Patient Confidentiality

In my 1st week of my Neurology Prac, I was sharing a patient with a fellow physio student. This patient had been admitted to hospital after inducing nitric oxide recreationally and had subsequently suffered myelinonopathy of her peripheral nerves and hence weakness in her limbs. She was a very pleasantly spoken patient, however was trying very hard to keep any information concerning substance abuse away from those other than health professionals and friends.

On her last couple of days at the hospital, we had written up a referral, in order to provide her with assistance where necessary, just to get her used to having to look after herself again. We entered her room intending to tell her of this referral and were holding the form which she needed to sign to gain consent. When we entered there was another lady in the room, who appeared to be a friend or relative. We discussed with her the referral and that she had to sign the form. When we showed her the form, she noticed that the words “nitric oxide” has been written under the headings: diagnosis/condition. We explained that we needed to have to form back, but she was trying to hold onto the form.

When the visitor in the room left she told us that the lady was her boss and was desperately trying to avoid her know that she had been inducing nitric oxide recreationally, and that she preferred us not to be bringing around pieces of paper that had such “confidential information” written on it.
The other student and myself were later discussing, that we did not understand how her boss could come to visit her in hospital and not know why she was in there for. However, even though we had not verbalized the words “nitric oxide” while the boss was in the room, the patient had seen the information on the form as a threat to confidentiality.

The lesson that can be learned from a situation like this is that we cannot presume that visitors in the room know the details of the patient’s admission. Or that the patient intends to tell the visitor the reasons for their admission. We felt that since we had not actually discussed the reasons for her condition while we were in the room, we had acted appropriately. However, perhaps, if the patient does not say who the visitor is in the room, it may help to enquire their relationship with the patient (which needs to be done with sensitivity also).