Saturday, February 09, 2008

Gossip, or Good Intentions?

So we had a heated discussion in one of my classes this week about patient confidentiality and gossip. Just this morning, I saw this link about a ban on gossip posted on Paul Levy’s blog, Running a Hospital, and figured the forces were aligning in such a way as to warrant a post.

Specifically, we discussed the types of conversations that take place at nurses’ stations, cafeterias, and outside patient rooms. Everyone was adamant that a certain amount of patient information needs to be shared between shifts and between providers for optimal patient care. But they were worried about the fine line between what is medically necessary information and what is merely gossip, particularly when it is shared within earshot of other patients, families, and visitors. They’re all familiar with the axiom “Don’t take it home” in regards to patient information, but several of them wished there was something more concrete in place to help them navigate that precarious line.

Patient confidentiality certainly raises timely questions, and one without easy answers. For example, if a patient has a roommate, there is no way to avoid some information transfer to that roommate and his or her visitors. But when one patient’s relative has extremely detailed knowledge of the roommate’s lab results, family situation, and legal issues, then confidentiality has been breached.

I can approach their discussion from a different perspective. I can see why healthcare providers would need to know about changes in my physical and emotional states when I am an inpatient, and I want them to know if it means they can better address my needs.

On the other end of the spectrum, I once bumped into a medical assistant from my endocrinologist’s office at a bar. She introduced me to her friends as her patient, asked me if my new dose of medication (which she named) was working, and told them I was a difficult stick for blood draws. (She wasn’t sober, can you tell?) I was not impressed. At all. Obviously this is an egregious example way outside the bounds of the classroom conversation, but yet it’s still part of the conversation.

I know that my colleagues and I face similar boundaries in sharing student information. It’s one thing to describe a classroom situation and seek advice or bounce around ideas about how to handle it, or to very generally describe someone’s extenuating circumstances when in committee meetings to discuss failing grades. It’s another thing altogether to reveal any specific, personal information that has been shared with us, and we need to make the same kinds of distinctions between what will help us best help our students and what should always remain confidential.

I think in any profession where you establish relationships with people, where trust and respect develops and you begin to really care about people, you’re going to confront these issues. If you didn’t care, the details wouldn’t matter.

But knowing that doesn’t make it any easier in the moment, does it?


chronic chick said...

Hope this week gives you more energy... its zaps me too with the lupus..

Anney E.J. Ryan said...

I remember the first time a colleague talked about students to me... I was horrified! I was like, Are we supposed to be having this conversation? Honestly, I tell my students more about us teachers (our tendencies, our thinking, not our individual personal info) than I tell teachers about my students. When teachers talk about their students, it's only good intentioned if there's a problem and the teachers are trying to fix it. Anything else, and yeah, it's gossip. It's not fair to the kids; as teachers, we have the upper hand. It's more awkward for them to catch us talking about them, than for us to catch them talking about us.

Anonymous said...

I have to say that as a social work student, I struggle with this. I'm interning at a hospital for children, and I've attended care/case conferences. And I found out recently that I'd be on the agenda of one at the pain clinic I attend. To be honest, that makes me feel very awkward.

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