I accidentally outed a patient as HIV+ to her boyfriend and worried about getting in really big trouble

[bluescoop, BSN, RN]

This was a confidentiality breachthat occurred when I was dispensing medications to a TWOC who is HIV positive, in the presence of her boyfriend and others in the lobby of our primary care clinic that specializes in serving the HIV, LGBTQ, and POC communities. The patient takes the HIV treatment Cabenuva and asked me to clarify the purpose an appointment on an appoinmtent reminder card and I mistakenly replied "I think that's for Cabenuva" unintentionally disclosing her sensitive HIV status to her boyfriend and potentially others who were in the area as she had not chosen to disclose this information herself. The patient later called me expressing she was very upset with me and wants to live a normal life without people knowing about her HIV status, though she said she would not "blow it totally out of proportion" and that she knows I didn't mean anything by it.  I am now extremely distressed and worried about the potential consequences of being fired or losing my RN license and realize in hindsight that I should have immediately moved the conversation to a private room once the discussion shifted beyond simple medication dispensing. I feel like I fail to come to terms with HIV status being sensitive information or I would not have openly mentioned the name of an HIV medication when explaining her appointment. 

[Emergent, RN]

It should be a crime for your patient to withhold her her HIV+ status from her boyfriend, in my opinion. What a selfish, terrible person she is!

[Tweety, BSN, RN]

Undetectable=untransmittalbe,  so it's understanding why someone would want to keep that information to herself and have a normal life.  There is still a stigma attached to being HIV positive.

Personally I would be upfront about it but it's not for me to judge someone who might want to wait to disclose it someone she's dating and that's for us not to judge or disclose.

You live and learn.  Doubtful there will be no consequences because it sounds like she's going to let it go.  

[ValLyn]

She opened the opportunity when she asked questions in front of the others. You just answered her question.  If she wanted to be discreet, she should have pulled you over to the side or call/come back and ask.

[DavidFR, BSN, MSN, RN]

You answered a straight question. That she asked in an open area would have led you to  believe that she didn't mind an honest answer. 

Her boyfriend has surely asked her why she's attending the clinic? And if she's lied he has possibly had his suspicions given the nature of the clinic. Does he even know what Cabenuva is? 

I understand why you feel jolted. It's a horrible experience but as others have said, it sounds like she's letting it go. Learn. Move on. Don't beat yourself up.

[HiddenAngels]

ValLyn said:

She opened the opportunity when she asked questions in front of the others. You just answered her question.  If she wanted to be discreet, she should have pulled you over to the side or call/come back and ask.

Yes this is true... 

Next time just say it's about the efficacy and dosing of one or more of your medications. 

[MochaRN424, ASN]

My hospital insists that bedside report be done at the bedside and we as nurses are asked not to say certain things when visitors are in the room. You may not blurt out some information but if it's that sensitive then either visitors should be asked to step out or not be done at that time. I can't understand how someone can keep an HIV status from someone I think it's deceptive and the other party should be given the opportunity to have the information so they can make a choice to get involved or not. If she wanted to keep that information private why was the boyfriend allowed in the room with her? Perhaps it happened for a reason.

[bluescoop, BSN, RN]

MochaRN424 said:

My hospital insists that bedside report be done at the bedside and we as nurses are asked not to say certain things when visitors are in the room. You may not blurt out some information but if it's that sensitive then either visitors should be asked to step out or not be done at that time. I can't understand how someone can keep an HIV status from someone I think it's deceptive and the other party should be given the opportunity to have the information so they can make a choice to get involved or not. If she wanted to keep that information private why was the boyfriend allowed in the room with her? Perhaps it happened for a reason.

I talked to her on the phone yesterday and she seemed to not be upset anymore. I can see why she shares in some of the responsibility for what happened since she chose to have a conversation with me in the reception area with her bf there. While I personally think there's nothing wrong with keeping a disease private if there is no risk of transmitting it, some jurisdictions will still prosecute someone either an HIV+ person with undetectable viral load for not disclosing their status to a sex partner. It's just like with trans people who choose not to disclose their trans identity or sex assigned at birth to their partner because there's still a lot of discrimination and prejudiced reactions. Not that it's any of my business, but I wouldn't be surprised if her bf still has no idea she's HIV+ or even trans. 

[gcupid]

She was rightfully upset bc she would expect you to know better as the professional but she also recognize that it's her fault for not disclosing her status.  She probably felt ashamed. No one wants a lobby full of people that you don't even know to hear that especially when she didn't even tell her boyfriend whose sitting right there,  She is probably taking it as a sign that it was meant for him to know and that the guilt can finally be lifted.  Who knows? he probably accepted it and it may lead to them eventually getting married. She is free to be herself finally...

 

I wouldn't worry over the situation. I know It's easier said than done. 

[abbnurse]

Tweety said:

Undetectable=untransmittalbe,  so it's understanding why someone would want to keep that information to herself and have a normal life.  There is still a stigma attached to being HIV positive.

Personally I would be upfront about it but it's not for me to judge someone who might want to wait to disclose it someone she's dating and that's for us not to judge or disclose.

  

Well said, Tweety !