What happens when a doctor breaches confidentiality?
January 27, 2009 8:27 PM   Subscribe

What happens when a doctor breaches confidentiality?

I was talking with my doctor in her office at my appointment and mentioned my friend Jane Doe. My doctor said, "oh I know her, I treated her for these conditions, and furthermore you should know she is this kind of person." Now I feel like I may not have privacy with my doctor because who knows what she's saying behind my back? (I have not told Jane Doe that I know about her medical condition.)

I got the number for a local patient advocacy place, and would like to call them, but I want to know what will happen? Will the doctor just get into minor trouble or will she lose her license? Will I need a lawyer? What if she tries to say I lied and she didn't tell me this information? Can she get some kind of revenge or sue me? If the doctor goes to a new state, will the complaint follow her or will she be able to start fresh with a new license?

My husband does not want me to turn her in. He says that other doctors will not want to treat me after I do this. Is he right?
posted by anonymous to Health & Fitness (26 answers total) 4 users marked this as a favorite
Call your state medical board. Explain the situation. You shouldn't need an attorney. As far as other doctors not wanting to treat you--it's not their business.

If I were Jane Doe, I'd want to know. AND if I were Jane Doe, I'd call the state medical board and file a complaint.
posted by 6:1 at 8:39 PM on January 27, 2009

What happens when a doctor breaches confidentiality?
That's up to the medical board. Tell them. And tell your friend too. It'll be an awkward conversation, but if the situation was reversed you'd like to know.

And that's exactly why you should call the state board. Because this shouldn't happen, and if it is the patients should know.

My husband does not want me to turn her in. He says that other doctors will not want to treat me after I do this. Is he right?
No. This is exactly the kind of thing the board exists for, and any doctor worth their license isn't going to blacklist someone because they have a legitimate complaint. (Not that they would ever find out anyway.)

If you're worried about it, don't give your name to the board. But definitely report it.
posted by Ookseer at 8:55 PM on January 27, 2009

My husband does not want me to turn her in. He says that other doctors will not want to treat me after I do this. Is he right?

He is right, but only if you're living in an episode of Seinfeld.
posted by rhizome at 9:00 PM on January 27, 2009

My husband does not want me to turn her in. He says that other doctors will not want to treat me after I do this. Is he right?

My state medical board deals with, I don't know, maybe a hundred or more complaints every month. I seriously doubt that doctors, with their already huge workload, have either the time or inclination to keep track of all that.
posted by TungstenChef at 9:08 PM on January 27, 2009

Will the doctor just get into minor trouble or will she lose her license?

Almost certainly neither. As much as you may want to think there are real repercussions for stuff like this, a slip-up by a doctor who discusses a mutual acquaintance will not be worth a medical board's time. Forget about it, you're wasting your time.
posted by jayder at 9:15 PM on January 27, 2009 [1 favorite]

This stinks, but I don't know if telling Jane is the best thing to do, for her own sake. If the fill-in-the-blank happened to be "I treated her for self-mutilation and hallucinations, and Jane is a schizophrenic", why traumatize her for no reason? If Jane is having serious problems, does she really need to waste her time and focus thinking about this Chatty Cathy shit?

The problem should be definitely be reported to the medical board, by you, because you're the only one who witnessed it. Jane can't do a thing: "I heard from a friend my doctor was talking about me behind my back!" is third-party hearsay, and won't hold up. (Besides, if she does have a history of instability, how is that report going to make her look? No good will come of it.) Report it yourself, find another reason to convince your friend to change doctors, and let it go.
posted by aquafortis at 9:33 PM on January 27, 2009

If everyone whose confidentiality was breached said "forget about it", there'd never be any true regulation or liability. The board exists for a reason, and this is a clear ethical violation.

Tell Jane. Let her decide what to do about her own case. File the complaint about yours.
posted by cmgonzalez at 9:34 PM on January 27, 2009 [7 favorites]

I shouldn't think a doctor would lose her license for this, but I imagine a series of small complaints like this would have a chance of getting noticed. So it might be worth trying to figure out who to tell. The wiki article on HIPAA tells you (or actually your friend) where to complain about the disclosure of the Protected Health Information.
posted by MadamM at 9:34 PM on January 27, 2009

Although on a second, closer look, it appears that they might not actually care that much. It still might be worth taking it to the medical board, or just to give you some peace of mind.
posted by MadamM at 9:36 PM on January 27, 2009

Honestly, a doctor who does something like this so blatantly should be reported. There could be other complaints about this same doctor.
Depending on what information the doctor shared with you about your friend, it could either be good or bad to tell her. If it's something super embarrassing or traumatic, like a severe mental health problem, or an STD or something, you should tell her.

Also, in regards to your husband's fears, I seriously, seriously, doubt that other doctors would know that you had made a complaint with the state medical board about another doctor. Most doctors would probably think your doctor is an idiot for what he did, anyway.

Here's where you can find the contact info for your state medical board.
posted by fructose at 9:46 PM on January 27, 2009

I meant if it's something traumatic/embarrassing, maybe you should NOT tell her.
posted by fructose at 9:46 PM on January 27, 2009

And I should have said she, not he. Sorry, it's late and my brain isn't working properly.
posted by fructose at 9:47 PM on January 27, 2009

Nthing that you should tell Jane. Her doc, her condition being discussed with you. Some people would be mortified by someone even knowing which doctor in town they saw. Some people would be OK with their MRIs being put up billboards along major freeways. You don't know how Jane feels about the doc talking about her.

You know for a fact that you're uncomfortable with idea of the doctor talking about any of his patients to anyone else. If you aren't comfortable with your doctor, for any reason, find another one. When the door closes to the exam room, you need to be able to have a free flow of information between doctor and patient. If you don't feel comfortable talking to your doc, you won't get the best treatment because you won't give the doc the full picture. I doubt your doc would blackball you, but I'd say that you need to start looking for another doc if you're this upset by what happened.

There's something about this story that doesn't ring true to me on the face of it, though. I worked in doctors offices for my last two years of starving student days, and more of my family members work in medicine than I'd care to list here. I'd just find it really strange that a doctor would get into value judgments of a patient, as well as a full run down of diagnosis, prognosis, lab test results, etc, with another patient who just happened to mention this person's name. I've only seen docs bring up positive value judgments if they're making a referral to another doc... usually, the absence of the positive will indicate a neutral opinion. Some of that is professional training, but mostly it's because they're interested in you as a puzzle to solve or a system to maintain, and only very rarely because of things outside of that.

How extensive was this discussion? I'm also kind of amazed the doc had the time to give you the full bio on Jane. Usually, they're scheduled in half hour/45 min blocks, and if it's flu season, they're double or triple booked with patients who can't or won't wait.

Not saying it didn't happen, but I'm saying that either this doctor is blowing a gasket (in which case, you'd see a patient exodus or they might already be under investigation by the medical board)... or there's something we're not seeing here.
posted by Grrlscout at 11:20 PM on January 27, 2009

I say call the state medical board and Jane. This kind of breach of trust is simply unconscionable.
posted by eclectist at 1:04 AM on January 28, 2009

Contrarian view:
I think you should confront the doctor with the inappropriateness of their behavior and suggest that he/she should attempt to resolve the situation before you go to your friend or the medical board.

I have been on the receiving end of situations that were not discussed with me and came out of left field without having an opportunity to explain. Direct face to face conversation about how you feel and what you heard, with the person directly involved is always best.
posted by Xurando at 5:23 AM on January 28, 2009 [2 favorites]

Telling you anything about your friend's treatment or health status without her consent is definitely a HIPAA violation. The penalties are not too severe for something like this, but it is not OK.

Tell your insurance company, and urge your friend to tell hers. They should have a department that deals with patient complaints about practitioners. Depending on the insurance company, they may investigate, or may just make a note in her file.

Is your doctor a solo practitioner, or part of a larger group? In some cases (though definitely not in all) the group will want to take some action, especially if they keep track of HIPAA compliance for any reason (which many larger groups do).

At the very least, get a new doctor. Yours is not operating with a full set of ethics.
posted by fidelity at 5:49 AM on January 28, 2009

Agree with speaking to the doctor first. There are always going to be exceptions, but as a rule, we are all better off if we try to solve our problems by starting with the person we have the problem with. There's no reason not to in most cases. If the doctor brushes it off, then you know the doctor has an ethics problem. But if the doctor is horrified, perhaps doesn't even realize she's doing it, you've given her an opportunity to change her behavior.

Advice to sue? For what? Even if Jane indeed felt mortified, where's the damages? What would she sue for?
posted by gjc at 6:18 AM on January 28, 2009

Damn! Beat me to it :)

I have no idea what your Doctor was thinking, but maybe for some reason she thought that it would be ok. Casually ask her? It will be a good lead on to the fact that it blew your mind... "and um could I ask that you never speak about my personal concerns in that manner." (Flash a slightly embarassed smile to avoid coming across as snarky.)

But WTF! She's a Doctor... not a fucking hairdresser. I would love to know what motivated her to do such a thing??
posted by mu~ha~ha~ha~har at 6:34 AM on January 28, 2009

This may depend on what state you're in, but for at least two states that I know of, medical confidentiality is a joke. Your complaint will get dropped into a giant bucket somewhere, and some day that bucket may overflow, whereupon the gears of punishment will start to turn. Until then, nothing will happen. Whether this matters to you is another question entirely; perhaps merely "doing the right thing" will suffice for you.

Why I know this: large urban hospital near me routinely sells patient info to medical marketers. As in, they clearly do daily uploads of new patients to those marketers in order to maximize the "freshness" of the marketing opportunity. They've done this for at least three years, I'm not sure how far back it goes, but it is happening now.

I am aware of this from the front-end (I know patients who wonder why they're magically getting specialized mailings about their newest private problem less than a week after seeing that hospital), and I'm aware of it from the back-end as well (once worked on an insurance system which had "flag record for sale" fields which processed nightly and dumped to FTP. The fields had cleverer names than that, of course, but that was their function).

Based on those experiences, unless your doc has been printing out flyers laughing at Jane, a whole lotta nothing will happen. Heck, one of those obscure documents she signed probably gives the doc total legal coverage.
posted by aramaic at 6:39 AM on January 28, 2009

Perhaps keep in mind the thousands of patients that could lose a highly skilled doctor (who has probably saved countless lives) for a simple case of gossip. Everyone is human. I would mention to the doctor in a casual way that "I hope you don't talk about me to people like you do about Jane." That will certainly make them realize they crossed the line and will hopefully put them into their place.
posted by jazzman at 7:13 AM on January 28, 2009

I would talk to, or write a letter to, the doctor herself. It's likely to both be more effective and less likely to be ignored than going to the medical board. If she responds with something like, "I am sorry, I will endeavor to not do that in the future," then you have been effective. If she says something like, "I didn't say that! Shut up, crazy patient! I'll do whatever I want, I'm the doctor!" then it's medical board time.

Dealing with people as if they are reasonable humans with faults and good intentions is always the way to go before you go the legal/bureaucratic/paperwork route.
posted by jennyjenny at 7:57 AM on January 28, 2009 [2 favorites]

For all those who think the doc should somehow be given a pass.

The situation described is so obviously a breach of trust. If the medical profession thinks that such things are too trivial to matter, then ignoring it undermines not just the credibility of the offending doc, but of the whole profession. It makes it that much easier for parents to refuse immuniztions for their kids, qwacks to peddle BS remedies etc. That is no small thing. It took the medical profession centuries to achieve the authority it has today, and for the most part, society is better for the fact that they have. That is too damn important to let slip away.

I think doctors and patients both benefit if docs are a trusted part of the community. They can do a better job for their patients if they know more about their lives than they can get from a short exam once or twice a year, but it is obvious that this incident crossed the line by the fact that anon posted about it. The fact that her husband is afraid they'll be blacklisted just shows that trust of the profession is already low in some quarters. The way to fix that isn't to blow off the small stuff. The small stuff has to be taken seriously, because it all ads up.

As for what to do about it, it would be good if the poster felt like they could take it up with the doc and let him or her know that they thought the discussion was inappropriate, and made them concerned about what the doc says about her before deciding whether to make a complaint to an ethics board, but if they dont feel comfortable doing that, they should still make the complaint. Making the complaint is unlikely to result in any immediate action, unless there are already too many complaints to ignore. If there aren't, it's still important to get it on the record so the evidence is there when someone is fianlly ready to consider it.
posted by Good Brain at 9:26 AM on January 28, 2009

What is it that you hope to achieve I guess is the question? Do you want the doctor to be reprimanded and if so, to what extent? Or do you want the doctor to be aware of the mistake (a significant one, to be sure) they made and correct their behavior? Do you want both?

Also, have you considered the possibility that the doctor mistakenly assumed (perhaps based on something Jane had told him) you already knew about the details of Jane's health that were shared? Or has he perhaps received tacit approval to share this info from Jane herself? Would he be sharing the info purposefully with the interests of Jane in mind? None of these change the fact that sharing private medical information is a big no-no but they are mitigating circumstances which may be at play.

Reporting the doctor to the medical board will likely lead to nothing at all, possibly lead to a warning or similar slap on the wrists, or perhaps more serious consequences particularly if a pattern of prior behavior has been established.

My personal bias (admittedly as a doctor) would be to bring it up to the doctor and discuss it with Jane (assuming the information revealed wasn't "sensitive") as others have noted. At least do this before filing any formal complaints. If you choose to file an official complaint with a medical board, hospital, insurance company, or whatever, it most certainly won't come back to hurt you as your husband fears. But it could lead to unintended consequences that you might want to consider. As an extreme example: let's say you report this incident without talking to him or Jane and for whatever reason the doctor loses their license. Then Jane finds out and turns out to be upset about what you did. What if Jane is willing to forgive the indiscretion, because this is the first doctor who has actually helped her deal with her medical condition when others have failed? What if the doctor's other patients are adversely affected.

If nothing else, as a practicing doc who is genuinely always trying to maintain absolute discretion with respect to patient info, I can imagine myself slipping up (if very rarely) in this regard despite best efforts. And being made aware of when/if I violate HIPAA would certainly help me improve my practices.
posted by drpynchon at 9:44 AM on January 28, 2009 [1 favorite]

Advice to sue? For what? Even if Jane indeed felt mortified, where's the damages? What would she sue for?
gjc, I actually agree with the main thrust of your post. But, um, statuatory damages?
posted by vsync at 11:48 AM on January 28, 2009

FYI--There are new, stricter HIPAA regulations that went into effect Jan. 1.
posted by 6:1 at 3:21 PM on January 28, 2009

I just read that state attys just got new enforcement powers regarding HIPAA violations and immediately thought of this question
posted by fructose at 9:15 AM on February 3, 2009

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