When confidentiality isn't quite the same

[nursingaround1]

I know confidentiality is considered one of the most important things in medicine, but I learned from a friend working in another country how we in the west treat confidentiality, isn't necessarily right for everyone.

My friend is from Zimbabwe, but works with me here in Europe, and she told me what is was like when HIV really got hold of her home country. She describes how all the parents died, and the grandparents were left raising the grandchildren - she banded some of these grandmothers together and now has a charity helping children.

Anyway, she was saying that even when the WHO and other powers made effective medication free for many people in third world countries like hers, people kept on dying, when they shouldn't, especially young men.

She said a lot of the doctors treated patients like they would in the west, and when they first told a young man he was HIV positive, they would tell him in utmost confidence, and outline his treatment plan, and how to take his meds and when to have follow-up appointments and when to get extra help.

The men would leave, not take their meds, and eventually die.

My colleague and friend said confidentiality is different where she is, and you would never tell a young man or woman such a diagnosis, and would automatically involved the whole family. You wouldn't even ask if the family should be there, you would automatically tell them all to be there. Then the patient with HIV became not just a family issue, but a community/village one, and the outcomes suddenly reversed and people stopped dying. It also made a huge difference in stopping parents passing on the virus to their children.

I know in the west, to do something like this goes against everything we're taught. And I'm not saying one is more right than the other, as that is not the issue, but it was really interesting to hear such a significant cultural difference.

Anyway, I'm sure I'll be picked to pieces for this. But I genuinely think it quite fascinating and hope someone out there does to.

[cracklingkraken, ASN, RN]

Well, I brought popcorn!

ETA: HIPAA didn't even exist until less than 20 yrs ago. Confidentiality in the States is relatively new.

[OrganizedChaos, LVN]

*sitting & waiting*

[brownbook]

I think it is obviously an appropriate way to deal with different cultures. I am to practical, I can't see how anyone would object to this?

[Horseshoe, BSN, RN]

I know in the west, to do something like this goes against everything we're taught. And I'm not saying one is more right than the other, as that is not the issue, but it was really interesting to hear such a significant cultural difference.

In the US, it wouldn't even matter if we thought what you've described was right and the best way to approach care. It is illegal, plain and simple.

[am27]

So prior to HIPAA, there was no such thing as the concept of patient confidentiality? K. Pretty sure HIPAA is not HIPAA worldwide, either.

[I_Nurse]

When I was in school on of the subjects we focused on was Cultural Sensitivity in Nursing. In nursing we are put into similar scenarios with people that come from all different cultures. The care we give to people may vary person to person based on the culture they are from. Knowing that people from this culture may benefit from having the family more involved would aide healthcare workers. We would of course have to ask the patient if it was okay for the family was involved, but we could also encourage the patient to look for assistance from the family. There really should be a patient and family based approach in this situations, especially if what you said was true and it could possibly prevent their children from being infected.

[cracklingkraken, ASN, RN]

So prior to HIPAA, there was no such thing as the concept of patient confidentiality? K. Pretty sure HIPAA is not HIPAA worldwide, either.

Prior to HIPAA, there was no national health privacy law.

[am27]

Prior to HIPAA, there was no national health privacy law.

I acknowledged that. Just because there wasn't a law, doesn't mean the concept and implication of patient confidentiality didn't exist.

[Jensmom7, BSN, RN]

So prior to HIPAA, there was no such thing as the concept of patient confidentiality? K. Pretty sure HIPAA is not HIPAA worldwide, either.

You sound shocked. That means you most likely haven't been around health care very long.

Back in the 70s and 80s, every floor in a hospital had a chalk board prominently displayed at the Nurses' station. On that board were the room numbers, full name, diagnosis and physician of every patient.

Chart forms were on a clip board at the foot of every bed.

There was no EMR, physical charts were in a chart rack, or more often, strewn about the Nurses' station, easily accessible by anyone.

So, to answer your question; No, prior to HIPAA there was no concept (and no expectation) of patient confidentiality.

[NOADLS]

My interpretation:

HIV patients in less developed countries are treated like western sex offenders.

"I moved in next door and am required to tell you that I have HIV. If you have any questions about my history, please check in with the local hospital and they will discuss my file with you."

[sailornurse]

Back in the 1970's/80's- local paper actually listed who was admitted to the hospital. If you had a baby it listed that.

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