Involving family members and patient confidentiality

[chimpanzee]

I'm just wondering from a patient point of view, when does it cross the line to involve family members.

I've been in psychiatric wards before and as a patient i've had both doctors and nurses disclose information to family members without my permission or even consulting me. Most of the time i didn't really mind but some of it i would have preferred to have been kept private. The main thing that bothers me is that they did it without consulting me first. It would have been nice to be asked before hand.

Also i thought this was a violation of patient/doctor(or nurse) confidentiality

I thought that everything discussed was to be strictly kept confidential....

Is this right or wrong?

I've been searching all over the internet and can't seem to find a straight answer to this.

Some clarification about the whole patient/doctor/nurse confidentiality thing would be greatly appreciated.

Thanks

[Davey Do]

Excellent question, chimpanzee!

Your question, Is it right or wrong to discuss matters regarding your welfare be kept from you, causes me to think about how things were in times past. Typically, any type of information which might upset the Patient was often withheld from that Patient.

But, you know, we still do that sort of thing with our Patients today. Often times, in report, we hear, "The Doctor plans to discharge the Patient tomorrow, but don't let the Patient know that". Or something similar, regarding the patient's placement after discharge, is withheld until the Patient is discharged. Usually the Patient's Family is aware of plans long before the Patient is made aware.

Very poignant question. And I'm trying to come up with an appropriate answer. That's a tough one.

On one hand, I understand the reasoning behaind the motive. The ways justify the ends. However, it is a Patient's Right to be informed of any sort of action which affects them.

Okay. Here's my perspective: If I am part of, or aware, of the plans for the Patient, and the Patient asks me about something which directly affects them, I woulld have to be honest and inform them of factual information. I cannot force other Team Members into following my perspective- I can only give my opinion of what I believe is right.

I truly believe that any Patient has the Right to be informed of anything which affects them.

How's that, for seeing the progress of an answer in process?

Dave

[chimpanzee]

Thank your for your response Davey Do.

I am aware that doctors and other health providers can with hold information from a patient if they believe it will have an impact on their health/well being.

I am also aware that as a patient i can request my own medical records which includes doctor and nurse notes like said above as long as it doesn't affect the patient in a negative way. I haven't actually done this...

What i'm talking about is though for instance a patient in the psych ward confesses to the psych doctor that they are suicidal and so on and then the doctor turns around calls(or tells when the family member attempts to call for information) the patients details of what they just stated to the doctor in that case it would have been the suicidality.

Would that be a breach of patient/doctor confidentiality?

The main thing i was asking about though was things directly being said by the patient to the doctor or nurse and then being passed on to family members.

I was always told that everything you said between doctor and patient was kept in confidence and even if a family or friend called they technically aren't even supposed to acknowledge your presence in the facility/ward without patients permission.

Thanks

[Davey Do]

What i'm talking about is though for instance a patient in the psych ward confesses to the psych doctor that they are suicidal and so on and then the doctor turns around calls(or tells when the family member attempts to call for information) the patients details of what they just stated to the doctor in that case it would have been the suicidality.

Would that be a breach of patient/doctor confidentiality?

The main thing i was asking about though was things directly being said by the patient to the doctor or nurse and then being passed on to family members.

I was always told that everything you said between doctor and patient was kept in confidence and even if a family or friend called they technically aren't even supposed to acknowledge your presence in the facility/ward without patients permission.

Release of information is part of the Treatment Plan process in gaining and/or releasing information to entities outside of the Facility. Usually, Family Members are seen as part of the Treatment Team, in that they support the Patient during and after Inpatient treatment. If a valid Release of Information Form has been generated, and includes, for example, in your case, a current Patient status, then any member of the Treatment Team may exchange information about the Patient. Of course, Continuity of Care is the primary reason for the exchange of information. However, other parallel information which is prudent and has its focus on Patient care is acceptable.

A way that some Patients get around information being released to Family Members or other People is they have signed Releases for is to specify the type of information to be released. For example, many Patients specify acknowlegement that that are an Inpatient. So, if a Family member telephones the Unit and asks to speak with the Patient, Staff may acknowledge the Patient's status, yet may legally and ethically release no other information.

Dave

[seizetheday]

On our unit we would ask you to sign release of information forms for the people that you want to be involved in your healthcare. once we have the signed forms we do not ask the patient each time, can i say this or that. However if patient says lease dont' tell my family this part - we don't unless it involves risk. So if you are about to be discharged, still having active suicidal thinking but you don't want anyone to know, we would be worried and might not discharge you until you let us speak with someone who could support you. If someone calls or asks a question and we don't have a signed consent we tell them nothing. If someone is releasing your personal health information without your consent that is a violation of your rights under HIPAA.

[IdrilRN, BSN, RN]

Unless you give permission for someone to have information then no one can have it. Or if required by law. As far as suicidality is concerned, you are already in a safe place.

I don't know how many times I've admitted someone only to have their family member cal,, who dropped them off,l an hour or two later to see how they are settling in. Well no release I can not confirm nor deny that they are there.

Usually I put them on hold and go and find the patient to sign the release and all is ok.

[Whispera, MSN, RN]

There's a federal law (sorry, I can't remember what it's called) that states a family member (parent, sibling, child) can petition the court to get the doctor to give out information even if the patient hasn't signed consent. This can be helpful for the family that can't get any info from the patient that could help the patient stay safe and out of the hospital in the future. As someone who has a parent with bipolar disorder, it's helped me avoid the helpless and hopeless feeling of inability to do anything, that I would have had otherwise.

[chimpanzee]

Thanks i was asking in general and also because of personal experience.

Hmm i have never ever signed a consent(or even been asked to sign one) in the hospital. They've always just gone ahead and blabbed any info that i've said onto a family member. It really doesn't help seeing as in the future people just wont tell them information and as result people won't get the real help they need.

I mean it wasn't that much of an issue as my family knew why i was in there but it did sort of ticked me off when i found out that they gave specific details without even consulting or asking me. I found out when i was listening to the voicemail on the home phone and found a detailed message from the doctor. I've since reported this doctor to higher ups. However this isn't the first time this has happened where a doctor has given specific information without my permission.

Also what happens if they did ask me to sign the release forum but i objected to do so would that mean that they wouldn't be able to share information or would it make a difference?