Wednesday, 17 March 2010

Confidentially Yours?

CK over at Life Under the Lights has written a motivational post for all EMS staff, worth not only reading, but also acting on. Are you the best that you can be at what you do? Are you the sort of paramedic that you would want called for you or your nearest and dearest? If not, what are you going to do about it? Go read his post, and come back when you're done. His is definitely a worthwhile read.
For me, Chris's post raised a completely different subject, and took me back to a major dilemma I had quite a while back. I know this sounds a little strange, but it all started when I was 14 years old.
Back then, I had just changed schools, and on my first day I was marched into a classroom, told to take the one empty seat and just get on with it. The person I sat next to that day became my friend for life. He'd only been at the school a few months longer than I had, so was also finding his feet, and yet he always made certain that I wasn't left out of whatever was happening, knew where I was going, which classes were where, and most importantly where the nearest shop supplied with chocolate was. "KitKats", said the owner every single time we walked in. "33p each, but special offer for you guys, 3 KitKats for £1". Happy days.
Our lives have since taken very different paths, in totally separate parts of the world, and yet we always make sure to keep in touch. Life sometimes gets in the way, and we don't communicate as much as we'd both like to, but anytime there's any major news in my life, he's one of the first to know about it, and vice versa.
When he moved to the USA, his parents stayed here in the UK. After a while I got to see him again, when he had to return for his father's funeral. These were not the circumstances under which I'd envisaged seeing him again, but despite the tough times, it was still a great feeling to be in the same place at the same time, if only for a short while.
Not long after he returned home to the States, I had a call to a very familiar address. My face told my crewmate more than my voice did. The address, one where I had spent so many happy hours pretending to do homework, practising our different martial arts and generally beating each other up, eating, drinking, watching TV, being teenage boys, now appeared on our MDT screen, alongside "Female, fallen, ? conscious, ? injury". I wasn't sure I could face it, and briefly considered asking one of the other crews to take the call. However, I decided that if anyone deserved my help, it was the person who'd looked after me, welcomed me into her house and regularly force-fed me all those years ago.
We arrived to find that she was conscious, but confused and injured, and would require transport to hospital. As anxious as I was about attending this call, she was just as pleased to see me emerging through the front door again, albeit in a different capacity altogether, and she wasn't entirely certain why I was there. This time, I had to do the looking after. We transported her to hospital for them to tend to her injuries, and I made a mental note that at the end of the shift I'd call my friend and tell him what had happened.
This is where I had a problem. I have treated several people over the years who either know who I am, know my family, or have some other connection to people I know. I have never, will never, divulge even the hint of the fact that I've met someone like that to my family or friends. If the patient wants people to know that they've met me, that's their prerogative and they can tell as many stories about themselves as they like. Often I'll be met with "You didn't tell MrsInsomniac that you treated me???" and other such expressions of surprise. Where I come from, it's gossip first, worry later, then gossip again anyway. I'm just not like that, not in general, and definitely not at work. My patient's privacy is first and foremost, whether they know me by my first name or not.
This time, however, it was my childhood friend. And his mum. People I have known for so many years, who I am very close to, and who are very much part of my life. How do I now go about calling him and telling him that his mum's in hospital, not in any state to talk to him or to tell me to do so, after I was the one who treated her.
Do I wait for the hospital to contact him, and hope that he puts two and two together?
Do I make the initial contact, breaking every rule in the protocol book?
Or do I go to my next call as if the person I just treated meant the same to as any of my other patients that day?
Which option would mean that I had treated the patient to the best of my ability, and in the best interests of the patient?
Friendship versus Confidentiality.
What would you do?


nickopotamus said...

Wow, that's a tough question. Professionally, there's only one answer, which is no unless you asked the patient if she minded you telling her son (and she gave you the ok).

Personally it's a completely different kettle of fish. Do you trust your friend not to let the act of telling him get you into any further trouble?

Jess said...

Assuming the hospital are going to contact him anyway, I would explain the situation to the hospital and see if you can make the call instead.

Were the situations to be reversed, I expect you would rather hear it from a close friend than a nurse you'd never met?

All this assumes that he is the listed NOK, there is no reason to suppose his mother wouldn't want him to know etc.

Anonymous said...

Tell a nurse or doctor you trust when you drop her off at the hospital that she was the parent of a good friend of yours and to give him a call as soon as possible. That way you are not being unprofessional and the hospital can give him the most up to dated information

ima shel j said...

personally I would agree with nicko.. of the first response and so I guess you would have to not say anything...BUT if it was my mum or dad I would def want you to tell me.... very tough call... do we get an answer???

S.Whitehead said...

I don't imagine I'd have any problem calling a good friend if his mother was injured and unable to tell him. We search peoples phones for "ICE" contacts. We look for family or friends when they are unconscious or dead, especially when we need guidance regarding their care and wishes. To that extent those are incidental disclosures.

There's also the aspect of, "No victim, no crime." If you are certain your patient would want you to contact her son then there is no victim to take issue with the possible violation of her rights.

If you aren't certain that is what she would want then perhaps you need to wait for her to be able to tell you.

Eileen said...

I'm old enough to be in this situation and I know all about the professional confidentially aspect - if it had been me I would have wanted you to call my son. But you didn't say if there was any other close family locally - and you did say that the son was back in the USA. I assume you made sure they knew she was widowed and the son was abroad.
I live in Italy now and it occurs to me that in a similar situation no-one here would know how to contact my daughters - there are two of us, but if both of us were involved in an accident the authorities here would have a mobile phone with some numbers on and a passport to go on. It'd take some time to do the detective work.

CrazyNewt said...

I'm with Steve on this one. Sometime, the minutiae of rules are just there to be broken. And yeah, "no victim, no crime".

RapidResponseDoc said...

As you say, IM, this is a classic, and I have been many times in the position of having treated a close friend or relative, and not mentioning it to ANYONE, not even MrsRRD. She found that tough at first, but copes much better with it now...

As far as your question goes, the answer is simple... is it in the patient's best interest for her son to know? If the answer is yes, then, in her best interest, you should tell him. If you can put hand on heart and say that the reason you want to tell him is because it is best for HER, then there is no conflict. If not, keep schtumm

medic999 said...

I think it has all been said already, but I also go down the line of thinking about what the patient and her family would want.

Even if you want to imagine that this is any other patient, she isnt. You have a long history with the family and I guess only you will really know what they would want to happen in this situation.

claire said...

Given a fair few of the people reading this know you, and some of those people can probably have a guess at who you're talking about, is that not more of a confidentiality issue than calling her son?

Sorry, just a thought.

InsomniacMedic said...

Thanks all for your comments! I will post an answer in a couple of days - but just wanted to answer Claire's point, which is a valid one.
Just so you feel more comfortable with this - this was something that happened a few years ago, and I raised it now only as a response to another post. In this case, as I had contact details (obviously), I asked my friend for his permission to publish before releasing it to the general public.
Thank you for taking the time to comment, and no need to apologise!

Anonymous said...

As the friend mentioned in this post, I wanted to chime in. I can confirm that I was indeed asked permission by InsomniacMedic whether he could write this post. Obviously, I said yes... and a mighty fine post it is to. InsomniacMedic's writing in general is very emotive -- this post of course was extra powerful for me as it was hard for me to be in America with my parents in London. The truth of the matter is that we've needed to call in the paramedics to help my Mother even when I was living at home. Sometimes I could physically help her up myself and know she was OK... but sometimes I would know that we'd need help even if I was there. I could relax a little when she moved into a home... but only a little... unfortunately falls still happen.

As you can imagine, having InsomniacMedic as one one of my very closest friends is an extremely treasured blessing for me (not only, for the help he offered my Mother... but for the length and depth of our friendship). Even if you only know him through this blog, you can imagine what a gem of a person InsomniacMedic is in real life.

I'll only leave off saying that InsomniacMedic played all his decision calls perfectly. Mum and son are (and were) extremely grateful for his care. In addition let me say a big THANK YOU to all the paramedics here -- the work you do is really appreciated.

InsomniacMedic said...

Well as you can all see judging by the comment above - I did call and tell him. I felt it was justified both by the fact that it was in his mum's best interest and because I felt it was the right thing to do personally. A combination of the two, combined with the fact that the doc at the hospital suggested it would be a good idea for me to make the call, eventually overtook my reservations - and believe me it took some time to do!
Thanks all for your comments!