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August 16, 2019

Physicians Talking With Their Partners About Patients

Author Affiliations
  • 1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
JAMA. 2019;322(15):1447-1448. doi:10.1001/jama.2019.12293
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    4 Comments for this article
    Good grief! How far should we take HIPAA?
    Richard Reiling, Clinical Professor | Wright State University School of Medicine
    It takes a psychiatrist to discuss the ethics of discussing patients with partners who is out of touch with the current care of ill patients in the hospital or in the clinics. Surgical and medical practices in which coverage is necessary requires discussion of patients with partners, residents and PAs. To do otherwise is not safe. In addition, discussing patient care with partners and colleagues for clinical advice and support is also a very common and important part of the practice of medicine.

    I can understand the import of this paper in that
    casual talk is not appropriate, but publishing this type of information can be harmful and carry difficult legal problems for physicians who have no intention of violating patients rights and are engaged in legitimate professional interaction. This paper could subject them to ambitious lawyers and disgruntled patients.
    I didn't but...
    Bruce Stringer, M.D. |
    When my wife and I were living in a smallish Midwest city I would not discuss identifiable patient information with her. My partners in our 3-person radiology group were not so circumspect. If I did an imaging study on a member of our temple the person would assume that I had told my wife about it and would engage her in conversation on the presumption that she was fully aware of what I had earlier done. She would have to repeatedly inform them that I did not discuss personal information with her. It took quite some time for that knowledge to spread in our social circle.
    A Lost Opportunity
    Amos Grunebaum, Professor | Weill Cornell Medicine, NYC
    You say:

    ..talking with their partners in generalities about patient encounters may be one way for physicians to cope with the stressors inherent to the practice of medicine...

    ..Given their intimate ties to physicians, partners might be among the best-positioned individuals to provide support for physicians...

    ..Some partners may bring useful outside perspectives, for example helping physicians work through distressing encounters with patients...

    Those are all reasons that you agree with as reasons to talk to a partner about patient experiences.

    Then you finalize by saying:
    style="margin: 0px 0px 0px 40px; border: none; padding: 0px;">
    "Physicians take oaths to their patients and make commitments to their partners. The challenge is to fulfill one set of promises without breaking the other."
    Yes. That is the challenge. You have told us what the challenge is, and we know it. But we need answers, and you failed to give them. Another opportunity lost to learn something.
    Named Persons versus General Issues
    Bruce Quinn, MD PhD | Physician Policy Consultant
    Surely there is a huge difference between named (or, identifiable) and non-identifiable patient information. Conversations with a spouse about an anonymous patient who blew up at you or used profanity, eg, is entirely different from some of the examples offered in the comment letters, such as a radiology partner talking with another partner's wife about a third and named person's medical illness.