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Seeing patients and their relatives creates additional HIPAA considerations but ultimately improves patient care.
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One aspect of practicing family medicine that I find challenging is maintaining confidentiality when I take care of multiple members of the same family. Some of them will come in together for back-to-back visits, happily sharing all information with each other. Others purposely arrange appointments on different days. In other cases, they ask me to design a situation in which they are not seen together without letting their family member (usually a spouse) know that they do not want to be seen conjointly.
I treat patient information with the utmost respect and confidentiality. I am cautious in what I share, even whether I’ve seen their family member for a visit recently. However, I am often privy to information from one family member that impacts another. This requires me to tread carefully as I cannot ignore important information relevant to one patient’s health but also cannot disclose a confidence that violates HIPAA for another.
Recently, I was seeing both a husband and wife on the same afternoon. They were each in a separate room, so I conducted each visit independently. The wife shared concerns with me about how her husband was using one of his medications. She said that unless she managed it, he would take too much. “But you can’t tell him I told you,” she admonished, “or he might get angry that I said anything.” This scenario is almost always shared out of concern and caring, although sometimes one family member will seek to undermine the care of a patient for their own reasons.
I tried to consider how to address my patient without indicating that his wife told me anything. I considered recent visits and the conversations we’d had around medication management. Seizing on a previous conversation about cutting back on medication, I gently inquired about his openness to continue to re-evaluate medications. Fortunately, he was agreeable, and I was able to adjust his medication dosing to a safer level.
For all the complexity of managing patients in family relationships, I find the additional context to be very helpful in evaluating and treating my patients. Family members will often clarify a winding narrative or correct a history. A wife may accompany her husband to make sure he doesn’t minimize concerning symptoms. A husband may tearfully offer that his wife is very forgetful, and he’s worried about dementia.
Even with potential difficulties and contradictions that come with caring for multiple members of the same family, I wouldn’t want to limit these insights and reports. Our patients are complex. How they see themselves or experience their own health and disease is of primary importance, but the additional perspective of loved ones who see them with greater frequency, objectivity and clarity rounds out their psychosocial and medical status. That helps me improve the quality and depth of care I can provide.
Jennifer Frank, MD is a family physician and chief medical officer in northeastern Wisconsin. She continues to find medicine to be the most rewarding profession imaginable, second only to motherhood. She's married to a fellow physician and has four children. Her family reminds her of what is most important and inspires her study and pursuit of work-life balance.