Is this HIPPA breach or just rudeness?

[Apple-Core, ASN, BSN, RN]

Hi

Hoping somebody can advise me. This is not homework, these two incidents happened to me personally and as a student nurse, I am not 100% sure on what constitutes HIPPA violation and/or what is just (what I perceived to be) rudeness.

Incident 1: I had been referred to a specialist. I lost the contact details, so I went in to my doctors office to request the information. I was stood at the reception desk. The waiting room was full. The receptionist/medical assistant (I think they double up on duty) started looking for the information I requested. She kept sighing a "huffing" and then, very loudly, said, "I can't see any specialist you're talking about, although you have *LOADS* (said in sarcastic tone) of specialists listed here.... optical specialist, osteopathy, behavioral health specialist, cardiologist....."

At that point I stopped her because I was mortified/embarrassed (the entire waiting room overheard) and, furthermore, did not recognize the specialists she was talking about. Then she said, "oh, silly me, I'm in the wrong chart", and went back to looking. (She did give me contact details, but after I got home they were the wrong ones....ugh!).

Was she violating HIPPA by yelling all that info out in public, or was she just being ridiculously insensitive and unprofessional? As it turned out, it wasn't actually my info, but at the time she didn't know that.

Incident 2: I took my daughter to the OBGYN for a personal reason. To begin with the receptionist stank of cigarettes, which I realize is a personal choice but for an OBGYNs office I was quite disgusted. Not a HIPPA violation, obviously, but it was bad start!

Anyway - when I told the receptionist why we were there she literally looked shocked/disgusted and raised her eyebrows. I explained we'd be sent from her PCP office to make an appointment with them and she started asking questions about the situation (questions that I don't feel she should be asking because they were to do with treating the problem, but perhaps that is perfectly ok to do, I don't know??). Then she said, "wait here", and asked for my daughters "medical care plan" which I had with me. The medical care plan is the print out that they give you after an appointment with the PCP. It had nothing to do with the reason we were there, and didn't even mention it on there. I told her that, but she still grabbed it out of my hands and walked off.

After she returned she said she'd need a longer appointment time then went into details about why. Again, I felt TMI for the reception desk. We made the appointment. No, I did not say anything at the time because of my daughter.

As we were leaving, a second receptionist sat down next to her. We left, but the way their office is designed it is somewhat open plan. I had a feeling she was going to talk about us after we left, so I hesitated by the door where she couldn't see us, and sure enough as soon as she thought we were gone, she started gossiping about my daughter with the second receptionist.

Needless to say, an already difficult situation has now really upset my daughter and I was livid. However, I am not sure where I stand regarding complaining because a lot of the behavior was "body language", which is purely subjective on my part (although I am fully aware of what she was thinking based on that alone), such as rolling eyes, raised eye-brows, pursed lips, etc.

Thoughts? Let it go? Contact there manager? Make a generic complaint about customer service?

Thank you in advance -

[meanmaryjean, DNP, RN]

Well, first of all it's 'HIPAA" not HIPPA.

Neither situation is a HIPAA violation but both are examples of poor customer service and should be rationally discussed with the office manager.

[psu_213, BSN, RN]

#1--I don't really see a HIPAA violation, but, based on your description, it is rude.

#2--there's a bit more to this. I think it is the receptionists "business" to, within reason, gather information about why the patient needs an appointment, what the pt's PCP says about the situation, etc. She has to determine how long of an appointment the pt. needs, if the pt. should see a particular specialist in the office, and she may need to determine the correct day for an appointment (for example, if the pt needs a procedure and the MD only does XYZ procedures on certain days of the week), etc.

It was completely inappropriate for her to gossip about you and your daughter; however, it was also completely wrong of you to hide and eavesdrop. This does not make what the receptionist did any less wrong, but you certainly don't want to get in the habit of nor want to be labeled the student/nurse who is regularly spying on other people having a conversation.

[JKL33]

The first situation is a nothingburger, HIPAA-wise. And she made herself look like an idiot. So let that one roll off.

The second: There's no excuse for the rotten attitude you had to deal with. Beyond that, one problem in this scenario is that the typical office is not set up to provide much privacy at the reception desk. It's too bad that it should have to be incumbent upon the patient to do something to avoid a sense of privacy violation (for instance, an option in this situation would be to state, "I need to make an appointment regarding a sensitive issue - is there another place we can do that?" - - however my position is that practices should be very well aware that this is a possibility and should inquire from the outset whether the patient prefers to come to a cubicle or other area for the discussion).

I do think you should discuss especially the second incident with the office manner. Facts only. Focus on the nature of the information requested at the desk. For goodness' sake, I can't imagine an OB/GYN office hasn't figured this out by now.

I agree that rather than eavesdrop (which you were tempted to do because of the poor behavior you had witnessed up to that point) it would have been better to address things outright in the moment. Eavesdropping is not okay. Never strive to lower yourself to the level of mean or stupid people.

[TriciaJ, RN]

I agree that a chat with the office manager is in order. Everyone working in a doctor's office should be aware that they're dealing with sensitive information and should know better than to scream out any kind of details. Also, huffing and eye-rolling are extremely off-putting and these staff members need to be spoken to.

I don't take such a dim view of you hiding and eavesdropping. You knew how it was going to go; you needed the confirmation. I would probably have done likewise. Do speak with the office manager. The doctor has no other way to know of issues impacting his/her practice.

[AnnieNP, MSN, NP]

I agree, discuss with the office manager I would also discuss it with the MD at the office visit, because sometimes the office manager and some of the staff are "tight, and cover one another".

[wondern, ASN]

I think the second scenario could be a HIPPA violation. If the other receptionist was not working with y'all at all and they just started gossiping before you could even get out of the door; and obviously really were not very concerned if you had actually made it out the door. I don't think that was eavesdropping at all. It could've just as easily been your neighbor walking in while they were still gossiping about your daughter. Those receptionists need some serious training! So does the first lady sounds like.

It seems so many places are hiring unprofessional help who sometimes don't have a clue or just don't care about your privacy. There's a thread on here somewhere where someone wants to hire a professional, maybe a nurse, for a ridiculous price to basically run their office, it seems like, in addition to providing patient treatments between answering phone calls, etc., and some people are actually encouraging that, so there you go. Just saying, you get what you pay for in so many cases.

On second thought, I think both were HIPPA violations, really, just on another patient in the first case scenario.

[trytounderstand]

You need to discuss it with the office manager and the doctor. Because the doctor may not even be aware of how the office staff are dealing with their patients.

After many years of different types of customer service, the receptionist represents the office. If she/he is rude or condescending to whoever walks through the door and to the desk, it is wrong. I have worked in some places that you would see the most dreaded customer approaching but you were expected to turn and treat them with respect and kindness. I agree if they were looking through your records all the specialist names etc should not have been blurted out surely they have an area where you can step through a door and speak privately.

As far as listening in on their conversation you were just confirming what you thought might be going to happen. If you could hear it so could the next patient in line or someone in the waiting area could have heard it as well. The office manager and doctor need to know about the behavior because as I stated earlier, the doctor may not even be aware this is happening and it could possibly affect how much confidence his other patients have in their privacy being respected. But try to keep your emotions under control.

[Apple-Core, ASN, BSN, RN]

Thank you all for your informative and detailed responses. Sorry for my big DOH writing HIPPA instead of HIPAA! LOL!

I should stress I didn't stay and listen to the receptionists talking about us as we left - it was literally matter of seconds to confirm my suspicions. I agree it looks poorly on me the way it was written; as if I hid and listened to the entire conversation. Is was more a case of hesitating a second or two longer that I would normally. I absolutely agree eves-dropping on conversations is poor form and unbecoming behavior in general and not something I would do. In this specific incidence I needed the "proof" to confirm what I suspected.

I decided to discuss things with the office manager. I kept it very factual and didn't dramatize things at all. Just the facts of what occurred and my disappointment at the level of CS and insensitivity.

Thank you all for your input!

[Have Nurse, ADN, RN]

Well, first of all it's 'HIPAA" not HIPPA.

Neither situation is a HIPAA violation but both are examples of poor customer service and should be rationally discussed with the office manager.

Actually, I have to disagree with this. The O.P. was spoken to directly in situation 1 as the patient in front of others, which made her identifiable.

In situation 2, it was the same, only this time, details were discussed regarding her daughter.

And I do agree that it is deplorable "customer service."

Most facilities do have a HIPAA officer or Clinical Manager with whom you may speak. You also have recourse by seeing the Patient Rep.

[psu_213, BSN, RN]

Actually, I have to disagree with this. The O.P. was spoken to directly in situation 1 as the patient in front of others, which made her identifiable.

In situation 2, it was the same, only this time, details were discussed regarding her daughter.

I agree with you that #2 could be a violation. How is #1 a violation?

[Apple-Core, ASN, BSN, RN]

I agree with you that #2 could be a violation. How is #1 a violation?

From my perspective, I was thinking that since I was identifiable as the patient, and the receptionist was shouting out the list of specialists I'd be referred to, the people in the waiting room overheard it and were now aware of all the specialists I'd been to see, so could then infer from that the type of medical problems I have or had.

As it turned out, she was shouting out the list of specialties from somebody else's chart. However, that is somewhat beside the point.

I'm guessing because nothing specific was mentioned, it isn't considered a violation. Perhaps if she'd shouted out "oh yes, I see you went to see the endocrinologist about your hypothyroidism", then that may have been an issue??