When your privacy is violated in the doctor’s office

Few patients enter our health care system prepared for the unexpected and embarrassing circumstances that can routinely happen.

Most can accept it when we’re treated with modesty and respect.  But not many are prepared for those times when you might be unnecessarily exposed or treated rudely.  The possibilities for embarrassment are endless and it is usually unexpected.   When avoidable incidents do happen, most patients are not prepared to speak up.  Many regret their inability to speak at the time of the incident.

In fact it is important to speak up at the time of occurrence if at all possible, or if not, as soon as possible thereafter.  It can often be difficult or impossible to identify the offenders days or weeks after the occurrence.  Situations are most likely to be rectified if they are brought to the immediate attention of the offenders and their superiors.   A common example would be being exposed in an examining room when someone leaves the door open or comes in without warning.  Few patients appreciate that but most don’t say anything.  But if you wait several days to complain, it is likely that the office will not remember who was involved.

Despite your embarrassment, the office personnel may recall nothing unusual; it was just in a day’s work for them and consideration of patient’s privacy doesn’t cross their radar.  In a hospital a common occurrence would be for the patient to be exposed during a bath or procedure with the curtain or door being left open.  The potential is even greater for embarrassment if you’re in a semiprivate room and your roommate has visitors.   Even without exposure, having your history taken in a semiprivate room with or without visitors present may cause you to reveal embarrassing and confidential information.  Once again, if you don’t speak up immediately, it will be difficult to identify the perpetrators later.

It helps to have a clear idea what you want from your protest.  A simple apology is the easiest to obtain and may be all that’s needed.   If you want a clear indication that policies will be changed to prevent re-occurrences of the problem, you will need to go beyond a simple apology and communicate the problem with the physicians or managers in charge.  They may indicate that policy directives will be updated and sent out on their own, but if not you may have to request that they take specific action to correct the problem.

The best course of action to take depends on where the incident occurred.  Usually make the complaint immediately to the person who caused it.  In an office, this could be the physician, nurse or assistant.  If you’re not immediately satisfied with the response, also bring your complaint to the physician in charge.  If the infraction was incidental, a simple apology should be enough.  If the infraction was part of a pattern of behavior, you should notify the physician in charge.

If you don’t complain at once, the next best course is to call or write a letter as soon as possible afterwords.   If the complaint is serious and you remain unsatisfied by the response, the usual next course of action is to lodge a complaint against the physician with the state medical board.  All 50 states have them.  If they don’t handle the complaint themselves, they will tell you where to take it.  All states have a board which investigates complaints against physicians.  In all cases, when a written or electronic complaint is filed, you should keep copies and note that you will send copies to their superiors , or to the state and federal institutions which may have jurisdiction.

In a hospital, again make your displeasure immediately known to the person responsible.   If not satisfied, take your complaint to the head nurse or physician in charge.   Try to get the names of the people involved so that you can pursue the complaint more profitably.  If the complaint is against a specific nurse, you can also complain to the state nursing board.  Again all 50 states have them and will investigate complaints.  Most hospitals will deal with complaints against specific personnel internally.  If this doesn’t work, continue up the hospital hierarchy.  Most hospitals have a patient advocate whose job it is to handle complaints.  Start with her, but remember that she still works for the hospital no matter her title.  If still no satisfaction, I would send a letter to the CEO of the hospital.  When formulating complaints against a hospital, it is well to remember that nearly all publish a patient bill of rights which might give you considerable help in outlining your complaint.  If still unsatisfied, you should consider sending a complaint to the state board that regulates and licenses hospitals (I haven’t found one website that lists them for all states.)

Another possibility is sending a complaint to JCAHO, the Joint Commission on Accreditation of Healthcare Organizations, usually now shortened to the Joint Commission.   They are more likely to respond to systemic complaints against a hospital rather than one incident unless there were life threatening implications to the occurrence.

Of other venues to be considered, probably nursing homes are the most common source of complaints.  All states have regulations for nursing homes.  Many also have further laws concerning elder abuse.  Once again, see if the problem can be solved internally in the facility, but if the nursing staff and management won’t help, complaints to the state are appropriate.

Probably the last place to complain is with HIPAA.  They do take patient complaints but they are not oriented towards individual complaints unless it clearly has to do with information transfer.  If say a hospital posted photos of your operation on an instructional site without your permission, it could fall under their purview.  There is no right of private action under federal law though there may be under individual state laws.  Finally you can contact a lawyer at any time but beware that most privacy violations won’t bring large monetary damages.  So do so only if you are really motivated to obtain redress as the attorney bills will be significant.

Joel Sherman is a cardiologist who blogs at Medical Privacy, A Patient Oriented Discussion.

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  • Winslow Murdoch

    This post seems a how for hypervigilant angry persons to add stress and resentment toward patients for dedicated healthcare workers.

    If a healthcare encounter misses the privacy mark a little corrective humorous comment should suffice and bring it to the caregivers attention. Making it a “Seinfeld” moment is much more likely to result in better care in the future that per suing a disciplinary, institutionally rigid, launched attack.

  • Richard MD

    Wow. And why don’t you recommend retaining an attorney as well. Oh that’s right you do that too. Report the Dr. to the state board because the curtain was slighty open? This blog post may be well intentioned but borders on the ridiculous and seems to belittle and vilify health care providers.

    • http://patientsafety-advocateyourself.blogspot.com/ Cheryl Handy

      Dr Richard
      I hope the responses have given you pause to rethink your comment. Patients & caregivers don’t have attys on speed-dial. We just want to help our loved maintain some dignity. The next elderly relative could be yours.

  • SarahW

    There is a difference between a thoughtless lapse and a regular problem, or a policy problem. Knowing how to go up the chain is important to people who don’t get that apology or change, or who get dismissive, angry, or even abusive treatment resulting from a demand for privacy.

    Remember who is guilty of the breach – not the patient.
    Don’t you understand that patients are put in positions where they are often at the mercy of caregivers and health professionals?

    Expressed above is a strong sentiments that a patient should “please” someone who has grossly violated their dignity – help them “save face” when they are quite guilty of embarrassing or humiliating the patient. You want more than you will give?

  • Leslie

    Privacy violations happen a lot at the pharmacy counter. The pharmacy rarely has a designated line for customers to stand behind while someone is getting their medication. It’s annoying when you are there for a rather embarrassing medication. If I have a question about my medication I say that I don’t have any questions, then I call the pharmacy from my home.

    Even if it’s not for any sort of stigmatizing medication, why should everyone in the pharmacy know what the person in front of them had filled.

  • L.

    It’s sometimes not the big mistakes – but the small ones that erode a patient’s dignity over time. The little lapses that pile one upon another that serve to dehumanize the patient (perhaps that is the goal).

    - It’s the breast surgeon flinging (yes – flinging) wide the exam room door, without knocking, to reveal the patient just inside that door with her gown off having her wounds examined by a nurse – and then laughing off the fear and discomfort of the patient as if it were nothing – and no apology.
    - It’s the gaggle of residents who arrive at the patient’s bedside the morning after a 14 hour surgery and grab (yes – grab) at her gown to fully reveal her naked body to this group of strangers – without warning – without explanation, without concern.
    - It’s the “fellow” casually, relaxedly, throwing aside the curtain that covers the windowed door, who makes pronouncements, and departs – leaving wide both the curtain and the door when the patient is still tethered to mountains of equipment and unable to get to the door to close the curtain and the door herself.
    - It’s the curtains around the PACU bays that don’t fully cover the bay – and that no one to whom you point it out thinks matters. It’s the PACU nurse flinging (yes, flinging) open the PACU bay curtains as the patient stands – fully naked – as the surgeon marks her – and with several people standing directly behind her who get a front row view. Then sneers (yes – sneers) – and walks off – without apology.

    It’s the complete inability to understand that this everyday workplace of yours is an unknown and unknowable place with it’s own rules. One in which you are perfectly comfortable, but where your patients never are. It is a lack of empathy. It is wrong. Surely you can do better.

  • FInn

    Of course they’re perfectly comfortable. They’re fully clothed, healthy, and in charge while we’re naked, sick, and at their mercy–if they have any. My experiences have mostly been good, with doctors and nurses alike showing concern for my privacy, but there have been a couple of glaring exceptions: the physician who awakened me at 6am by flinging off my sheet and displaying my teenage body naked from the waist down to a gaggle of residents to discuss the “really interesting injury” to my leg, and the nurse who failed to pull the curtain during my EKG and flung the door to the waiting room wide open while I lay on the table naked above the waist. There’s no excuse for gross breaches of privacy like this, and there’s no excuse for failing to correct smaller breaches like leaving a curtain partly open after the patient calls it to your attention.

  • http://patientprivacyreview.blogspot.com/ Doug Capra

    I love the ” “Seinfeld” moment.” comment. Why not make
    it a “Scrubs” moment. That’s just as ridiculous. Humor
    can be a valuable tool, but what’s funny for the person
    naked on his/her back may not be funny for the person
    dressed standing above them. Learn the difference.

    i love this comment, too. “This blog post may be well intentioned but borders on the ridiculous and seems to belittle and vilify health care providers’
    On our blog, Dr. Sherman and I are writing about patterns of modesty and privacy abuse. And there are too many of them in medicine. Caregivers better get with the program and embed the kind of professional behavior that avoids these violations into daily, hourly practice. Those great core values you post, those tremendous patient rights documents you hand out, better be backed up by actual practice that observes them. Patients are becoming more savvy and are learning not to tolerate modesty and privacy violations anymore.
    To me, it’s mostly about good communication and basic good manners.
    Frankly, all this is part of how technology and the media is gradually eroding the boundaries between privacy and complete exposure. And many people seem willing to accept the blurring of these boundaries.Watch the TV reality shows. People are willing to completely expose themselves for their 15 minutes of fame. But don’t confuse the “reality” that the media says exists with the real reality on the street. In medicine, accept the media version it at your own peril.
    In his essay, Dr.Sherman is.recommending patients speak and deal with these modesty/privacy violations immediately and directly with those responsible for them. If you don’t want patients working their way up the food chain, then learn to avoid these incidents, learn to empathize more,by placing yourself or your son or daughter, or mother or father on the hospital bed, naked, embarrassed, frightened, Treat patients accordingly.
    Good manners, decency, dignity — this isn’t brain surgery or rocket science. It’s common sense.

  • PT

    To RichardMD

    WOW, disturbing on how many patients are
    sexually assaulted each year by medical staff.We won’t
    go there,but rather lets focus on the sexual impropriaties
    commited each day by medical staff,physicians,nurses,etc.
    Leaving patients unnecessarily exposed,common
    among nursing staff. Allowing staff to take peeks at an
    unconscious patient’s genitals because the word is that the
    patient is a hermaphrodite.Allowing other nursing staff to
    view an unconscious male patient’s penis to see his penis
    piercing. I could go on but then why should I have to richard?
    I work in health care too and certainly I’m sure you’ve
    seen these instances or do you just look the other way as
    long as it dosen’t happen to you or your family,right richard.

  • http://patientsafety-advocateyourself.blogspot.com/ Cheryl Handy

    Very good post. A patient doesn’t give up his or her privacy rights when in a hospital. My dad was 75 yrs old & very often nursing aids presumed he was too old to care whether the door was shut when they bathed him. He would ask that the door be shut & 20-somethings laughed at him and said “everyone out there has seen penises.” It wasn’t so funny when I addressed the issue with the charge nurse.

    But dad was “punished” when the same nursing aids refused to bathe him again and instead restrained him, slapped him and yelled at him while forcibly pushing a foley cath up his penis.

    My dad was in tears. It was more than losing his dignity. My dad stopped trusting the medical profession on that day.

  • Eliz52

    I think doctors, nurses etc may feel differently, if they or a loved one were left exposed and vulnerable. I consider cavalier disregard for a patient’s bodily privacy and dignity as unprofessional. I know doctors and nurses who’ve make special arrangements when they’ve had surgery, given birth or had intimate procedures – closed theatres, no medical students, same sex doctors/nurses/theatre staff and other requests to ensure their privacy and dignity is preserved to their satisfaction…but this consideration is so often forgotten for others – the vulnerable masses who are not part of or don’t know how to play the system. It’s clear the way we’re often treated is not acceptable to many doctors and nurses when they become the patient or these special arrangements would be unnecessary.

    Some people in positions of power and authority take advantage, others use it to set a high standard.
    I never assume a medical person will respect my privacy, so make clear my expectations at the start…politely and firmly.
    It’s wonderful that Dr Sherman appreciates there is a problem and is doing something about it. I also agree that complaining straight away (or letting them know ahead of time that you want the door closed and to remain closed etc), you want a male or female Dr/nurse to shower you etc…is the best course of action.
    I think the better doctors and nurses would probably welcome the fact their sloppy, uncaring colleagues are being challenged.

  • maxine Brown

    Is it ok for an assistant to be looking at your private parts other than the gynocologist? The assistant is there only to assist and not to be there as a secondary Doctor. They are not trained in that area of examination. I felt very embarrassed when I’m lying on the table with my legs opened to be examined, and the young assistant is looking right up my alley. What should I do in the future?

  • http://patientprivacyreview.blogspot.com/ Joel Sherman MD

    Maxine, tell your concerns to your doctor. If your doctor is a woman, she may be willing to do the exam herself. If it’s a man, he may or may not be willing as his legal risk is greater. But he can always position the assistant out of the way so she’s not directly watching.