When personal information becomes too personal

While working in a hospital setting, it is quite common to have interdisciplinary discussions about a patient or to share your experiences with your peers. I believe that this is important because patient management should involve all medical professionals who need to communicate with each other in order to provide a holistic service to the patient. And sharing our experiences with our peers assists in the reflective process and learning more about conditions that we wouldn’t have known about without the input. But when the conversation is no longer patient confidential and it turns into an in depth conversation about the patient’s social history and we seem more judgemental than anything else, how do we react? 

There are many examples I can give, these are just a few:

I was in a patient’s room while two doctors were seeing the patient, when they started discussing the patient’s alcohol problem and why this is leading to her stubbornness and difficulty treating. They started making jokes about how she’s actually being forced to go ‘cold turkey’ and the only reason why she’s being difficult is she is craving a drink. All of this was said in front of the patient. And I was standing there thinking that this was so wrong, but I actually found myself joining in the conversation in order to ‘fit in’. 

I was told that I had to see a patient that was also a prisoner. This freaked me out and I was not sure how to deal with the situation because it was a first time for me. So I resorted to what I know best, and I spoke to a peer about it. It would have stayed confidential but my peer knew exactly who I was talking about as she had seen him previously. We discussed details of the patient, which I knew was wrong but I was relying on her information to ease my mind.

And many a time I have overheard nurses, doctors and physiotherapists share information about patients I wouldn’t dream about sharing. I know the workplace can get boring but turning the patients into some form of entertainment is wrong.

 

The patient’s right charter states:

Information concerning one’s health, including information concerning
treatment may only be disclosed with informed consent, except when
required in terms of any law or an order of the court.

According to this law, we have been doing things wrong. I searched for something that would help me with this problem. I found a great article, in it, it states that the duty of confidentiality requires that doctors keep secret the information they are given by patients and/or that they discover or learn about patients through their professional interactions. And some commentators have argued that breaches of confidentiality are a normal part of contemporary healthcare.

From a patient’s perspective:

If I was a patient, I know I would not appreciate health professionals discussing something about me that is personal. I would consider that as a breach of confidentially. If it has nothing to do about my condition and management, why do they need to discuss it? Overhearing them would decrease my trust in my medical team and make me feel violated. I wouldn’t want to share anything else with my doctor, even if it was important. 

From a professionals perspective: 

From a professional’s perspective, I would appreciate knowing details about a patient that would assist in my management with the patient. Discussing personal information might help me get a better understanding of the patient. In some cases it would be easier if one person interviewed the patient on all their personal and social information and we all got to share in that information, but since it doesn’t work that way I would either have to ask the patient or a medical professional that knows more than I do. It’s more convenient to ask a professional because then you don’t need to be aware that the patient might not appreciate you asking them that question. 

Where to go from here:

After reading through the article about patient confidentiality, I have realised how common patient’s experience a breech in their confidentiality. And I know that I am to blame for this problem. Next time I will not engage in conversations that involve in depth information about the patient and I will try to get the information that is relevant to me from the patient instead. I am definitely more aware of what kind of information is okay to talk about with my peers and what to avoid, and I will try be more careful about what I share and choose to listen to. 

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One thought on “When personal information becomes too personal

  1. Hi Kristin. Thanks for another interesting post. I especially liked your insightful comment about “turning patients into a form of entertainment”, which is a very powerful way of looking at the problem you describe. In fact, I think that this perfectly sums up what is the problem. The use of humor to deal with stress had been identified often in the medical literature. No-one is saying that it is right, only that it is understandable. Here’s a brief article that might shed some light on the phenonemon: http://www.sciencedaily.com/releases/2011/09/110926151735.htm.

    There’s also nothing inherently wrong with discussing a patient’s condition, assessment options or management plan. That’s one very effective way for us to learn and develop as professionals. However, you highlight some of the challenges e.g. maintaining patient privacy and confidentiality during those interactions. The problem really comes up when we start going beyond a conversation that has the patient’s best interests at heart. And, as you rightly point out, when the conversation moves towards discussing personal issues of the patient, or information that has nothing to do with the therapeutic relationship, then you’re quickly moving into unethical territory.

    What I really like to see is the fact that, when confronted with a potential dilemma, you’ve gone and done some research. Judging from what you found and have used in your reflection, it’s clear to me that you have an understanding of how to use the literature to inform your thinking and decision-making, which is great to see. Keep it up.

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