Question

Stephen, a hospital administrative consultant, selected a complex case on the 10th-floor orthopedic unit for review. Stephen reviewed the patient's record. Following several questions about the patient's care, a staff nurse asked, "Would you like Dr. Williams, the orthopedist, to discuss this case with you?" Stephen said, "Sure, that will be fine." Dr. Williams soon arrived and appeared a bit disturbed that he had been summoned. Stephen introduced himself and said that he just had a few questions he would like to ask. Stephen asked Dr. Williams which diagnoses the patient relayed to the organization at the time of admission and which diagnoses were made during the course of the patient's hospitalization. Dr. Williams said, "I am treating the patient for her orthopedic problems, not all of these other diagnoses." Following a few questions with the physician, Stephen asked to interview the patient. Dr. Williams agreed, "OK." Stephen asked, "Could you please ask the patient if I could speak with her?" Dr. Williams said, "That's not necessary." Dr. Williams and Stephen walked to the entrance of the patient's room. Stephen waited outside the patient's room. Dr. Williams walked into the patient's room, returned to the hallway, and said, "The patient was sleeping, but I woke her up."

Upon entry to the patient's room, realizing Dr. Williams had forgotten Stephen's name, Stephen introduced himself to the patient. Dr. Williams asked Stephen if he wanted him to leave the room. Stephen, politely, said, "You can stay if you would like."

The patient said, "Oh, I know what you do. My husband is a nurse." Stephen smiled and asked about her care. She said that it was excellent. She said the food could be better but she was pleased with her overall care. She talked about her hip fracture and back problems. Dr. Williams, interrupting the conversation, proceeded to tell the patient about her orthopedic issues. He described in explicit and frightening detail how the discs in her back were collapsing and how things could progress and how she could eventually be confined to a wheelchair.

Following his brief conversation with the patient, Stephen said, "You will be all right." The patient smiled and said, "Thank you." Upon leaving the room, Dr. Williams asked, "What kind of doctor are you?" Stephen replied, "I am not a doctor; I am an administrative consultant." Not having listened to Stephen's answer, Dr. Williams said in a threatening manner, just outside the patient's room, "Don't you ever tell one of my patients they are going to be OK!" Stephen said calmly, "I was not speaking clinically; I was relating a compassionate goodbye to the patient." Stephen then extended his hand to Dr. Williams, saying, "Thank you for your time." Dr. Williams shook Stephen's hand and then quickly walked away down the corridor.

Based on Chapter 9, Medical Staff Organization And Physician Liability, Reality Check: Disruptive Physician, answer the following questions:

B) What information should Stephen share with the corporate leaders, if any? Discuss your answer.

C) Dr. Williams later apologized to Stephen for his conduct stating that he thought Stephen was a physician and believed it to be out of place for saying that his patient would be okay. Discuss how this affects how you would handle the conversation between Stephen and Dr. Williams.

Answer 1

Points to be remembered while maintaining the confidentiality of a patient

1. It is the duty of HCPs ( Health care providers) and nurses not to disclose any clients information to other people who are not involved in direct patient care. It includes family memebers, neighbours, friends and other staffs. But a nurse or HCP can disclose information with clients consent.
2. The eligible staff members who can go through medical records are Nurses, HCPs, Social workers, unit managers, advocates of the client, technicians, therapists ( If any) and administrators. The administrators can review medical record for quality improvement and analysis.
3. Answers
4. B) As an administrator , Mr.Stephen is eligible to review the patient care and record. However he cannot disclose any information to corporate leaders unless they are a part of quality team ( For ex:He cannot discuss the patients condition with finance department) . Stephen can discuss the patient information and feedback to other memebers in quality team (Clinical administrators) for Statistical analysis and determining the quality.
5. C) When stephen asks permission from patient, as a nurse, it is mandatory to take consent from the patient to meet stephen. Dr williams cannot say thats not necessary. As a nurse, you cannot disturb the patient when he/she is sleeping unless there is a clinical reasons to wake her/him up. When a nurse introduces Mr stephen to Dr williams, he/ she can also explain to Dr. williams for the purpose of his visit and his designation. Even if nurse forgets, Dr williams should be aware of all this before allowing stephen to the patients room. It is the duty of a nurse to tell the truth to the patient. Mr stephen cannot say everything would be okay which makes patient false hope. As a nurse you should be aware of this before allowing stephen to patients room. As a nurse you cannot allow Dr. williams to shout to stephen while leaving the room ( When patient is able to hear). A nurse can interfere such situations politely without disturbing the patient.