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Explain that the patient is progressing well and should be discharged within the next few days.
6%
4/70
Provide the cousin with the patient's most recent progress notes and a draft of his discharge summary.
0%
0/70
Direct the cousin to the patient's room, telling him that you will be by within the hour to discuss the plan.
3%
2/70
Refer the cousin to ask the patient's wife about these topics.
Explain that you cannot discuss the patient's care without explicit permission from the patient themselves.
84%
59/70
Select Answer to see Preferred Response
The Health Insurance Portability and Accountability Act (HIPAA) dictates that a physician may not tell a patient's family member information about the patient or patient's care without the patient's permission. If there is not explicit permission obtained from a patient for a family member to be involved in the patient's care, then it is considered unethical to share information with with the family member. One notable exception to this rule is that it is acceptable to share information with family members (in the absence of patient permission) when the information directly endangers the family member. Other instances where it is acceptable to breach confidentiality include situations where it is a legal requirement to report certain diseases/conditions or situations (abuse). Omole et al. discuss the intricacies of interacting with the patient's family members during an office visit or hospital admission. Often, family members can be an invaluable resource in providing useful information and assisting in carrying out a treatment plan. However, it is important to maintain an appropriate balance in communication in order to support the alliance of the patient, physician, and family members. The authors also note that it is important to speak with the patient alone for a period of time during each interaction in order to provide an opportunity for private communication and assessment of the patient's own concerns and thoughts. Levine discusses HIPAA regulations as a barrier to improved care, as family members are often barred from becoming fully engaged in a patient's care. Interestingly, HIPAA includes the following, in that it "permits covered entities to share information that is directly relevant to the involvement of a spouse, family members, friends, or other persons identified by a patient, in the patient's care or payment for healthcare." However, information cannot be shared if the patient objects. Sharing of information should be limited to a few individuals who the patient identifies as being involved in their care. Incorrect Answers: Answers 1&2: These scenarios are violations of patient confidentiality; explicit permission from the patient is required prior to communicating any information to a family member. Answer 3: Communication to both the cousin and patient together still may compromise patient confidentiality. Before including family members in care conversations, it is important to ask the patient, when alone, who they permit to hear and receive information pertinent to their care and prognosis. Answer 4: It is better to be direct with the cousin and inform them of your inability to share information without patient permission; the patient may also not want his wife included in the information surrounding his care.
3.0
(1)
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