Managing Patient Expectations related to Disclosing Personal Health Information

1. Managing Patient Expectationsrelated toDisclosing Personal Health Information Jodi L.H. Butts Legal Counsel and Corporate Privacy Officer

2. The Importance of Transparency

3. Case #1:Info to the Public Health Nurse • Patient had history of mental health issues which clinically predisposed her to post-partum depression • This info was released to Public Health nurse for the purpose of follow-up at home • Patient felt “ambushed” when PH nurse telephoned to discuss her mental health

4. Case #2:Info Sent to Family Physician • Obstetrician dictates note without looking at record; assumes family MD referred patient • In fact, patient was referred by fertility specialist • Obstetrician “thank you” referral letter referred to fertilization using donor eggs • Patient’s family MD was a family friend and she did not want this info going to him

5. ‘Locking’ Information when everyone has a ‘Key’

6. Privacy Working Group:Toronto Central HIN • Working to harmonize privacy policies • Project ‘lockbox’ has been the primary task to date • Developed a brochure for patients who request some form of ‘lock’ on record • In addition, patients sign off on ‘request form’ as to limitations of ‘lock’ requests

7. ‘Lockbox’ brochure • ‘Lock’ cannot be followed when: • Warrant for information; • As permitted by law, i.e. ‘permitted uses’ • As required by law: • reporting to the police the name of a patient being treated for a gunshot wound; • certain diseases to Public Health; or • to report suspected child abuse. • To eliminate or reduce a significant risk of serious bodily harm to patient or to others

8. Managing the Tension

9. Lessons Learned • Very often what people are most sensitive about must be disclosed • History of violence in family, communicable diseases, gunshot wounds • Sometimes it is just the “ambush” that inspires the complaint, even though the disclosure is lawful • ‘Statement of Disagreement’ is sometimes a better remedy than a ‘lock’ • Gives the patient an opportunity to have his/her side of the story told in the record • But still allows subsequent clinician to consider the observations of previous care givers

10. Jodi L.H. Butts Mount Sinai Hospital 416.586.4800 ext. 3909 jbutts@mtsinai.on.ca