- The Washington Times - Thursday, June 10, 2004

Paging Dr. Discretion.

A study finds patient privacy is seriously threatened by chatty receptionists, nurses, doctors and other health care workers who casually discuss the details of patient cases in hospital halls, waiting rooms, lobbies and cafeterias.

Water-cooler commentary about lab results, office procedures or other sensitive medical details are more than just bad manners; they constitute a serious breach of confidentiality, say researchers at Purdue University and West Virginia University.

The researchers said small talk can subject already troubled patients to identity theft, discrimination or social stigma.

“The country has recently invested a tremendous amount of resources in the nation’s largest set of federal privacy laws to prevent health care providers from divulging or selling patient information,” said Marifran Mattson, a health communications analyst at Purdue.

“But we found that daily conversations of physicians, nurses, hospital staff and technicians can jeopardize the same kind of information,” she said.

New patient privacy rules contained in the Health Insurance Portability and Accountability Act (HIPAA) went into effect in April 2003 to limit access to sensitive information. The act has caused much hubbub in the medical world as hospitals and practitioners scramble to comply with the new regulations in all their permutations.

According to the Health and Human Services Department, HIPAA requires doctors, pharmacies, health plans and medical facilities to heed patient requests to keep their personal information confidential. Among other things, employees must be trained in “privacy procedures,” the agency said, and offices must have a designated “privacy officer.”

But folks still talk, and the damage continues, the researchers found.

“Confidentiality breaches are occurring daily,” said Maria Brann, a communication professor at West Virginia University who monitored hospital hallways, elevators and other well-traveled spots for evidence that personal medical information was the topic du jour.

She found plenty: hospital employees who talked over medical cases with one another within earshot of strangers, receptionists who used speakerphones when consulting with insurance companies, indiscreet mention of Social Security numbers or medical tests in a waiting room.

“While health care providers may not be malicious in their disclosures, they are still sharing patients’ most personal information with unauthorized individuals,” Miss Brann said.

She also interviewed 51 patients about their privacy concerns to find that blabby health care workers also exact an emotional toll.

“The most serious concern is that people will find out about a loved one’s health problems from someone other than their health care provider,” said Purdue’s Miss Mattson, adding that patients who think their privacy is at stake “may be less likely to share important details with their physicians or nurses.”

The providers themselves have been struggling with the nuances of HIPAA in the past year.

For example, Amednews, a publication of the American Medical Association, offered a primer that suggested preferred ways for medical receptionists to call out patients’ names in a waiting room, where to discuss lab results and whether it was proper to leave medical details on a patient’s answering machine.

“A code of silence is not necessary, but discretion is,” the primer advises.

Since HIPAA went into effect, HHS has issued multiple guidelines to help health providers get their bearings.

“HIPAA does not cut off all communications between providers and the families and friends of patients,” Richard Campanelli, director of the HHS Office for Civil Rights, said in an open letter to the nation’s physicians last month.

Information can be shared with anyone “a patient identifies as involved in his or her care — as long as the patient does not object,” Mr. Campanelli said.

HHS guidelines, in fact, go into excruciating detail. A doctor, for example, could in good conscience “give information about a patient’s mobility limitations to a friend driving the patient home from the hospital,” according to one scenario.

The two researchers, who published their findings this month in the Journal of Health Communication, urge health care providers to be vigilant and “teach privacy awareness and skills” in the meantime.

Doctors, nurses and other staffers “need to pay attention to how they personally breach confidentiality laws,” said Miss Mattson, who also advises concerned patients to speak up.

“When you overhear a phone conversation in a waiting room where the receptionist is repeating personal information such as Social Security numbers, gently remind that person or supervisor that you are concerned,” Miss Mattson said.

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