he had a record. And even then he still has a full license. So I would say the Tx medical board seems to be tough on some but not all physicians.
 
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Ironically I submitted a complaint for a highly unethical and shady physician in Tx to the Tx medical board - who has tons of complaints on Yelp, and the board did absolutely nothing. The dude is completely dubious. We had an attending who was fired from prior residency as a resident - then got some sort of "action" or probationary period with the Tx board, among other things that he would be professional, etc. HE terrorized most of us during residency, countless of complaints were filed about him on evals. Then the GME/ACGME got involved when complaint was filed, and he was eventually let go from the program as an attending. That did not seem to get the board's attention. The only other "sanction" or whatever he got was for not reporting some sort of domestic dispute for which he had a record. And even then he still has a full license. So I would say the Tx medical board seems to be tough on some but not all physicians.
As I understand it's reputation the TX board can be brutal when handing out licenses but plays very defensively once you've already received one.
 
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As I understand it's reputation the TX board can be brutal when handing out licenses but plays very defensively once you've already received one.

Well that might be just right then. Because both of these people are a disgrace to the medial profession yet they both still have licenses.
 
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