Thursday, August 18, 2005

the anonymous patient

Ann Althouse blogged recently, Sure, I'll keep it private, linking to this NY Times article (registration required).

The article, "It's Time for the Truth When the Body Clock Strikes 13" by Perri Klass, MD, is an engaging look at what transpires between the adolescent and his or her doctor. The doctor solicits questions from his patient, assuring him that he can ask anything and his Mom will be none the wiser. Here's a quote from the article:
"Really? I can ask you questions and you won't tell her?"

"I'll keep anything you ask me or tell me private," I said. "What's your question?"
Then, of course, Klass goes on to discuss some actual questions.

Althouse comments: "I'll publish it in the NY Times, but other than that I'll keep it private." She thinks that the patient's privacy has been abused, that the doctor broke his promise and committed an ethics violation in writing this article.

Several people in the comments thread agree with Ann, but I don't, and said as much, over there -- there is no way to identify a particular patient from the narrative of the article. I'd be willing to bet that the described scene is actually a pastiche of hundreds of encounters this doctor has had.

But to Ann, and some of her commenters, the fact that the doctor said "I'll keep it private," prohibits him from writing about the interaction or even referring to it, without obtaining the patient's prior permission, even if it's anonymous, and there is no way to connect any one individual to the scene under discussion.

So, medbloggers -- where do you stand on this issue? Is what Klass did ethical, or not? As far as I can see, the identity of the patient(s) is(are) protected, and therefore there is no ethical violation. Is that not good enough? I've never been to med school (obviously) or studied medical ethics, so I'll rely on you experts for guidance.

All I know is, I regularly read medblogs -- Dr Charles immediately springs to mind -- who employ literary devices in discussing patient cases, but always maintaining the patient's privacy by shielding their identities completely. As long as that is the case, I'm not seeing any ethical -- or HIPAA -- violations. But I'd really like some knowledgeable folks to weigh in on this issue.


Dr. Charles said...

always a contentious topic, and for good reason. i think your arguments are supported by most of the literature, ethical standards, and common sense out there. my "purpose" page details what i specifically do to avert any breach of confidentiality... does that seem reasonable, excessive, totally paranoid???

The Platypus said...

HIPPA guidelines are pretty clear. If the patient isn't identifiable, it's okay. Be careful about describing unusual cases that can be traced to a perticular place or time and there should be nothing wrong with it.