Truthfulness and Confidentiality

What is truthfulness?

conformity with fact or reality (a fluid concept)

What is veracity?

obligation to tell the truth and not to lie or deceive others

Veracity is fundamental to the establishment of ___

trust among individuals

Truthfulness is summed up in 2 commands:

1. do not lie (this rule alone allows tech to say nothing at all to avoid lying)

2. communicate with those (and only those) who have a right to the truth

What is a lie?

a falsehood told to another who has a reasonable expectation of truth

Lies are judged in terms of ___

consequences for the individual and society

Expectations of the truth vary with what 3 conditions?

1. place of communication

2. role of communication

3. nature of the truth involved

(all 3 are related to obligation of confidentiality and right to privacy)

Explain place of communication as a condition of expectations of the truth

• the environment of the expectation of truth

• should be in a private setting

• do not want anyone overhearing and possibly becoming distressed

Where can the student have an expectation of truth 100% of the time?

in the confidential classroom setting

Explain role of communication as a condition of expectations of the truth

• relationship between the communicators

• role of imaging caregiver and patient (or any two parties)

Explain nature of the truth involved as a condition of expectations of the truth

• alters the expectation of truth in questions concerning private matters

• caregiver should not expect a truthful answer (if asking anything of a personal or private nature)

• there is no reasonable expectation of the truth

Is concealment of the truth considered a lie?

not necessarily

Informed consent process is necessary when ___

making decisions about treatment and when making important nonmedical decisions

Explain the roles of the radiologist and technologist in discussing exam results with patients

• radiologist or physician can provide detailed information on exam results

• imaging professionals do not have the authority to discuss pathologic findings with patients

What is confidentiality?

duty owed by health care providers to protect the privacy of patient information

Confidentiality concerns the keeping of ___

secrets

What is a secret?

knowledge a person has a right or obligation to conceal

What are obligatory secrets?

secrets that arise from the fact that harm will follow if a particular knowledge is revealed

What are the 3 types of obligatory secrets?

1. natural secret

2. promised secret

3. professional secret

Explain natural secrets (as 1 of the 3 types of obligatory secrets)

• information shared in a natural secret is by nature harmful if revealed

• ex: HIV status

Explain promised secrets (as 1 of the 3 types of obligatory secrets)

• a secret that the receiver has promised to conceal

• harmful effects of breaking a promise

• breach of confidentiality AND lose trust as employees or friends

Explain professional secrets (as 1 of the 3 types of obligatory secrets)

• the most binding of the obligatory secrets

• both the patient and the imaging professional are harmed

• damage to the reputation of the professional, their department, and their institution

The ___ was published by the ___, and discusses professional secrets

The Patient’s Bill of Rights; American Hospital Association

The Patient’s Bill of Rights discusses ___

the importance of professional secrecy has been recognized by society and a body of laws have been created that encourages privileged communication

What are some exceptions to confidentiality that are mandated by state laws?

• certain types of wounds (i.e. gunshots)

• communicable diseases

• auto accidents

• abuse (imaging professionals are required to report suspected cases of child or elder abuse)

• birth defects

• industrial accidents

• drug addiction (only in some states)

What does HIPAA stand for?

Health Insurance Portability and Accountability Act of 1996

What are the 3 major purposes of HIPAA?

1. to protect and enhance the rights of consumers by providing them access to their health information and controlling the inappropriate use of that information

2. to improve the quality of health care in the U.S. by restoring trust in the health care system among consumers, health care professionals, and the multiple organizations and individuals committed to the delivery of care

3. to improve the efficiency and effectiveness of health care delivery by creating a national framework for health privacy protection that builds on efforts by states, health systems, and the individual organizations and individuals

When information is required to be released, can you release all information?

NO; only the minimum necessary information for the purpose of disclosure should be released, rather than the entire record

With HIPAA, when are disclosures allowed without permission from the patient?

• disclosing to the patient

• to other health care providers for treatment purposes

• for payment of services

• for health care services (ie. quality assurance info)

• appointment reminders

• treatment alternatives

• health-related benefits

• approved research projects

What are some HIPAA special circumstances?

• subpoenas or court-ordered disclosures required by law

• law enforcement requests

• to other entities for billing purposes

• organ and tissue donors

• public health risks

What are some patient rights that are created or reinforced by HIPAA?

the right to…

• inspect and copy their records

• ask for the information to be amended if the patient believes it to be inaccurate

• ask what disclosures have been made

• request restriction of the information disclosure

• request the method of communication

• a paper copy of the privacy notice of the institution

If info disclosure permission is given, does that permission last forever?

no; it may be revoked in writing at any time

Release of patient information to outside reviewers is governed by ___

state law and HIPAA

Explain the relationship between HIPAA and state law

HIPAA supersedes state law in most respects and covers VA hospitals and other federal facilities

Does state law override HIPAA regulations?

NO

The Medicare program requires providers to ___

allow peer review organizations access to records of Medicare patients

What should imaging professionals do in regards to patient authorization?

consult the risk management department, in the absence of statutory or judicial support for the release of information to outside reviewers

The sharing of information from the patient medical record poses ___ risks

liability

___ are the most common outside requesters of medical information

third party payers

Is patient consent necessary for release of information to third party payers?

used to be, but is not necessary anymore

Most insurers require patients to authorize ___ when they file for payment

the release of information

Statutory disclosure says that the duty to report is a legal obligation to include:

• venereal disease

• contagious disease (such as TB)

• wounds inflicted by violence

• poisonings

• industrial accidents

• abortions

• drug abuse

• abuse of children, elderly people, and people with disabilities

Why are some things required to report (statutory disclosure)?

to protect public health

The duty to warn third parties is the obligation to ___

disclose information of a risk of violence or contagious disease (or some other risk)

Warning to third parties is usually based on ___

statutes

Warning third parties may come in conflict with ___

the duty of confidentiality

Breach of confidentiality extends to ___

oral, written, and computer communication as well as reproduction of records and employee conduct

Breach of duty to hold information in confidence may cause ___

liability for the individual and the facility

What is breach of confidentiality?

breach of contract or implied contract between the patient and the health care provider or health care facility

What is defamation?

the making of a false statement to a third party that is harmful to another’s reputation (said to another person about a patient, family member, visitor, employee, or a physician)

Defamation can be ___ or ___

written or spoken

What is slander?

defamation statement expressed orally

What is libel?

defamation statement that is written

In order for something to be considered defamation, ___

harm MUST have resulted from the false statement

What is slander per se or libel per se?

statement concerns criminal activity, a loathsome disease, business/trade/professional misdeeds

no specific injury needs to be proved