Unit 8Section 6 Exercise 24 Physical Environment: Medical Privacy

The examples below illustrate different perspectives on the issue of privacy.

1. The video clip narrates a story that refers to a time before the Health Insurance Portability and Accountability Act (HIPAA) was conceived. After viewing the video, read the quote below from the HIPAA rules. Finally, read a doctor’s perspective on the need to keep confidences.

2. The HIPAA Privacy Rule

The Privacy Rule standards address the use and disclosure of individuals’ health information—called “protected health information” by organizations subject to the Privacy Rule — called “covered entities,” as well as standards for individuals' privacy rights to understand and control how their health information is used. Within HHS, the Office for Civil Rights (“OCR”) has responsibility for implementing and enforcing the Privacy Rule with respect to voluntary compliance activities and civil money penalties. A major goal of the Privacy Rule is to assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public's health and well being.

Incidental Use and Disclosure. The Privacy Rule does not require that every risk of an incidental use or disclosure of protected health information be eliminated. A use or disclosure of this information that occurs as a result of, or as “incident to,” an otherwise permitted use or disclosure is permitted as long as the covered entity has adopted reasonable safeguards as required by the Privacy Rule, and the information being shared was limited to the “minimum necessary,” as required by the Privacy Rule.

3. From“A Young Doctor’s Hardest Lesson: Keep Your Mouth Shut.” Kent Sepkowitz,

Are doctors boring people?...A person’s trust in you, in medicine, in society’s ability to assure someone’s safe passage through illness requires learning quickly how to keep secrets. This sober business of maintaining confidences is the closest we came to the priesthood. Forget healing, forget laying on of hands: it is the importance we place on silence that is our most important spiritual activity…we learn to keep quiet about the whole thing, trusted advisors in the persistent palace intrigue. But conducting business this is what is confusing. What is off limits, and what remains in play? Can I say this or that? Pretty quickly, it becomes clear that the easiest and safest—though the quietest and dullest—approach is simply to shut up concerning just about everything. It makes for some admittedly dim evening, perhaps, but at least this way everybody’s odds and ends stay locked up and out of reach.

The New York Times, Health Section, December 28, 2004

Study Questions

1. All three segments support patient privacy. Summarize the rationale of the patient, policy and physician perspective.

2. View the photo below and reflect on the relationship between privacy and anonymity. To what extent is anonymity a desirable function of privacy? To what extent does privacy undermine personhood?

Andreas Schreiber, Patient Charts" With permission.

3. Now that medical records are electronic, who should have access to this patient information? What about the risk of these records being misused?