Small Town HIPPA

  1. Anyone here live in a small town? I do, and I find that knowing many of your pts and their families poses unique problems and temptations regarding confidentiality. Yesterday I cared for the mother of a woman who goes to my church. The mother recognized me from the church too. She was a very neurotic 87 old woman who was driving the staff crazy. Her daughter, who is almost 70, is one of those controlling churchladies who gives all churchladies a bad name.

    Anyways, because I took care of this old lady and had to work through the details of her discharge, I now know the there has been a recent falling out in this dysfunctional family between obnoxious daughter and obnoxious mother. I also know many things about other people in town, like who's on antidepressants and many other details of people's lives. I also have to be super careful about what I say to people.

    HIPPA is harder in a small town...:uhoh21:
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  2. 14 Comments

  3. by   gr8rnpjt
    The type of situation you speak of happens whether or not you are in a small town, a mid size city or a large inner city teaching hospital. However, I don't know where the dilemma is. I have enough problems in my life, I am not interested in other's problems. We are all people, after all. Everyone has their medical/emotional/family problems. It's the human condition. What you are talking about is gossip. Only now HIPPA protects us from people who may want to spill the beans about what they know. And the penalties will bite where it hurts, in your wallet. Not sure what the big problem is. I never believed in gossip, and now there are laws that protect me. :stone
  4. by   TazziRN
    The difference is that in a larger town/city it is more unlikely that you will know your pts from social circles. I know what Garden Dove means, I live and work in a small town too.
  5. by   GardenDove
    Quote from TazziRN
    The difference is that in a larger town/city it is more unlikely that you will know your pts from social circles. I know what Garden Dove means, I live and work in a small town too.
    It's very awkward, you have to live in a small town to understand. For instance, I just got back from the only supermarket in town. I've taken care of a bagger there recently who was a DKA. I've also taken care of one of the clerks husband, who had a significant drug history, and filled me in on some very private details of their marriage during his stay.

    Sometimes people will ask you about people who they know who have been in the hospital, it's tricky to not give out too much info.
  6. by   SmilingBluEyes
    It's not tricky at all. I lived in a very small town in OK. I just said simply, "you know I can't discuss this case with you" and ended the conversation. It really was that simple.
  7. by   Spidey's mom
    I live in a small town and I think what Garden Dove is talking about is NOT how hard it is for us to keep quiet about things but that now we know private things about people we go to church with, people who are friends with our kids in school, people who work with our spouses, etc. And they know we know and it can effect the relationship. Just today I've taken care of a man who works with my #2 son and now I know stuff about him he probably is uncomfortable with me knowing.

    I know almost everyone I take care of - I'm the ob nurse of a 16 y.o. who goes to school with my dd . . . and I know her mom and now I'm privvy to info her mom may not have wanted me to know. It was a dilemma at first - to take this patient or not . . . long story. HIPAA.

    We are doing well - so far.

    Small towns are different.

    steph
  8. by   tntrn
    I grew up in a small town and everybody knows everything or thinks they do.

    October 2005, my DH and I were struck head on in our 34 foot motor home by a fellow who fell asleep at the wheel. We were in a very rural part of Utah and it was 3 days before we were able to get home. The other driver died on impact and our motor home was destroyed.

    HIPPA did not exist there at all. Everybody in the two towns near the accident scene knew the fellow, or was related to him. We met people everywhere who knew all the details. At the market, the checker was the mother of the x-ray tech who was called in to take x-rays of my hubby's ribs.

    I didn't feel like my privacy was being jeopardized, in part because this community was great impacted by this fellow's death. We were treated very respectfully by all and even invited into the home of one of the local docs and his family for a real meal!

    I agree with SBE, though. When asked for details, you must just politely decline.
  9. by   GardenDove
    Quote from stevielynn
    I live in a small town and I think what Garden Dove is talking about is NOT how hard it is for us to keep quiet about things but that now we know private things about people we go to church with, people who are friends with our kids in school, people who work with our spouses, etc. And they know we know and it can effect the relationship. Just today I've taken care of a man who works with my #2 son and now I know stuff about him he probably is uncomfortable with me knowing.

    I know almost everyone I take care of - I'm the ob nurse of a 16 y.o. who goes to school with my dd . . . and I know her mom and now I'm privvy to info her mom may not have wanted me to know. It was a dilemma at first - to take this patient or not . . . long story. HIPAA.

    We are doing well - so far.

    Small towns are different.

    steph

    Precisely! Thank you.
  10. by   GardenDove
    I guess I'm more talking about the discomfort of knowing all this stuff. For instance, the mother of a girl my daughter plays with was my pt. I know that she is on 2 antidepressants and has a psyche history because I read it in her H&P. She loved me as a nurse, but I'm not as comfortable sending my daughter to play at her house now.
  11. by   SmilingBluEyes
    Sometimes we can switch assignments when we are too closely involved. Like I said, I never ran into a huge problem. It was not hard for me to separate professional relationships from personal ones. If it was too close for me, I would request a switch in assignments. Fortunately, I did not find this to be too big a problem. I kind of chuckle when I remember, babies born on weekends got so many visitors. I swear, 1/2 of the First Baptist Church would show up to visit, right after morning services were over. Small town life was so very different for this Chicago native.

    We do become privvy to a lot of knowledge we may be uncomfortable with..but it goes with the territory. We just have to be careful how we handle it, obviously. I found it more uncomfortable being a patient of people with whom I worked, than being their caretaker. I guess we all have our feelings to deal with. It's not easy being a nurse, particularly in the rural environment, I know that is true.
    Last edit by SmilingBluEyes on Jan 10, '07
  12. by   GardenDove
    Yes, you can switch assignments, but you don't always know ahead of time that you will find out sensitive info. People trust their nurses, and I must be particularly trustworthy looking because the other nurses are always surprised by the interesting social background that pts confide in me. Pts really trust me.

    For instance yesterday's pt, I had no idea ahead of time that I would now become privy to an ongoing family feud that is occuring, plus I didn't know what a nutty woman the churchlady's mother was. No, I wouldn't have much trouble not discussing it with others.
  13. by   SmilingBluEyes
    Seems you are adept at solving this dilemma already. My hat is off to you.
  14. by   santhony44
    Quote from GardenDove
    I guess I'm more talking about the discomfort of knowing all this stuff. For instance, the mother of a girl my daughter plays with was my pt. I know that she is on 2 antidepressants and has a psyche history because I read it in her H&P. She loved me as a nurse, but I'm not as comfortable sending my daughter to play at her house now.

    I'm small town too, and I know exactly what you mean.

    We know a lot of stuff about a lot of people we'd just really rather not know.

    It's almost a "loss of innocence" thing.

    I rarely have any difficulty in keeping things to myself (my husband says I'm "secretive" anyway). Sometimes my husband has a hard time with it- we'll see someone somewhere and he'll ask "Where do you know that person from?" and when I say something like "Oh, I just do" he gets peeved with me. I've explained over and over that I cannot tell him even that someone is or has been a patient but he tends to take it personally. Then again, he's one of these people who can be characterized as a "babbling brook:" if it crosses the brain it comes out the mouth.

    One of the difficult things for me is knowing how to react to people in public. I usually smile, nod, and keep going. I don't want them to think I'm unfriendly, but if I stopped to chat, then that person might get asked about me- and I don't want them to have to explain that to whoever they are with if they don't want to. If the patient approaches me and starts a conversation, that is fine. (Or, like my [former, not current] pastor's wife, announces to a kitchen full of people that I had just done her pap smear that week!! You'd have to know her, though.)
    Last edit by santhony44 on Jan 10, '07

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