The federal government has taken an active role in attempting to prevent violations of a patient’s privacy. The Health Insurance Portability and Accountability Act of 1996 (HIPAA), discussed in Chapter 10 , includes stiff fines and other penalties if a patient’s privacy is violated. However, in spite of federal regulations, some healthcare workers are still invading a patient’s privacy, often just to satisfy curiosity.
For example, seven-year-old Nixzmary Brown was found beaten and starved and left to die in a small room that her brothers and sisters called “the dirty room.” Her mother and stepfather were both charged with the crime. According to New York’s Health and Hospitals Corporation, dozens of workers, including doctors, nurses, technicians, and clerks, opened the patient’s computer file even though they had nothing to do with the case. There were several employees who had a legitimate reason to view the file on a “need to know” basis, but investigators believe that 39 employees opening the file were just too many. It was determined that “sheer curiosity” had driven many of the healthcare workers to open Nixzmary’s file. The stepfather was convicted in 2006 of first degree manslaughter and sentenced to 29 years in prison. The mother was convicted in 2008 of first degree manslaughter and sentenced to 43 years in prison.
On October 9, 2009 the governor of the state of New York signed into law “Nixzmary’s Law” making the maximum penalty for torturing and murdering a child life in prison without parole. This child’s death caused an overhaul of the Child Protective Services system. The 39 hospital employees who violated the child’s privacy were suspended for 30 to 60 days without pay and received privacy training before returning to work.
Opening a patient’s medical file should always be on a “need to know” basis. Any other reason may constitute an illegal action.
It is just as inappropriate to look at a coworker’s personnel file as it is to illegally examine a patient’s file. A coworker’s personnel evaluations and salary levels are privileged information. Viewing personnel records without a “need to know” could result in dismissal from a job.
A person’s background and experience heavily influence personal beliefs. Ideally, everyone entering the medical profession should examine his or her own cultural background to be sure he or she will be able to provide patient care in sensitive situations.
Because family can be extremely important in some cultures, do not be surprised if your patient brings along the entire family for emotional and physical support. In some cultures, a male must always be present if a female member is being examined or meeting with strangers.
The diversity of the U.S. culture presents many challenges for both the healthcare professional and the patient. Stereotyping can occur when negative generalities concerning specific characteristics about a group are applied unfairly to an entire population. For example, a statement such as, “Those people are all welfare cheats” is unfair and incorrect when applied to a large group of people. A bias , or unfair dislike or preference against someone, can prevent a healthcare professional from making an impartial judgment. Do not judge a person by their clothes, body piercings or tattoos, or hygiene. As an example, different cultures have their own practices for personal hygiene. A bias occurs when a healthcare professional doesn’t pay any attention to a person who displays poor hygiene or has a body odor.
It is always wise to keep one’s opinions about the use of deodorants, clean clothing, and frequent bathing to oneself, unless the patient’s health is suffering as a result of poor hygiene conditions. Slang terms for dealing with bodily functions should never be used. It’s perfectly acceptable to ask a patient if he or she has to use the bathroom.
Ethnocentric people tend to believe that their way of viewing and experiencing the world is superior to others’ views. It is a method for judging the actions of others according to our own cultural background. For example, if one is heterosexual, then to decide that gay and lesbian persons are inferior to one’s own background is ethnocentric and can result in stereotyping and prejudging people. In order to avoid these negative behaviors:
· Be aware of your coworkers’ and patients’ beliefs.
· Learn as much as you can about other cultures, races, and nationalities.
· Be sensitive to the feelings of others.
· Evaluate all information before accepting it as a belief.
· Always avoid ethnic jokes. Walk away if a coworker is telling an ethnic or disrespectful joke.
· Be open to differences in other people.
Communication can be a challenge for many people who do not understand English. For example, a nod of the head up and down means “yes” to an American, but it means “no” in some other cultures. Non-English-speaking patients need brochures and handouts in their own language. Many publications are now available in Spanish and other languages. Always attempt to find an interpreter when giving instructions to a non-English-speaking patient. If one is unavailable, the website http://babelfish.yahoo.com/ is helpful in translating English words and phrases into a second language. It is imperative, and in some cases required by law, that an interpreter be present when explaining important information to a patient. Patients in hospitals and other medical facilities are now routinely given a form to sign asking if they wish an interpreter. Patients may have to be assisted in finding the best community resource to help them because in some cultures it is unthinkable to ask strangers for help.
Healthcare professionals must be ready to help people regardless of their income levels, cultural origins, or attitude.
Since there is often a strong ethnic population in some hospitals and medical practices, it is wise to learn all you can about their beliefs. For example, in some cultures it is considered rude or disrespectful to look directly into a person’s eyes or to touch the top of a child’s head. Some cultures, including Americans, consider modesty to be extremely important. It is always important to make sure that patients are covered with either a gown or draped sheet when having an examination. In some cultures a woman is not allowed to undress or bare any part of her body in front of a man without her husband’s permission. Shaving hair before an examination or surgical procedure is not allowed in some cultures. These cultural restrictions can pose difficult situations that need to be handled carefully and sensitively.
It is wise to keep in mind how you would wish to be treated if you were a patient in another country without the use of the language.
Many people, especially the elderly, do not like to be addressed by nicknames such as “dear” or “honey.” It is always wise to use a title such as Ms., Mrs., or Mr. unless told otherwise by the patient.
Respecting religious beliefs of others can be a difficult, but necessary, responsibility for the healthcare professional. Advance directives, consent to treatment, and the use of birth control devices are often influenced by a person’s religious beliefs. In some cases, it may mean rejecting medical interventions such as blood transfusions, but in other instances it might mean that a patient rejects all medical care.
From an ethical perspective, the principle of patient autonomy , or independence for their beliefs, is always an important consideration. However, all of these, sometimes conflicting, conditions can result in confusion for the medical professional. As long as a person is competent, he or she has the right to make his or her own decisions. Bioethical and legal issues arise when a person is called upon to make this decision, based upon his or her own religious beliefs, for another person such as a child or an elderly or incompetent adult. In these cases a guardianship may have to be established by the courts so that the best interests of the patient are observed. There will always be ethical discussions about where religious boundaries should be drawn and when the state should step in to protect the individual.
It is never appropriate to judge, either with verbal or nonverbal criticism, another person’s religious customs and beliefs. An exception occurs when there is evidence of abuse as a result of a religious practice.
There are some beliefs that do not allow a person to receive a blood transfusion. When such a situation occurs a physician may seek a court order for a child to receive blood over the objections of the parent. The case of Prince v. Commonwealth of Massachusetts reasoned that “Parents may be free to be martyrs themselves. But it does not follow that they are free in identical circumstances to make martyrs of their children” (Prince v. Commonwealth of Massachusetts, 321 U.S. 158 1944). An even more difficult situation arises when a pregnant mother refuses a transfusion that could save her life and the life of her unborn child. According to her religious beliefs, the mother may believe that “ingesting blood” may doom her in the eyes of her God. In this case a physician, or hospital administrator, would have to seek a court order to administer the blood transfusion.
Remember that the patient’s wishes should be honored if they differ from our own beliefs. The exception to this is when a belief may result in harm to either the patient or the health-care worker. In that case, a supervisor must intervene.
An employer has a legal obligation under the Civil Rights Act (discussed later in this chapter) to make accommodations so that employees can practice their religious observations. For example, members of the Jewish religion must observe Saturday as the Sabbath day on which they may not work. Therefore, it would be improper to set up Friday evening meetings after sundown or Saturday meetings that require all employees to attend. It would also be inappropriate to schedule Sunday morning meetings that Christian employees are required to attend. The law also requires that businesses must provide reasonable accommodations, such as a prayer room or a special cleansing bathroom, for employees to practice their religion, as long as it doesn’t interfere with other employees’ rights.