Our Lips are Sealed

December 31, 2011

Part of the fun of meeting famous people is that you can tell everyone that you met them, right? Well, not if you work at a health care facility where they are admitted and you are under strict ethical and legal restrictions prohibiting you from mentioning anything at all.

I met someone famous recently at one of my many contracted facilites. I know all of you reading this want me to tell you who it is, and believe me I want to. I just can’t. I can’t even tell you if it’s a male or female, what their age is or why this person is famous. Bummer. But… rules are rules, and if we didn’t keep these secrets, you know that pretty soon everyone would know not only the physical whereabouts of the person, but also private medical information about the person.

I certainly don’t want that to happen.

This doesn’t just happen with the rich and famous, however. I work at a psych unit near where I grew up, so occasionally someone I know will be admitted to the unit. The first time it happened, I was very freaked out, but I kept my cool and only said hello to the person. I didn’t look at the person’s chart (I was curious about the dx but didn’t give in to temptation) and I decided I would only have a conversation with that person if they approached me. Another person was a family friend, and I had to approach the person to let them know that I wasn’t going to look at his/her chart, let alone tell my family about it (I “found out” later from the fam that this person had been there).

In past posts, I have been very careful to keep people’s information a secret. I use clients’ first initials, but sometimes I change the initial depending on the setting. I may mention diagnoses at times, but because I don’t mention the person’s name or the names of the facilities I work, it is almost impossible for anyone, anywhere, to ever know who I’m talking about. The world of HIPAA regulations and patient confidentiality makes it illegal for me to talk about patients in a casual sense, but I’m wondering where the line is.

I was recently at the annual AMTA (music therapy, not massage) conference and attended several sessions where other professionals mentioned names (first names), diagnoses, facilities and generally private information about individuals. These were anecdotes about our work, and while I’m not offended or bothered by the way in which some of my colleagues mentioned their clients by name, I have to assume that the clients may not have appreciated it had they known. Was it okay because it was at a professional conference? Was it okay because most of the people in the audience were music therapists? Had the presenters gotten permission to use the names of their clients at the conference? All good questions, some of which I wil never know the answers to. I am only concerned because of my own boundaries and personal ethics.

Something else came up recently, also at the conference, that is currently haunting my blog and may be one of the reasons that I haven’t been posting as much recently (sorry, faithful readers!). My (very cautious) internship director of old is publishing a book of some past interns’ weekly anecdotes about clients who taught us something. I was notified that one of my “patient highlights” was in the running to be used in the book, and is it okay if they use it (?). Of course it is. Would I have ever known that it was mine if I read the book without being asked? Probably not. Would I have cared? Probably not. Is my name on it? No. Was my patient’s name on it? No, but his diagnosis was and the unit he was admitted to in mid 2006. Even though this patient has long since been discharged from the hospital, and no real identifying information was given in my paper, the people working on this project had to ask permission from the hospital to use the information that was there.

Question: If that project is following ethical and legal guidelines, then how ethical is the information I put in my blog?

I hadn’t thought about this until the conference, but I haven’t been able to get it out of my head. Because of this, there are three or four posts “on deck” that I haven’t posted because I’m worried about being unethical. I did go to a “privacy in social media” session at the conference hoping to get some validation or at least some clear guidelines, but it was just about facebook’s ever-changing privacy settings, and professionalism on the web, not ethical boundaries in social media. New regulations and ethics considerations have arisen because of the world’s use of the internet and social media to talk about formerly unknown or uncommon topics. Is the information I’m giving too telling? Is a client going to find my blog and know I’m talking about them? What is the line between presenters at conferences talking about their clients using first names, ages, where the client resides and diagnoses and me writing about my clients in a profession-based blog? I haven’t decided yet. Any thoughts?

Let’s go back to my famous person from the first paragraph. Something that has made this all more difficult is the fact that other people, other clients at this place, know who this person is and have told their family members of my client’s whereabouts. The family members come in for a visit and seek my famous client out to chat. These family members don’t have as great a responsibility to my clients as I do, so who’s to say that they’re not going home to their spouses, friends and coworkers and letting them know who they met earlier that day? In this case, does it make the boundaries more relaxed? Does this mean that eventually it will be okay for me to talk about it with my friends, boyfriend, family and coworkers? If it ended up in the news, would it be okay then? What about if I was finding out about this from random people I meet? There are such gray areas surrounding the topic of client confidentiality, and it seems like no matter how hard I try, I can’t understand where certain lines are – not only in blogging – though if I have a nagging question about whether something is ethical, I generally put that post on a shelf and wait for an answer from somewhere.

What about clients who have passed away? Their obituaries are in a dozen newspapers all over Massachusetts stating where they lived for the last ten years of their lives, who their family members are, sometimes what they had been suffering from, and their age and background. At what point would I be allowed to talk about the person as a person, instead of an initial, if ever?

I don’t need to talk about my clients – any of them. All I want is to talk about instances that may be of interest and provide education to other people in my field or a similar one, but is my desire to share useful information compromising my ethical standards and boundaries? I am very intentional about how and when I share information, but is that good enough?

When and how do the gray areas turn into something clearly defined? What can we ethically say in conversation and/or public forums?

Discuss (for real).

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