Writing a more believable medical hero/heroine…day 2, confidentiality

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Ever heard of HIPAA?

If you’re writing a medical hero or heroine, you should have heard of it.

Also, if you’ve been to the doctor’s office in the past umpteen years, you have heard it.  You just might not realize that is what it is.

In 1996, HIPAA, also known as the Health Insurance Portability and Accountability Act, was endorsed by Congress.

Why does this matter when writing a doctor or nurse? Because your doctor or nurse should have a basic understanding of it. You don’t need to go throwing that term in there, because your readers might not understand it.

But your medical readers, and there are a lot of us, will laugh or roll our eyes or get downright irritated when you trample all over confidentiality… because that is what this is about.

Confidentiality.

Confidentiality has always mattered to an ethical nurse or doctor, but after HIPAA came into being, it got more important. Talking about a patient in the cafeteria, where other people can hear you can lead to serious trouble.  Looking through records you have no business accessing can get you fired. (Link)

Facebooking about a patient can lead to big trouble.  Nurses get fired over this. (Link)

And while this case here – the woman took photos for pete’s sake – look at what is under the header…referred to the FBI.(Link) That FBI thing should clue you in… confidentiality is no joking matter.

I cannot tell you how many books I’ve read where the hero or heroine is somehow connected to the medical field…a doctor, nurse, EMT, etc and will be in the cafeteria, talking about Ms. Shaw and her hip, in the elevator, talking about cranky old Mr. Roberts and his dialysis, etc, etc.

Yes, the staff will talkBut…the smart ones, who value their jobs, aren’t going to do it in public where anybody but staff can hear.

And it shouldn’t be gossipy.  Say a nurse in ICU hears you’ve got a hunky cop on the med-surg floor.  She comes up and wants details… yes, this is totally believable, right?

Do you know that if you are overheard discussing those details, you can get fired?

Basically, you share only the necessary information with the necessary people.

So if you’re overheard discussing patients at yoga…in the supermarket…with your BFF…that’s a no.

You might think this is too restrictive to your story, but if you want to make your medical character more believable, then you can find a way to work it.

Basically:

  • No gossiping, especially not in public spaces
  • You can’t have the hero/heroine pull the doctor or nurse aside for info on a patient.  Unless that patient has given permission, and the staff should check, that doctor/nurse is risking his license, his money, possibly his freedom by giving out those details so easily.
  • The same goes goes if a character out of the blue asks the doctor/nurse for info…unless that doctor/nurse knows the patient has okay’d that release of information, they aren’t going to give it.  They like having their license, the money from the job…and yeah, not being investigated, thrown in jail, etc, etc.
  • If your nurse/doctor goes digging for personal data, s/he’s doing it at the risk of losing his/her job, possibly her license. Since many records have gone digital, this can be tracked…and it often is.
  • Only the minimum amount of information needed for patient care is accessed.  Again, say I’m working a med-surg (medical-surgical) floor and there’s a patient in ICU, I can’t go flipping through their file.  I have no business doing it. Again, that information can be tracked.
  • Violations can and do lead to fines and/or jail time, so this is serious shit. Nurses/doctors/CNAs/Aides they all understand this…we don’t take it lightly, neither should your characters.

 

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10 Comments

  1. 17 July, 2013    

    I’m having flash backs. I was the Compliance Officer for a large physicians group when the Privacy and Security regulations came out. I know that legalese well. I’m probably one of the only folks who don’t get annoyed by all the privacy notices, lol.

    I’m so glad to read this post. These are important details that help make the stories feel believable. Thank you. :)

  2. Carla's Gravatar Carla
    17 July, 2013    

    Unless you work for the government. My son is a patient at the NIH, I frequently heard a particular nurse bad mouthing patients and families. When I questioned her, “she told me good luck getting anywhere with that; I work for the federal government.” Imagine my non-surprise when she shipped all of my sons test results and medical records to another family half a country away. When I contacted the NIH to file a HIPPA violation, I was told that she made a mistake while completing a federal job. Federal law protects her. I have been battling her and her non-sense for a year now.

    I am quite amazed though when I read books that have poor fact verification in medical situations. HIPPA

  3. 17 July, 2013    

    Carla, that’s appalling. I wonder if the state licensing board might offer some insight?

  4. Carla's Gravatar Carla
    17 July, 2013    

    I contacted my Congressman. He told me that filing a complaint woul potentially cause the program to be shut down while they investigate. I was appalled. The program is the only one in the world researching an auto-inflammatory disease my child has my choice was allow the misdeed to go unremarked or shut down the only research currently being done to treat my child. I went with an option not mentioned and spoke to the director of the NIH. I explained that another parent in our protocol currently had all of my child’s information. She was kind enough to contact me to let me know. When I called the nurse in charge to address situation, she told me that I didn’t have a leg to stand on because she was a federal employee. We worked out a lovely compromise in that she was put on probation while I spoke to people in the FBI about federal privacy laws being broken. (I had reported something to Homeland Security a couple of yrs ago and it turned out to be something. I ended up having contact with local FBI agents.) they helped me formulate a complaint that wouldn’t violate the protocol.
    Unfortunately, the nurse still has her NIH job, but isn’t allowed to work my child or the otherboys’s case.

  5. 17 July, 2013    

    Sometimes, the lesser evil is the only way to go. You did the best thing.

  6. Donna D's Gravatar Donna D
    17 July, 2013    

    While I do not DISAGREE with HIPAA regarding confidentiality, it has made it harder for pastors to do their jobs. Yes, I agree, congregants should let their pastor know when they go to the hospital — but many, most do not. THEN, they are hurt and/or angry when the pastor does not come to see them. Before HIPAA, pastors could go to the hospital and see the admission list to see if there were any he needed to visit.

    And yes, authors should be aware of these things because reading the stories does cause a bit of a disconnect when the reader knows better.

  7. nightsmusic's Gravatar nightsmusic
    17 July, 2013    

    Donna, you must be in a smaller community (maybe not! I’m just guessing here) because we have 8 major hospitals (two are teaching and one is a top university hospital) all within 30 minutes drive from here. Our pastor announces weekly to remember to let the staff at the church know or there will be no visit unfortunately because he can either pastor, or drive all week. While I think a pastor should be able to present credentials and then ask if a patient is at that particular hospital, credentials can also be falsified so it’s a catch 22.

    Carla, I’m so sorry you’re dealing with something like that. Our tax dollars at work, huh? *shakes head*

    I have to admit, I was still working in the hospital when the HIPAA laws took effect and the hardest I got hit with it was, I missed the white board! I missed seeing all the info I needed for my patients in one spot. Silly thing, I know, but still…

  8. Kris's Gravatar Kris
    17 July, 2013    

    This is one of my biggest pet peeves in books because I want to scream You can’t talk about that!

  9. Alicia's Gravatar Alicia
    18 July, 2013    

    I love this series of posts. I really hope there are authors out there reading this and making note of it for future reference. I’m not in the medical field (legal, which has its share of just plain wrong in books, too. As well as quite a few other fields) but there are plenty of things I’ve read that had me laughing out loud then side-eyeing the author for thinking it would fly.

  10. Sue Peace's Gravatar Sue Peace
    20 July, 2013    

    Another great post (I am reading backwards because I missed the week while working, lol)…all your posts are reasons why I don’t read any kind of medical fiction, it drives me nuts!!! Oh, and confidentiality! I work in ICU and for one patient we had to have a code word with the next of kin/contact person because other people would try to get information, or staff from elsewhere would try to get information from us…I’ve had a ‘nurse’ (allegedly) call wanting information on a ‘friend’ so I just say “If you’re really a nurse you’d know I can’t tell you anything!)

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