Tricky Question

[Dr. Dukes]

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I have a potentially tricky question.
This morning I was reading the news, and I saw an article about "Don't Ask, Don't Tell." MY QUESTION ISN'T ABOUT THE POLICY, it is about medical care.
Social history is obviously part of medical history, and sexual history is part of social history. How do MilMed physicians reconcile the policy (it is illegal to ask someone if they're homosexual) with the need to get an accurate sexual history on a patient? I would assume HIPPA applies here (i.e., you can't tell anyone that patient X is gay/lesbian), but that doesn't get around the fact that it is illegal (as I understand it) to ask patient X if they are gay/lesbian.
Pre-emptive thanks from a potential USUHS student...

 

[delicatefade]

Wow. I had never thought of that. I'm also interested in the answer to this question.

 

[USAFdoc]

I have a potentially tricky question.
This morning I was reading the news, and I saw an article about "Don't Ask, Don't Tell." MY QUESTION ISN'T ABOUT THE POLICY, it is about medical care.
Social history is obviously part of medical history, and sexual history is part of social history. How do MilMed physicians reconcile the policy (it is illegal to ask someone if they're homosexual) with the need to get an accurate sexual history on a patient? I would assume HIPPA applies here (i.e., you can't tell anyone that patient X is gay/lesbian), but that doesn't get around the fact that it is illegal (as I understand it) to ask patient X if they are gay/lesbian.
Pre-emptive thanks from a potential USUHS student...

I would have no problem asking that question when appropriate and would NOT document the answer in the record or notify the military in most all circumstances. This is one place where I believe the doc/pt relationship trumps the "needs/rules of the service".

There was never any guidence I received from the military on this good question


my 2 cents😉

 

[paradude]

I would have no problem asking that question when appropriate and would NOT document the answer in the record or notify the military in most all circumstances. This is one place where I believe the doc/pt relationship trumps the "needs/rules of the service".

There was never any guidence I received from the military on this good question


my 2 cents😉

We took a course this term called Intro to Clinical Medicine and one of the objectives was to learn some patient interview skills. When it came to the Social History, concerns similar to your own were raised. USAFdoc's advice was essentially the same advice my preceptor gave me. In fact I got dinged for asking my active duty patient "Do you have a girlfriend, are you sexually active?" When the appropriate question was, "Do you have a sexual partner?" but hey, I'm learning!

Actually, I don't think "Don't ask, don't tell" is a policy that has a lot of life left in it, especially if the country gets a litter bluer in 2008, but that is just my 2 cents.

 

[Ex-44E3A]

I didn't always agree with how the military handled privacy issues. If a person over X rank was admitted to the hospital, there was a long list of people who had to be notified about it, including the admitting diagnosis.

I can understand their commander and supervisor needing to know, but the rest of the list was a bunch of administrative types who really had no involvement in providing any actual care. I suspect some of it was protocol people, but others had no business knowing that kind of info.

If I'm some navy captain admitted for neurologic sequella from my syphilis I acquired during a SOUTHPAC cruise as a young sailor, I damned sure wouldn't appreciate everybody and their brother knowing about it. There's all kinds of issues that might come up where a little discretion would be advised (if nothing else, for the privacy of the patient)... but how do you do that when 20 people already know about it?

Two people can keep a secret if one of them is dead.

 

[Dr. Dukes]

I would have no problem asking that question when appropriate and would NOT document the answer in the record or notify the military in most all circumstances.

When would you? Anything a patient tells you in confidence is confidential unless they are a creadible threat to someone else.
I'm just trying to figure this all out, thanks for all the info.

 

[NavyFP]

When would you? Anything a patient tells you in confidence is confidential unless they are a creadible threat to someone else.
I'm just trying to figure this all out, thanks for all the info.

That is where you are mistaken. ANYTHING a patient tells you can be released to the patient's chain of command. (at least at the CO level.) There is no confidentiality between milmed and AD members. If someone reports a condition that is contrary to the UCMJ you are obligated to report that to the members chain. Unauthorized piercings are supposed to be reported.

That is the letter of the law, what actually happens is we don't tell or document.

 

[kzjonez]

That is where you are mistaken. ANYTHING a patient tells you can be released to the patient's chain of command. (at least at the CO level.) There is no confidentiality between milmed and AD members. If someone reports a condition that is contrary to the UCMJ you are obligated to report that to the members chain. Unauthorized piercings are supposed to be reported.

That is the letter of the law, what actually happens is we don't tell or document.

HIPAA Don't mean squat in the military , if am to place some one on quaters I am obligated Yes!! That's right !! Mandated to put the diagnosis and wheter the illness is contagious or not in the admin paperwork , so everybody and their mother in the members CSS/orderly rooom finds out !!!

 

[Apollyon]

Knock, knock.

Who's there?

HIPAA.

HIPAA who?





I can't tell you!


(except in the military)