4.18 Patient Confidentiality and HIPPA
Patient confidentiality is a critical value for physicians and physicians-in-training and is essential for maintaining the patient-doctor relationship and for preserving the trust that society has placed in the medical profession. Medical students are privileged to learn information that patients share only with healthcare professionals and have opportunities to participate in some of the most personal moments of patients’ lives. Patients, in turn, trust that physicians and trainees will preserve their confidentiality; as a key component of medical professionalism, medical students must honor this trust.
At times, ensuring patient confidentiality may conflict, or appear to conflict, with other important values, such as academic freedom and freedom of speech, giving rise to complex ethical issues. These ethical issues are difficult to navigate, particularly for students who may be new to clinical environments. In confronting these issues, students are strongly encouraged to take advantage of the many resources available to them at the Medical School. For example, students may consult with clinical mentors and attending physicians, patient-doctor faculty, medical ethics faculty, society masters, and/or the Office of Student Affairs.
When concern that a student has violated the confidentiality of a patient arises, the Medical School will initiate a fair process to determine the validity of the concern. Students, faculty and administrators are expected to act in good faith while carrying out this process. The Medical School will convene a committee, composed of three student representatives to the Curriculum Committee and three faculty members, to evaluate the concern. The faculty members appointed to the committee should have no evaluative responsibility for the student, should not be administrators of a program in which the student participates, and should not be the faculty members who initially raised the concern. The members of the committee, as well as any community members who were involved in alerting the Medical School to the potential violation, should maintain the confidentiality of the committee’s proceedings, including the confidentiality of the student. The committee will make its decisions by majority vote.
The committee first will determine if patient confidentiality has been violated. If not, no further action may be taken. If patient confidentiality has been violated, the committee then will determine the circumstances of the violation, including, for example, whether or not the student believed he or she was acting in good faith. In making this determination, the committee will take into account that the student's understanding of patient confidentiality may be limited by his or her level of training on the topic. If the committee concludes that the student acted in good faith, then the committee will discuss the matter with the student, help the student learn from the experience, and find an appropriate resolution. The focus of this process is on creating an educational, rather than a disciplinary, experience for the student. If the committee concludes that the student acted in bad faith, then the committee ordinarily will discuss the matter with the student and the student’s society master. In this case, the committee may consider referring the case to the HMS Promotion and Review Board for further evaluation and/or disciplinary action.
All students must follow Health Insurance and Portability and Accountability Act (HIPAA) rules when participating in clinical activities at affiliated hospitals and clinics; HIPAA compliance includes maintaining confidentiality of paper and electronic health records. When violations of HIPPA by a student are identified by a hospital, clinic, physician’s office, etc., the violation will be reviewed by the HMS Promotion and Review Board, which will recommend remediation and and/or sanctions, including the possibility of required withdrawal or expulsion.
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