In the course of helping patients, it is possible technicians may encounter unique situations. While some translate directly to care, other concerns regarding privacy or legalities might arise, and technicians should know what to do (or not do) if they happen to come across them.
I address three memorable cases I was involved in and review the relevant points outside of the standard medical or vision care of the patient.
Case 1: Privacy
SCENARIO: New patient, age 22, comes in with her boyfriend. The front desk staffer relays that both patient and boyfriend smell like they have recently been “smoking” and winks at me. I take the patient and her boyfriend back and begin the work-up.
She presents with a medical history that sounds like a corneal abrasion and clearly has a subconjunctival hemorrhage OS. She gives permission for her boyfriend to stay in the room during the work-up.
ME: I see the red spot on your white part of your left eye. Can you tell me about that?
PATIENT: It happened earlier today. We were parked at a stop sign and as soon as the car moved forward, it happened. (She giggles and looks at boyfriend who smiles but is obviously uncomfortable.)
ME: Did something hit you in the eye at that point? It may be important for the doctor to know.
PATIENT: OK. (Pauses.) When the car moved, my "cigarette" hit me. It does not hurt much even though it is a little bit blurry, but when my boyfriend saw the red spot he said we should go see the eye doctor. (She blushes.) Please don’t let my father see these records.
ME: (Thinking: OK.) I’ll let the doctor know. Thanks. Let me check your vision and quickly peek at your eyes, then doctor will come in to check.
I chart the history about lack of pain in that eye, but don’t write that I smell marijuana—or that she asked for the visit information not to be divulged to her father. (I was thinking: Wow, that’s a large abrasion, she’s in no pain, and they both smell like they recently smoked marijuana).
CONCERN: Privacy has clearly been brought forward by the patient.
– What else should you ask? What shouldn't you do?
– Do you really write all that in the chart? Could I have done anything differently?
– How does our office restrict information, and what can be restricted?
Taking care of the patient’s abrasion and redness is generally straightforward.
I needed to investigate the marijuana smell and the privacy concerns I had to, so I ask the office manager and also tell the doctor before she sees the patient.
Here is what I learned:
1. Not many people in the office knew about our policies on how to restrict chart access to outside entities. The Privacy Rule under theHealth Insurance Portability and Accountability Act (HIPAA) was implicated, so we all had to know who to ask about it.
It turns out the patient could prevent her father from finding out; that might refer to it. Some states might also have their own rules, so we checked that, as well.
2. I also learned that we needed to restrict the billing records for this visit from outside access from her regular insurance coverage because that also came up when we explained things to the patient.
1. U.S. Department of Health and Human Services. The HIPAA Privacy Rule. Available at: https://www.hhs.gov/hipaa/for-professionals/privacy/index.html. Accessed 9/12/19.
2. Lorenzo-Morales J, Khan NA, Walochnik J. An update on Acanthamoeba keratitis: diagnosis, pathogenesis and treatment. Parasite. 2015;22:10.
3. Centers for Disease Control and Prevention. Acanthamoeba Keratitis Fact Sheet for Healthcare Professionals. Available at: https://www.cdc.gov/parasites/acanthamoeba/health_professionals/acantham... Accessed 9/12/19.