Menu Icon Search
Close Search

Medical Missions: There Is No HIPAA in Haiti?

Created October 24, 2012 by Alison Hayward
Share


The next time you’re sitting through a PowerPoint lecture on someone’s recent medical mission experience, I’d like you to consider it through a different lens. Take a pause, between cooing over the cute children they played with and gaping at the rare pathology they treated, and think: is this HIPAA compliant?

I am sure that the last thing you want to think about during a fun global health lecture are the Health Insurance Portability and Accountability Act privacy rules. They’re boring, they’re suffocatingly restrictive, and they create endless mountains of paperwork for all involved. I would argue, though, that there is an important principle buried under all that red tape. Patients have a right to privacy, and they value that right. Patients expect confidentiality of their personal health information when they access the healthcare system. Healthcare professionals have a duty to respect patients’ rights to privacy, except in rare situations where another moral duty supersedes the right to privacy of the patient.

In the United States, elaborate measures are often taken to try to protect the privacy of patients during presentations or in publications. Even when making an educational presentation to our peers, physicians typically refer to the patient by their initials only, or perhaps just by their age and gender. If the presentation is to be made in front of members of the public, or if the publication is to be widely disseminated – such as in a blog, a newspaper article, or a book – further attempts at concealment might be made. Key details about the patient, including gender or age, might be altered. Other details, any that might provide identifying information about the patient’s appearance, family members, or location, may be omitted. Healthcare institutions in the United States also monitor closely the use of social media by their staff. Physicians can have their licenses revoked over violations of patient privacy online, healthcare professions students can be disciplined or expelled, and other staff members can be fired.

Most of us know these things – we have to, because they’re included in our hospital orientation before we start work. We think of them when we’re in the hospital, and especially when we’re in the elevators, where posters have strategically been placed to remind us not to talk about the patients where others can hear us. When we provide healthcare outside the walls of our home institution, and travel outside the borders of our home country, does HIPAA follow us? We have entered a gray area in patient confidentiality. The care was not provided in the United States, and the patient is not an American citizen. When we travel and undertake research projects in developing countries, we are obligated to have that research examined by our Institutional Review Board, and encouraged to submit our plans to a local Institutional Review Board as well, if one exists. As yet, no such organized bodies review the clinical care provided by traveling healthcare workers, nor does any review board or hospital committee discipline their staff based on inappropriate use of information or photographs gathered while on international ‘mission’ trips.

Based on my experience, after attending umpteen global health conferences, seminars, and lectures, most of us are not strict about adherence to privacy rules when we make presentations under these circumstances. There is a large range of behavior encompassed here, from public presentations or sales of non-medically-related photographs that were taken and used for commercial or educational purposes without the permission of the subjects, to the stark display of shocking medical photographic material without any effort to obscure the identity of the subject.

A partially nude woman in extremis is presented on screen, for example, her face contorted in pain. Does the fact that she lives in Botswana, and that it is extremely unlikely any audience members would be able to identify her, mean that we can show images of this patient’s condition and her suffering with impunity? What if a photograph is shown of a child who was treated by the presenter, smiling after being given a curative treatment, with the healthcare provider’s arm around her and the child’s name underneath in the caption? The child was happily treated and embracing the healthcare worker in gratitude. Is it important that neither the child nor her guardian was asked permission to show her photograph or her name in a public presentation?

I would argue that the rights of the patient to privacy and confidentiality are not just codified in an irksome piece of legislature, rather, the legislature was designed to support a universal truth. To whatever extent reasonably possible, the patient you treat in Port-au-Prince should be accorded the same rights and respect that you give a patient in Portland, Oregon.

It seems likely that most such presentations or publications related to patient encounters are done with good intentions. The presenter wishes to illustrate most clearly the situation that they were working in. They may be rightfully proud of the work they did to provide humanitarian aid under crisis conditions. Or they may simply have made a human connection with their patients and been inspired by their stoicism and their ability to overcome adversity. And it is common for such presentations to be done as part of a request for donations to help with further humanitarian efforts.

On a less selfless note, I do wonder to what extent such photographs and stories reinforce disturbing subtexts or themes to humanitarian aid efforts. The healthcare providers are heroic, powerful, resourceful, and often white. The patients or members of the community being assisted are helpless, impoverished, desperate, passive, and often brown or black. Do these stories and photographs about the patients, and our power to reveal their identifying features or personal health information, provide stereotypical messages about race, ethnicity, or nationality, to those in the audience? There is no law to guide you in answering these questions, only your conscience.

References

Lee, S. “Social Media in Healthcare Creates Risks, Benefits.” San Francisco Chronicle, 6/21/2012. Found at: http://www.sfgate.com/health/article/Social-media-in-health-care-create-risks-benefits-3650284.php

Stanford Encyclopedia of Philosophy. “Privacy and Medicine.” Last revised 2/28/2011. Found at: http://plato.stanford.edu/entries/privacy-medicine/

U.S. Department of Health and Human Services. “Summary of the HIPAA Privacy Rule.” Found at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

// Share //

// Recent Articles //

Khan Academy MCAT Collection is accessible free online!
  • Medical, +1 MORE
  • New Study Materials Complete the Khan Academy MCAT Collection

  • Posted February 11, 2016 by AAMC Staff
  • The Khan Academy MCAT Collection now includes new study and guidance materials for the Critical Analysis and Reasoning Skills section of the MCAT exam. Tutorials and practice passages have been added, as well as videos that offer guidance on how to approach studying for this section. With the addition of the Critical Analysis & Reasoning Skills Section, the...VIEW >
20160210_Student_SS_244561711
  • Top Tips for Sub-Internship Success

  • Posted February 10, 2016 by Anubodh Varshney
  • The sub-internship is a crucial rotation for all medical students, no matter which specialty they plan to pursue. During this transitional phase in their clinical training, students begin to assume more independent responsibility for patient care. A sub-internship introduces students to life as residents, and it is often a source of recommendation letters for the...VIEW >
Image courtesy of Gil C / Shutterstock.com
  • How Has the ACA Changed Healthcare?

  • Posted February 9, 2016 by Brian Wu
  • The Affordable Care Act–the signature legislation of the Obama administration and one of the most contentious bills to be passed in years–was signed into being on March of 2010 and since that time most of its key passages have been implemented despite the attempts of opponents to walay it legislatively or in court. Since every...VIEW >
short coat logo 2015 with title
  • The Short Coat Podcast: How Residents Cope and the Costs of America’s Most Violent Sport

  • Posted February 5, 2016 by The Short Coat Podcast
  • On The Short Coat Podcast, medical students from the University of Iowa and their co-host Dave Etler discuss news, fresh views, helpful clues and interviews. Hear new episodes on iTunes and the Short Coat Podcast website every Thursday, republished Fridays on the Student Doctor Network.  What can medical students and residents do to keep their chins up during their training? That’s...VIEW >
IOTW-SDN small
  • Figure 1 Image of the Week: IVC Filters

  • Posted February 5, 2016 by Figure 1
  • IVC filters isolate a pre-existing deep vein thrombosis preventing the development of a pulmonary embolism. Common indications include cases where anticoagulation is contraindicated or a thrombus has formed despite anticoagulation. They are inserted via a jugular or femoral approach, often under ultrasound or fluoroscopy guidance, and may be temporary or permanent. See this image and more...VIEW >
20160204_Study_SS_101701741

// Forums //