Saturday, March 26, 2011


It is our pleasure to introduce this weeks guest columnist, Carolyn Thomas. Carolyn Thomas is a heart attack survivor and a 2008 graduate of the WomenHeart Science & Leadership Symposium for Women With Heart Disease at Mayo Clinic in Rochester, Minnesota - the first Canadian ever invited to attend this world-class training event. "Our Bodies Ourselves" of Boston named her one of their 20 "2009 Women's Health Heroes", one of 20 inductees from seven countries honored for community activism in women's health. She blogs at HEART SISTERS and THE ETHICAL NAG

A scene from the cable show, Nurse Jackie.

Does staff burnout lead to ignoring privacy considerations?

by Carolyn Thomas

As a heart attack survivor with an accordion file of ongoing complications, I’ve become a frequent flyer with my cardiologist, my longtime family physician, related specialists, the Pain Clinic, our local hospital, and in countless diagnostic procedure labs.

Many of these procedures – like a stress echocardiogram, for example – involve stripping to the waist and putting on the flimsy paper gown, but – in the case of a stress echo - with the opening at the front instead of the back to allow10 EKG leads to be attached to your bare torso during the test.

Not a big deal for male patients, but let me assure you – this is a very big deal to most women.

The last time I had a stress echo done, the experience was so profoundly upsetting that I not only filed a formal complaint to the departmental manager, but I created for her something I called Carolyn’s Top Ten Tips on How to Treat Your Patients.

It wasn’t the specific diagnostic procedure itself that was so upsetting that day. It was the appallingly poor social skills of the two attending technicians in the room. For example, when I entered the echo lab, one of the two techs present sat at a corner desk. He did not look up at me when I walked in, did not say hello, did not introduce himself. Was he the tech? Was he the doc? Was he the janitor?

As I later wrote to his manager:

“It’s not so much that these two people were openly rude – but it was their insufferable lack of people skills that pushed me over the edge. No introductions, no eye contact, no consideration of how awkward this test can be, no explanation of the test procedures or even the flimsiest effort at polite conversation.

“And by the way, next time I’m ordered to strip to the waist in front of a strange man, he’d better buy me dinner first.”

It has occurred to me during this and a few needlessly stressful medical encounters like it that the physicians, nurses and technicians who seem least likely to act like they give a damn may be the very staff who themselves are struggling with job burnout.

Burnout has been widely described as emotional exhaustion. The most conscientious people-helpers appear to be most vulnerable to burnout. Researchers like Maslach, Freudenberger and others dating as far back as 1977 gave the name 'burnout' to the special stressors associated with social and interpersonal pressures.

Dr. Arch Hart, who coined the term ‘compassion fatigue’, says burnout may include:

demoralization (belief you are no longer effective)

depersonalization (treating yourself and others in an impersonal way)

detachment (withdrawing from responsibilities)

distancing (avoidance of social and interpersonal contacts)

defeatism (‘why bother?’)

Dr. Christina Maslach has described burnout as “a state of physical, emotional and mental exhaustion marked by physical depletion, chronic fatigue and negative attitudes towards work, life and other people.”

She adds the following signs that you may be struggling with burnout:

decreased energy -'keeping up the speed' becomes increasingly difficult

feeling of failure in your vocation

reduced sense of reward in return for pouring so much of self into the job

a sense of helplessness and inability to see a way out of your problems

cynicism and negativism about self, others, work and the world in general

It was that last sign that should have waved a red flag (or at least a couple of EKG leads) in front of my face.

If a health care provider is feeling “cynical and negative about self, others, work and the world in general”, this person may no longer be capable of exhibiting even basic common courtesy or consideration about a patient’s potential discomfort or embarrassment during a clinical procedure.

Health care research on physician burnout by Dr. Evan Falchuk found:

“On days when doctors felt positive moods, they spoke more to patients, wrote fewer prescriptions, ordered fewer tests, and issued fewer referrals. However, when doctors were in a negative mood, they did the opposite.”

When I was casually told to strip to the waist by that stranger in the corner, neither he nor his colleague offered me a place to leave my clothing. Already feeling anxious and worried about this stress echocardiogram, I slowly pulled off my sweater and bra and clutched them tightly to cover up a bit while the two techs sat in bored silence, waiting for me to hurry up. One motioned to a chair in the far corner for me to place my belongings, and tossed me a paper gown.

Both could not possibly have demonstrated less respect for modesty even if they had deliberately set out to embarrass me. Afterwards, I described my impressions to their manager:

“To them, I was merely their 1 o’clock appointment, the obstacle between them and their next coffee break, just a piece of meat on a slab – but worse, an invisible piece of meat.”

In fact, it was this odd and inappropriate behavior of both these techs that first made me think: “Something is very wrong with you people!”

People suffering from severe emotional burnout could easily treat other human beings the way I was treated that day. Even saying a simple “Hello, my name is…” apparently required too much effort of them. They simply could not care less.

I was unable to identify this at the time, but when I read Dr. Hart’s list of burnout symptoms, a number of them leaped out at me to describe my stress echo techs: depersonalization (treating yourself and others in an impersonal way), detachment (withdrawing from responsibilities), and distancing (avoidance of social and interpersonal contacts). Check. Check. And check.

The most damaging part of this encounter was not the procedure itself. I’ve had many other far more potentially embarrassing medical procedures (sigmoidoscopy, cystoscopy, not to mention that I’ve delivered two babies the old-fashioned way) but none left me feeling as distressed as I felt during and after that stress echo.

Why? It just happened that the health care professionals who administered those other privacy-invading procedures had been universally kind, gentle, friendly, approachable, careful to explain what was happening, and solicitous of how I was doing throughout each test.

The good news: after receiving my complaint – tellingly, the second in the same week about the same people! - the cardiology departmental manager told me she felt quite alarmed to hear this about her employees. She not only spoke to the people involved, but then read my Top 10 Tips On How To Treat Your Patients aloud to all her staff at their next weekly meeting, posted it on their staffroom bulletin board – and even submitted it for publication to the hospital’s monthly internal newsletter. You can read it here at “An Open Letter To All Hospital Staff” on my blog Heart Sisters.

Sunday, March 20, 2011

Protecting Your Health Privacy
a book review

Protecting Your Health Privacy,  A Citizen’s Guide to Safeguarding the Security of Your Medical Information by Jacqueline Klosek is a comprehensive study of the law as concerns medical privacy.  The author is an attorney who specializes in privacy concerns and has published several other related books.  More information can be obtained at her website.

The book starts with a thorough review of the major laws governing health privacy, in particular HIPAA (Health Insurance Portability and Accountability Act) with its updates and the more recently passed HITECH Act.  There’s briefer coverage of other laws which also impact medical privacy including the Privacy Act of 1974, Alcohol and Drug Abuse Regulations, Family Educational Rights and Privacy Act (FERPA), Americans with Disabilities Act (ADA), the Genetic Information Nondiscrimination Act, and others.   All this is reviewed in a concise and lucid fashion.

The next chapter contains the information that patients need to protect their privacy.  It covers all aspects of an individual’s interactions with their medical providers in terms of obtaining access to their medical records and resolving disputes about them.  It outlines your right to privacy notices and how to restrict access to your records.  Any questions you may have concerning practical ways to obtain and protect your medical information will be answered.  Another chapter deals with personal health records, the services that Google, Microsoft and others are now offering patients to consolidate their medical records online and be able to make them available to any provider that needs them.  The author is more optimistic than I am that this is a valuable service that will also protect your privacy.  I think their potential for abuse is greater than their value, but the information is given for any who are interested.

There is also a section of concern to many, the laws governing employers’ ability to obtain and use your medical records.  This affects your employability and your chances for promotion.   Also covered are wellness programs at work, employers’ ability to monitor off duty conduct, and employers access to any social networking sites you may use.

A special section also reviews privacy issues when special protection may be needed.  The law may or may not afford such protection.  This includes mental health issues, addiction, and other socially stigmatized diseases such as HIV.  Anyone who suffers from these disorders should be fully aware of the special protection that the law may provide them.

Jacqueline Klosek
The rest of the book covers topics of broader interest which are not directly applicable to patient interactions.  Topics covered include data mining of medical information by companies and corporations.  Of special concern is the widespread data mining of your prescription information.  Suggestions are given as to how to protect yourself from this.  Another section deals with outright data theft and the various situations where it can occur including full medical identity theft wherein someone can obtain medical care under your name and you will receive the bill.

I have stressed the aspects of this book that are most pertinent to individuals seeking their own health care.  The book is equally of interest to physicians, other providers, businesses, and attorneys.   It could be used as the basis for a comprehensive course.  I personally wish the book had been organized a bit differently so that interested individuals would be directed easily to sections of greatest interest to them.   Nonetheless I know of no better reference source on this topic.