So what is a Hipaa violation, anyway?

Your first example would be ok but the second one has enough information that someone could know who you meant.It also depends on where you are when you are doing the talking.You never know who will overhear your conversation.

I think disclosing the minimum amount of info necessary (i.e., leave out patient identifiers) to get your point across is ideal:
“Hallway conversations. Talking about patient information in public places is problematic. Although HIPAA does not address this problem specifically, its privacy principles reinforce the professional commitment to use care in such situations to avoid unintentional disclosure of information. Talking in elevators, discussing a case over lunch, discussing a difficult situation with friends over dinner — all of these situations raise the possibility that a client’s protected health information will be revealed inappropriately. Certainly, professionals may discuss, and should discuss, difficult situations in a healthy atmosphere of learning and problem solving. Again, the “minimum necessary” rule will help to guide these discussions. Remembering to delete identifying information when possible, exchanging only enough information to further the discussion, and holding such conversations away from busy public places will improve the ability to protect patient confidentiality.” HIPAA and Confidentiality | CE513 > Page 2

It is a HIPAA violation to discuss or disclose enough information about patient that another person not related to their care would be able to figure out who it was. The 2nd example, the patient with an amputated thumb, who works at the sawmill, would probably be identifiable if there was only one sawmill in the town. The 1st example patient would probably not be specifically identifiable by the minimal amount of information released.

Incidental disclosure of that kind of information would probably be allowable if you are using that particular case as a teaching tool, and scrubbed as much information as possible out without compromising the usefulness of the case for teaching purposes. However, step should be taken to minimize the possibility that protected health information does not get out somehow.

On the other hand, if a lot of patients had their thumbs amputated and they all work at the sawmill, I would suspect that the 2nd example patient would be perfectly fine as it would be no longer very easy to determine which person that was that had their thumb amputated who worked at a sawmill.

In short, basically what you want to do is simply make sure that whatever you're talking about a patient that you do it in his private location as possible and that any information released would not allow the patient to be identified specifically, which includes telling the story about how they got sick or injured. Sometimes patient information is already in the public domain, that does not however, authorize indiscriminate release of protected health information. Even in very public cases, HIPAA violations can still occur.

You got it backwards. I said the first one would be fine but the second one has too much indentifying info. Even the first one could be questionable if you were in a smalll town ( like me).

I just don't talk about my patients outside of work except at my sisters house ( we work at the same hospital).

As someone who has similar feelings to the OP, this thread has been very helpful, thank you!