Dear DR, it's confidential!

May 31, 2015 10:19 PM

Parents keeping stuff from their doctor. I'm snitching. How do I address the letter?

I want to send a letter to my parents' doctor. Some things are worrying me (and sib)...
I'm concerned enough to want to write CONFIDENTIALLY to their MD.
How do I address the letter?
I don't want to do an email, sib and I think a letter is better.
Should I address it to

"Dr. Jill Smith, MD
Confidential Patient Information"
etc address

or

"Dr. Jill Smith, MD
PERSONAL"
etc address

Is there a way to make sure only the doctor will see the letter?

posted by mdrew to Health & Fitness (21 answers total)

Also want to add - I'm (fairly) sure their MD will not tell them I said anything (with HIPAA privacy and all, which I don't really understand), and we're in Phila, PA.
posted by mdrew at 10:34 PM on May 31, 2015

I would call and speak to the doctor.

You don't have to tell them who you are but ask them what to put on it so it only goes to them. Maybe they will say mark it with ___________ so they can tell their receptionist not to open it. But know that some things can be opened by accident and you have to accept that risk.

There's nothing wrong with just going to see the doctor if you can. You don't need your parents permission to see the same doctor and give the doctor information. The doctor should not disclose anything to you about your parents but if it's important, being able to ask and answer questions might be a good thing. Your parents will know you're the snitch(es) right?

If it's not important, stay out of it.
posted by stellathon at 10:39 PM on May 31, 2015

To clarify: you want to make sure it's confidential so the doctor doesn't telll your parents that you've given her info about them...is that right?
posted by hurdy gurdy girl at 10:44 PM on May 31, 2015

Are you trying to keep this information from other people working at the doctor's office or your parents or both? Because unless the circumstances are truly unique I don't think you can expect the doctor to not discuss this with their colleagues (especially if you're putting them in a weird position with your parents). And it depends on what you're telling the doctor, but are you expecting them to come up with some lie to tell your parents to justify some new tests or treatments? These are all things that you should discuss with the doctor, and not rely on their interpretation of the word "confidential". Call them (or meet with them). Otherwise if they don't respond to your letter you'll have no idea how they reacted and whether they'll take your information into consideration.
posted by acidic at 10:54 PM on May 31, 2015

Whoops, hit post too soon. I meant to add:

You're not worried about someone else like the receptionist reading it, more that the doctor might reveal to yor parents that you and your sister shared info about them, right?

I would make that explicit in the body of your letter. Patient privacy laws exist so that doctors don't share their patients' health info with anyone else, and won't prevent the doctor from sharing your info about your parents with them. You'll have to make it clear those are your wishes.

I think I know the sort of thing you're thinking of. My family wrote a confidential letter to an elderly relative's doctor about her driving and he ignored it and blithely kept signing off on her fitness to drive. She had multiple accidents (never hit a person, thank God) until we contacted the ministry responsible for driver licensing--she was then required to take a road test and failed it spectacularly.

So I'm just saying you may not receive a response to a letter. It might indeed be best for you and your sister to try meeting with the doctor in person. Like stellathon said, the doc can't share their patient info with you but can certainly listen to your and your sister's concerns and act accordingly. You may not get much action that wY either but you'll know the doc is aware of the situation at least.
posted by hurdy gurdy girl at 10:59 PM on May 31, 2015

Yes, hurdy gurdy girl, I think you understand what I mean.
I (and my sib) don't want our parents to know that we've told the doctor anything.
I think she'll keep our confidence, once she knows, but we really want to know the best way to
route a paper letter directly to her own eyes. (or are we being very old-fashioned?)
We don't expect a response, it's just to give the MD an alert on what's going on in reality, rather than our parents version of 'we're fine'.
posted by mdrew at 11:10 PM on May 31, 2015

I think if you're really set on sending a letter, you could just write "confidential" on it and it will likely get to the doctor directly. But I honestly think it's better to speak directly to the doctor, because if you send a letter she can't ask you further questions to get more details--or rather, she'd have to call you to get the answers anyway (she will almost certainly not write you a letter back).

I think the most convenient way to make sure your concerns get heard accurately by the doctor is for you and your sister to make an appointment to speak to the doctor in person. Your suspicion that a letter is a bit old-fashioned is correct--and I think it's not really as effective a way to communicate your concerns in this case as to have a conversation; the problem is that a letter isn't a conversation.
posted by hurdy gurdy girl at 1:13 AM on June 1, 2015

I spent what seemed like hours on the phone to my father's doctor when he was at that difficult stage of life, risky driving etc. For what it's worth.
posted by Coaticass at 3:06 AM on June 1, 2015

I've done this a couple of times, by calling the doctors - the thing is, they couldn't promise not to tell the patient I'd called. In my case, the items weren't "actionable" without the doc saying that they'd heard it from me. How do you say, as a clinician, "hey - I heard you've been drinking a lot lately"?

The doc can ask "what are your drinking habits like" and then the patient can proceed to fudge the truth.

The docs I spoke to couldn't keep me anonymous, told me that up front, and I appreciated it and went ahead and shared my concerns.
posted by vitabellosi at 3:09 AM on June 1, 2015

Every letter that goes to a doctor is confidential. Receptionists open them as part of their duties. I'd aim for a phone call or a visit. And sometimes doctors kinda know what's going on without being explicitly told. Particularly with older patients. A good gp is keeping an eye on all sorts of things at every visit, possibly not even asking explicitly, but noticing and noting.
posted by taff at 5:30 AM on June 1, 2015

I had concerns about my Mom, and when I visited, I took her to an appointment. It turned out the doctor had a very good grasp on things; my Mother decided what she wanted to accept from what he recommended, and proceeded as she chose. If you can visit your folks and visit the doctor with them, do. Or call. I think having the interaction with the doctor would be quite useful. I'd also try to individualize your concerns so that you can be specific about issues with Mom and issues with Dad. Their doctor must absolutely do this and I think it will be more effective addressed that way.
posted by theora55 at 5:41 AM on June 1, 2015

I think there's a couple "levels" of confidentiality here. I understand you want to express your concerns to your parents' doctor without your parents' knowledge. A letter is a good way to do this, especially if you include contact info for you and your sister so the doctor can follow up with you if she has any further questions. And make sure you include your parent's names and dates of birth for reference.

But is it also important to you to keep the content of your concerns private from all other members of the doctor's office staff, and/or out of your parents' medical records? I work in a primary care doctor's office as a file clerk. Part of my job is sorting and opening the mail, and filing stuff on patient charts. All patient-related mail is confidential, in that it is bound by HIPAA. But I'm going to open the envelope to see how to route your letter. And I'm also probably going to file that letter on your parent's charts, as it contains clinically relevant information. If this is what you're trying to avoid, a phone call is best. You'll probably have to leave a message with a receptionist or nurse, just say that you want to discuss some concerns about your parents with the doctor. There will be a record on the chart that you called, and the doctor's documentation of your conversation may be more or less specific, but it won't be a verbatim report.

There's advantages and disadvantages to both a letter and a phone call, depending on what's most important to you. A letter is a written record, so the doctor can refer later on to its exact content and your specific concerns. On the other hand, it's a written record. The documentation for a phone call is much less specific, but you can have an actual back-and-forth conversation with the doctor. Of course, it's not either/or. You could write a letter and have a phone conversation.
posted by Princess Leopoldine Grassalkovich nee Esterhazy at 6:13 AM on June 1, 2015

Thanks for these great responses!

Maybe I'm not being specific enough in my question, but...
calling the DR's office is something we've decided against,
we think having our concerns in writing is best (there'll definitely be a record of what we said, and when).

What I really want to know is...
how should the letter be addressed... so the dr will see it?

The dr's confidentiality/ethics are NOT in question,
I want to know how a letter should be addressed (on the envelope)
so it'll be brought to her attention!
posted by mdrew at 7:11 AM on June 1, 2015

How it should be addressed is probably hard to say. It just depends on the office. You could call and ask the receptionist.

Just so you know, since you mentioned it, HIPPA works the opposite way. The doctor is under no obligation to keep what you say confidential from your parents. However, the doctor can't share anything about your parents with you without their express permission. I'm not saying you shouldn't send the letter -- I just wanted to make sure you understand the legal framework.
posted by radioamy at 7:32 AM on June 1, 2015

A letter, as others have said, will become part of your parent(s)' chart if the medical office is behaving ethically, and patients have a legal right to their medical records. In addition, depending on the medical office, papers might get filed into a chart without the treatment provider seeing them first. (I realize that's what you're trying to avoid.) Even with "confidential" or whatever on the envelope, because pretty much every single piece of patient information coming into a medical office contains confidential information but not all of it gets put directly in front of an MD.

Because of all that, an unsolicited letter seems the least likely to achieve the goals you want to achieve.

I think the best way to make sure that your concerns are heard by the right people would be to call the office and share your concerns with whatever person is set up to address patient concerns and ask them if they want you to follow up in writing.
posted by jaguar at 8:02 AM on June 1, 2015

I think she'll keep our confidence, once she knows, but we really want to know the best way to route a paper letter directly to her own eyes. (or are we being very old-fashioned?)

This is fairly old-fashioned. A paper letter won't necessarily be routed to the doctor, definitely not JUST to the doctor. It doesn't matter what you put on the envelope; there is still probably a procedure for handling any mail set to the doctor's office. It won't be confidential from your parents either. HIPAA works so that your parents have access to their information, not protecting any information from being seen by them.

Verbal communication is the best way to keep things as confidential as possible-- which isn't very confidential, in fact.
posted by RainyJay at 9:00 AM on June 1, 2015

Set up a formal appointment and hand deliver the letter to the doctor's hands. Request that the doctor read the letter before it is filed anywhere. Consider telling them why you selected written notification and also what you'd like them to do with it.

Then leave if you gotta, but honestly, it makes sense for you to stay and discuss it in person (in addition to providing it in writing) but it sounds like you may have reasons you don't want to do that.
posted by juliplease at 10:47 AM on June 1, 2015

I'd address the letter specifically to the doctor, knowing that a receptionist or assistant will open it first. Therefore, I'd put a cover page on top of the actual letter, stating (in a bit larger font, but not big enough to be "yelling")..."The following page contains information meant to be read ONLY by Dr. Whatshisname in regards to a specific patient. Please give this letter directly to him." That way the assistant won't have to start reading the letter in order to know what to do with it (because a lot of letters are addressed specifically to a doctor but could be an advertisement). That mostly blank page will also be somewhat attention grabbing...it's unexpected enough for someone to click off the opening mail autopilot and actually pay attention to it. Hopefully!
posted by MultiFaceted at 11:52 AM on June 1, 2015

Many offices, especially larger offices, have switched everything to an electronic record where incoming mail gets scanned and added to charts; there may not actually be a system in place where a paper letter can be given to the doctor without a potential large disruption of the system, which lower-tier office assistants may not be willing to risk.
posted by jaguar at 12:12 PM on June 1, 2015

You've got great advice here for HIPAA etc. consider the category of the concern - health? Safety? Elder abuse? Some of these topics get different treatment. State your observations. We were at dinner last night and my parent ate 3 slices of pie after telling me that he disagreed with your diabetes diagnosis. There are new and disturbing damage indications on their car that they refuse to talk about, and they are now parking outside the garage at least until the contractor finishes repairing the recent damage. We have safety concerns, perhaps you've had similar discussions with patients. Parent A has questionable bruising/is afraid of spouse, adult child or caregiver and would benefit from a medical provider's referral for support, etc. the last hypothetical would get the most confidentiality.
posted by childofTethys at 5:10 AM on June 2, 2015

Given that you want to a) make sure the doctor knows, and b) make sure there is a paper trail showing that the doctor knows, I would do the same thing I do at work. Call the person and talk directly (so you know that they know) and then follow up with a written message (usually e-mail, but a letter would also be fine, so you have your paper trail). It's a little more work, but presumably this is a serious discussion of your parents' health, so it ought to be worth the effort, right?
posted by anaelith at 5:32 AM on June 5, 2015