Tuesday, August 19, 2008

Hypothetically Speaking, of course...

So, here's a hypothetical moral dilemma for those of you who may question your line of work.

story deleted because a co-worker has decided that if they worked hard enough at tracking my hypothetical patient down, they might be able to identify them. Of course, that would mean that this co-worker would need to search through medical records to do that, thereby violating HIPAA themselves just to nail me. Thanks for the overreaction co-worker!

More Later

Addendum 8/23: I've had many people ask about mandatory reporting, notification of authorities, etc. There is much more to this hypothetical story, of course. But I would be violating HIPAA if I wrote it all out here. Hypothetically speaking, of course. Thanks for reading.

Addendum 8/25: Many people have wondered if I am violating HIPAA by telling of this hypothetical story. Am I? Can anyone identify a person such as this? What about a drunk driver who kills a family but survives? Did I just violate that persons rights because I mentioned something that actually happens more often than it should? I have mentioned no names, birthdays, identifying traits, medical record numbers, or anything else that violates HIPAA. In any of my stories. I'm sure if you dug enough, you could find a person or two that could be pigeonholed into one of my stories. I stand by my belief that I have not violated any one persons rights by telling stories of a Paramedic. I could be almost any medic, almost anywhere, and would have similar, if not exactly the same stories. That's not a HIPAA violation. That's storytelling.

Addendum 12/2: After being called on the carpet at work for my writing here, I have agreed to remove patient scenarios that I wrote to describe the thoughts of a paramedic in certain situations. I continue to believe that no HIPAA rules were broken in my writings. But to protect the reputation of the hospital I work in, I will no longer be able to describe what I do for a living.


Testing group said...

Hypothetically Speaking, if I was the paramedic and I honestly felt this man due to his "illness" was a threat to himself or others, I would not let him leave the hospital, I would speak to my attending physician and see if he agreed that this man's illness posed a real and imminent danger to others (as demonstrated by his confession of abuse, and possibly statements that he intended to abuse again) and if the physician agreed I would help with the paper work to have him committed against his will. I would order a psych consult to make it all official and then transfer him to a larger institution where he could receive help and treatment that he needs. In Missouri and Illinois at least, I'm guessing it's the same in hypothetical world, anyone can be restrained and detained by a physician if he poses a threat to himself or others, pending a review of his mental status. If he tried to leave I would then use nice words, followed by clear explanations, followed by a little vitamin H and or soft limb or full body restraints. ( I personally, and hypothetically prefer chemical restraints to physical, but then that's just me). I would also make sure I called whatever child abuse hot-line and social service department in my area, because as a medical professional I know I am a mandatory reporter of any suspected abuse. HIPPA not withstanding. I would probably not take the patients word for it that he is already in trouble, and I would ensure that some type of social or criminal authority was also checking into the situation. That at least is hypothetically what I would do in a situation like this if it ever arose.

PS. I enjoy your blog John, keep up the good writing.

John said...

Thanks for writing TG. Hypothetically (of course) there is much more to the hypothetical story. The good folks in the hypothetical world had hypothetically done all the things you've written about a few days prior when the same pt showed up. (I would have hypothetically had that day off) But as you seem to already know, sometimes a patient knows how to play the system, and we are unfortunately bound to play by the rules. But calls were madem balls were set a rolling, and, well...Let's just say that hypothetically, if a patient like this were to fly back to their home state the next day, they would be greeted by all sorts of helpers from law enforcement, EMS, Social Services and such when they stepped off the plane. A hypothetical pt like this would probably be spending a lot of alone time in the not too distant future, regardless of how clever they thought they were being with us. Turns out the rules can work in our favor sometimes! Thanks again for the comment.

Patresa Hartman said...

wowzers. and also: holy hell. what an awful awful awful situation to be in!

i don't know how it works in your state or how it works in the medical profession, but as a school psych, i had 2 stipulations that trumped privacy:

1) mandatory child abuse reporter; and
2) "i can't talk about what we talk about unless you say you are going to hurt yourself or someone else."

if it's different in your situation, hypothetically, i might gather all the practical information (phone numbers, names, hours of operation, addresses, driving directions) i could in regards to community assistance, low-income legal aid, and child & spousal protective services, and i might hypothetically, drop those in an envelope and mail them to the mother. or hand deliver them if i were feeling particularly ballsy and safe.

my mom recently had a trip to the ER via ambulance (no worries; all is well.) and said afterward that paramedics must be very special people.