A 46-year-old man comes to the emergency department with chest pain that began 30 minutes ago. The patient describes the pain as a tight, squeezing sensation that radiates to the left arm. He also has increased sweating and nausea. ECG shows multi-lead ST-segment elevation, and cardiac troponin levels are high. The patient has a history of alcohol and cocaine abuse, but no history of cardiac disease. He undergoes emergency cardiac catheterization and is recovering appropriately in the postanesthetic care unit. The physician is approached by a distraught woman who says she is the patient's wife and asks about his condition. She says, "I am so worried; please tell me if my husband is okay." Which of the following is the most appropriate course of action?
While this patient is undergoing emergency treatment for acute myocardial infarction, a woman who claims to be his wife arrives at the hospital and asks about his medical condition. The Health Insurance Portability and Accountability Act (HIPAA) is designed to protect patient privacy. This requires the patient's explicit consent (or lack of objection when given the opportunity) to share medical information with others, including family and friends.
When the patient is incapacitated or is not present, basic information can be shared if, in the physician's professional judgment, doing so is in the patient's best interest. In this case, there is no way of knowing for sure whether informing this woman (whether she is his wife or not) is in the patient's best interest. However, the woman is distressed, and leaving her to worry for an extended period while the patient is recovering could cause the patient emotional harm if she is indeed family. The best approach to protect the patient's privacy is to explain that he is stable, but that further information (including general diagnostic and treatment information) cannot be shared until he is asked for and provides consent.
(Choice A) This discussion would violate the patient's privacy.
(Choices B and D) This patient has not given permission to release information to the presumed wife, even if she provides identification or marital status is confirmed. For instance, the patient could be undergoing a contentious divorce and not want any information released to his wife. HIPAA does not require proof of identity if the patient has given permission to share information.
(Choice C) Providing minimal information that the patient is "stable" would be appropriate. This response protects the patient's privacy by not revealing the diagnosis or other medical details, but also limits emotional harm to the patient by informing those who are likely to be family about the patient's condition. If permission to share information is obtained later, the physician should ask the patient whether he prefers that potentially sensitive details be omitted (eg, if the myocardial infarction was due to cocaine use and the patient did not want this revealed).
Educational objective:
Under the Health Insurance Portability and Accountability Act, physicians may disclose patient information to friends and family members in emergency situations or when the patient is otherwise incapacitated, depending on what is in the best interest of the patient. Otherwise, patient information may be disclosed only when the patient gives explicit permission or does not object when given a reasonable opportunity.