"Patient is a waste of equipment"

[sbuxaddict]

One of my friends who is on her clinical rotations, posted this on her Facebook.

"Pt unresponsive with a brain bleed in ER. Called neurosurgery. Couldn't believe it. Doc said: pt is waste of equipment (and refused to treat the patient). Thanks for the consult. good night. and left.

I learned plenty today. That statement struck me the most though. I hope we never end up in the hands of others who don't take care of us."

Thoughts? Most of the comments on Facebook (not med students or doctors) were all of disgust and anger, ranging from asking if it was legal to saying the doctor had no soul. I was actually shocked at the responses. I took it as "waste of equipment" in that there was nothing that could have been done to actually make the patient better, so my initial reaction was that I understood where the neurosurgeon was coming from ( although he/she definitely could have phrased that better). Am I a terrible, soul-less person for thinking that??

**I wasn't sure which forum to post this in. I'm about to start med school this fall so technically I'm still premed...but I was interested in seeing if people thought med school made them tougher or more cynical.

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[PrideNeverDie]

what happens in the hospital stays in the hospital

definitely a red flag to shame an attending through social media

also, using an unresponsive patient to get facebook likes screams attention *****

 

[dr zaius]

No, you're not terrible. That was probably the situation. *speculation* The neurosurgeon saw the CT, saw a massive intracranial bleed, and realized there was nothing that could be done from their standpoint with little to no chance of meaningful recovery. Was it a callous and less than tactful thing to say? Absolutely. Is the neurosurgeon a heartless goon hellbent on cutting open skulls? Maybe, but most likely not. Things are dealt with by people in healthcare in strange ways that seem inhumane to those outside of it. I doubt he/she had any ill will towards the patient and was acting utilitarian in what the public would call a terrible and troubling manner.

Now the real question is should your buddy have posted it on facebook. No. Absolutely not. She can get in trouble for this and she can get the neurosurgeon in trouble for this. She should take down her status and you should probably delete this post as well.

 

[Raryn]

One of my friends who is on her clinical rotations, posted this on her Facebook.

"Pt unresponsive with a brain bleed in ER. Called neurosurgery. Couldn't believe it. Doc said: pt is waste of equipment (and refused to treat the patient). Thanks for the consult. good night. and left.

I learned plenty today. That statement struck me the most though. I hope we never end up in the hands of others who don't take care of us."

Thoughts? Most of the comments on Facebook (not med students or doctors) were all of disgust and anger, ranging from asking if it was legal to saying the doctor had no soul. I was actually shocked at the responses. I took it as "waste of equipment" in that there was nothing that could have been done to actually make the patient better, so my initial reaction was that I understood where the neurosurgeon was coming from ( although he/she definitely could have phrased that better). Am I a terrible, soul-less person for thinking that??

**I wasn't sure which forum to post this in. I'm about to start med school this fall so technically I'm still premed...but I was interested in seeing if people thought med school made them tougher or more cynical.

If the neurosurgeon was on call and a formal consult was placed, his responsibility at the very least is to evaluate the patient. Especially if it's a trauma center. That said, he's absolutely, completely within his rights to decline to operate on anyone. If he, as an attending neurosurgeon, feels that his efforts would be wasted (degree of injury, other comorbidities, etc), he can (and should!) decline to proceed. Usually that determination would require an in-person evaluation as well as review of the appropriate studies, but given that your friend said the neurosurgeon was there ("and left"), it doesn't seem like there was anything inappropriate done.

At worst, he could use some more tact. That said, I'm willing to bet his discussion with patient's family and his consult note in the official record phrases it quite differently than how he stated it when talking to the emergency provider. Doctors frequently have black senses of humor and talk with each other in a way we'd never talk to anyone else.

(Your friend likely wouldn't get in trouble for posting a completely anonymized clinical anecdote. That said, she should be careful.)

 

[evilbooyaa]

Your friend shouldn't have posted that to facebook. Sure, the patient identity is confidential, but I'm assuming people know which hospital she is currently at, and thus know that some neurosurgeon was callous in a comment about a patient.

As to the comment by the neurosurgeon, yes it's callous, but he's well within his rights not to do futile care on a patient with an extremely severe brain bleed. He's not going to write on his consult note that 'patient is a waste of equipment', he probably said it in front of the ER doc to signify that there was nothing he could do.

I'd be a little taken aback by a comment like that by an attending, but getting my panties in a bunch and posting about it to facebook (so then people that have 0 medical education or sense of how doctors/hospitals work can try to brute force who the attending neurosurgeon was) is not something that I would recommend.

 

[jakeislove]

Is permanent residence on the vent floor really saving someone?

 

[neusu]

One of my friends who is on her clinical rotations, posted this on her Facebook.

"Pt unresponsive with a brain bleed in ER. Called neurosurgery. Couldn't believe it. Doc said: pt is waste of equipment (and refused to treat the patient). Thanks for the consult. good night. and left.

I learned plenty today. That statement struck me the most though. I hope we never end up in the hands of others who don't take care of us."

Thoughts? Most of the comments on Facebook (not med students or doctors) were all of disgust and anger, ranging from asking if it was legal to saying the doctor had no soul. I was actually shocked at the responses. I took it as "waste of equipment" in that there was nothing that could have been done to actually make the patient better, so my initial reaction was that I understood where the neurosurgeon was coming from ( although he/she definitely could have phrased that better). Am I a terrible, soul-less person for thinking that??

**I wasn't sure which forum to post this in. I'm about to start med school this fall so technically I'm still premed...but I was interested in seeing if people thought med school made them tougher or more cynical.

Probably could have been worded better. Coming from the other side of the consult, I can say it can be frustrating to be asked to provide treatment for something that is untreatable. We are asked to consult on patients that truly are brain dead or have an injury that is not survivable. Families often are unable to accept this and grasp at straws for something, anything to be done. In these situations, often the best thing we can do for the patient is to provide comfort care and let them go.

 

[colbgw02]

Probably could have been worded better. Coming from the other side of the consult, I can say it can be frustrating to be asked to provide treatment for something that is untreatable. We are asked to consult on patients that truly are brain dead or have an injury that is not survivable. Families often are unable to accept this and grasp at straws for something, anything to be done. In these situations, often the best thing we can do for the patient is to provide comfort care and let them go.

That seems like a silly thing to get frustrated over. I would imagine many times that's precisely why you're being consulted, to document that nothing can be done.

 

[SouthernSurgeon]

One of my friends who is on her clinical rotations, posted this on her Facebook.

"Pt unresponsive with a brain bleed in ER. Called neurosurgery. Couldn't believe it. Doc said: pt is waste of equipment (and refused to treat the patient). Thanks for the consult. good night. and left.

I learned plenty today. That statement struck me the most though. I hope we never end up in the hands of others who don't take care of us."

Thoughts? Most of the comments on Facebook (not med students or doctors) were all of disgust and anger, ranging from asking if it was legal to saying the doctor had no soul. I was actually shocked at the responses. I took it as "waste of equipment" in that there was nothing that could have been done to actually make the patient better, so my initial reaction was that I understood where the neurosurgeon was coming from ( although he/she definitely could have phrased that better). Am I a terrible, soul-less person for thinking that??

**I wasn't sure which forum to post this in. I'm about to start med school this fall so technically I'm still premed...but I was interested in seeing if people thought med school made them tougher or more cynical.

Honestly the only thing really inappropriate here was exposing the general Facebook public to the underbelly of medicine.

Sometimes we get frustrated. We say callous things in moments of immense tragedy like this because we are so jaded to the tragedy that gallows humor and comments like this are all we have left.

Sure, it was a tactless thing to say. But every single doctor out there knows exactly what he meant, and while it might make some of us cringe at his tactlessness, that's about the extent of our reactions.

I would also say that your friend needs to be careful about what she puts out there in social media. Lots of ways to hurt yourself, few to help yourself.

 

[boogaloo]

Honestly the only thing really inappropriate here was exposing the general Facebook public to the underbelly of medicine.

Sometimes we get frustrated. We say callous things in moments of immense tragedy like this because we are so jaded to the tragedy that gallows humor and comments like this are all we have left.

Sure, it was a tactless thing to say. But every single doctor out there knows exactly what he meant, and while it might make some of us cringe at his tactlessness, that's about the extent of our reactions.

I would also say that your friend needs to be careful about what she puts out there in social media. Lots of ways to hurt yourself, few to help yourself.

Agreed. I think the medical student has already screwed herself, especially since she probably has classmates on her FB who will know exactly which neurosurgeon was there. Word gets around fast, and all it takes is, "Oh, I heard from X student that this neurosurgeon said...". I know personal things about some people I've never even met just from hanging around residents.

 

[e30ftw]

Sometimes the facts hurt. Death over months/years from lab draws/vent pnas/sepsis is worse than death from central herniation or DNI status.

The medical student showed very poor judgement posting that on FB. The patient could be identified by anyone knowing the circumstances of the ED that evening, therefore she posted a HIPAA violation for thousands of people to view and discuss.

 

[michaelrack]

My prediction is that this incident will make the local newspapers on the 28th and hit the national newswires on the 30th of January- and that the medical student will be kicked out of school by the end of February 2014

 

[jakeislove]

Hopefully, this person will delete the comment and all evidence of their selfishness and immaturity.

 

[Law2Doc]

If people could theoretically put two and two together -- know what hospital and date and given that a finite number of people had massive brain insults on that date, its potentially a HIPAA violation and your friend better get it off Facebook fast.

I think the language the neurosurgeon used wasn't ideal, and is frowned upon in any circle. But often the sentiment is true -- should he work all night and use a million dollars in medical products and technology for a Herculean effort that is doomed from the start? ICUs are full of patients who will never recover and that didn't have good odds to start with, because our culture is to use massive efforts even with slight or sometimes no odds. Other countries don't go down this road, which often racks up bills a family can never afford to give a few more unconscious days of life to someone who will never leave the hospital. In days where healthcare costs are out of control, more doctors really should be making these hard choices. Its admirable that the neurosurgeon candidly did so, even if he said it badly. What is despicable is your friend who clearly doesn't get that it was his role to work with his team and help make the family understand that there wasn't much that intervention could do, rather than vilify the consultant who was really being straight with him (albeit with a poor word choice). You friend wasn't in the right, and wouldn't have helped his patient by forcing him/her to die after a Protracted surgery that had no chance of success. The only way he could "help" here would be to help prepare the family for the inevitable, and based on his Facebook post that point was already lost on him to start with.

 

[Bacchus]

Maybe NSG just didn't want to talk to the medical student . "OMGGGGGGGGGGGGGG NSG, *SWOON*" Imagine that gets old after a while.

 

[mcloaf]

TBH I hope your friend gets disciplined for a such a painfully obvious breach of professionalism. I would never want to work with somebody who couldn't keep things like this off of the internet.

 

[sbuxaddict]

Thanks everyone, glad to hear I wasn't being too callous or lacking a soul. She did end up deleting the post!

 

[NickNaylor]

Agreed that posting a Facebook thing perhaps wasn't the best call, though no personally identifying information was posted so I don't get why everyone is getting all righteous about HIPPA compliance. The OP's post is no different than you talking to a peer about a case with a CC and no other info, which I'm sure everyone does relatively frequently. It's just part of being in medicine and having peers also in medicine. You talk about interesting things.

As far as "unprofessionalism," I'm not so sure. In this case it seems like a cop out for "you made your superior look bad, tsk tsk." But it's that kind of attitude portrayed by the attending - someone being nothing more than a "waste of equipment" - that, if ANYTHING, should be called out. At the end of the day, these are people. Saying things like that is wholly inappropriate and more unprofessional IMO than posting about the situation in an anonymous way. "Unprofessional" is to medicine what "socialism" is to politics: a term thrown out so often and which is such anathema to any kind of serious discussion that we should really consider what is "unprofessional" and what isn't. Regretful behavior? Sure. Unprofessional? Yeah, don't think so.

 

[pdxhopeful]

I can't really say I'm 100% on either team on this.

I do consider the student's breach of patient privacy and automatic negative assumptions about the surgeon much more of a problem, and she ought to face some sort of discipline for it in proportion to any history of similar professionalism concerns (hate using the buzzword, but it's decent shorthand). On the other hand, what the surgeon said is pretty easily misinterpreted in an uncaring way and it might behoove them to be a little more aware of who could overhear...

 

[michaelrack]

I can't really say I'm 100% on either team on this.

I do consider the student's breach of patient privacy and automatic negative assumptions about the surgeon much more of a problem, and she ought to face some sort of discipline for it in proportion to any history of similar professionalism concerns (hate using the buzzword, but it's decent shorthand). On the other hand, what the surgeon said is pretty easily misinterpreted in an uncaring way and it might behoove them to be a little more aware of who could overhear...

I am also concerned about what the NSG said, and there are better channels (hospital committees, medical school training director, dean, rotation coordinator, etc) to address this (if the OP's friend really felt that it had to be reported) than FB. Regarding deleting the FB post- hopefully no one "shared" it.

 

[Evil_Abed]

Agreed that posting a Facebook thing perhaps wasn't the best call, though no personally identifying information was posted so I don't get why everyone is getting all righteous about HIPPA compliance. The OP's post is no different than you talking to a peer about a case with a CC and no other info, which I'm sure everyone does relatively frequently. It's just part of being in medicine and having peers also in medicine. You talk about interesting things.

As far as "unprofessionalism," I'm not so sure. In this case it seems like a cop out for "you made your superior look bad, tsk tsk." But it's that kind of attitude portrayed by the attending - someone being nothing more than a "waste of equipment" - that, if ANYTHING, should be called out. At the end of the day, these are people. Saying things like that is wholly inappropriate and more unprofessional IMO than posting about the situation in an anonymous way. "Unprofessional" is to medicine what "socialism" is to politics: a term thrown out so often and which is such anathema to any kind of serious discussion that we should really consider what is "unprofessional" and what isn't. Regretful behavior? Sure. Unprofessional? Yeah, don't think so.

Yea, it's fairly unprofessional. You don't have to explicitly say it was Dr. So-and-so because chances are pretty high that others on the rotation with her knew exactly who that was. So, now, you're attacking a person who can't defend themselves (I'm assuming they're not FB friends). I'd argue that warrants the appropriate use of "unprofessional" or, at the very least, an incredibly dick move on the student's part. Like others have mentioned, this should've been reported and dealt with internally instead being posted onto social media.

Second, let's be honest -- med students exaggerate the **** out of things. I would be willing to bet that the student in the OP "paraphrased" the neurosurgeon to make it sound a lot more dramatic than it actually was. I've seen this kind of exaggeration happen quite frequently on rotations so far, so I definitely wouldn't be surprised if that was the case. I see some of my own classmates post exaggerated things on FB with the aim of getting a lot of "likes." Things I know did not happen quite the way they described them because I was on service with them.

Third, if the neurosurgeon responded with those exact words, yea, it was badly phrased and I agree with you that it should've been phrased better. With that being said, I can understand the meaning behind the patient being a "waste of equipment." We get a lot of pushback from the MICU at our institution, for example, because if we send them someone that can be managed on the floor or the stepdown unit (regardless of how much extra work that creates for us or the nurses), then the MICU loses a bed that could be used for a truly sick patient who truly needs ICU level care. I completely agree with you, Nick, that the phrasing by the neurosurgeon (if he/she really did say that) could be a LOT better, but the rationale is likely a pretty sound one when resources are limited.

 

[NickNaylor]

Yea, it's fairly unprofessional. You don't have to explicitly say it was Dr. So-and-so because chances are pretty high that others on the rotation with her knew exactly who that was. So, now, you're attacking a person who can't defend themselves (I'm assuming they're not FB friends). I'd argue that warrants the appropriate use of "unprofessional" or, at the very least, an incredibly dick move on the student's part. Like others have mentioned, this should've been reported and dealt with internally instead being posted onto social media.

Second, let's be honest -- med students exaggerate the **** out of things. I would be willing to bet that the student in the OP "paraphrased" the neurosurgeon to make it sound a lot more dramatic than it actually was. I've seen this kind of exaggeration happen quite frequently on rotations so far, so I definitely wouldn't be surprised if that was the case. I see some of my own classmates post exaggerated things on FB with the aim of getting a lot of "likes." Things I know did not happen quite the way they described them because I was on service with them.

Third, if the neurosurgeon responded with those exact words, yea, it was badly phrased and I agree with you that it should've been phrased better. With that being said, I can understand the meaning behind the patient being a "waste of equipment." We get a lot of pushback from the MICU at our institution, for example, because if we send them someone that can be managed on the floor or the stepdown unit (regardless of how much extra work that creates for us or the nurses), then the MICU loses a bed that could be used for a truly sick patient who truly needs ICU level care. I completely agree with you, Nick, that the phrasing by the neurosurgeon (if he/she really did say that) could be a LOT better, but the rationale is likely a pretty sound one when resources are limited.

First, I don't disagree with anything that you've said. And I agree that posting things on Facebook is a dangerous proposition for a variety of reasons and should be done very judiciously. That said, it was done by a medical student who perhaps didn't know any better. No identifying information was shared. I don't really care if people know who the attending is or not. In my view that's irrelevant. Contrast that to an attending who presumably should know much better and uses that kind of sentiment not only around other staff but around junior trainees? I mean, are you kidding me?

Both are perhaps misguided IMO, but there is NO room for that kind of nonsense when you're an attending physician that interacts with medical students. None. I don't care how tired or irritated or whatever you are. That really is inexcusable in my view. Even if it was a "slip," I have an issue with colleagues that would ever refer to patients in that manner.

 

[e30ftw]

First, I don't disagree with anything that you've said. And I agree that posting things on Facebook is a dangerous proposition for a variety of reasons and should be done very judiciously. That said, it was done by a medical student who perhaps didn't know any better. No identifying information was shared. I don't really care if people know who the attending is or not. In my view that's irrelevant. Contrast that to an attending who presumably should know much better and uses that kind of sentiment not only around other staff but around junior trainees? I mean, are you kidding me?

Both are perhaps misguided IMO, but there is NO room for that kind of nonsense when you're an attending physician that interacts with medical students. None. I don't care how tired or irritated or whatever you are. That really is inexcusable in my view. Even if it was a "slip," I have an issue with colleagues that would ever refer to patients in that manner.

You stated that sharing patient information on a public forum when the patient could be identified is "getting all righteous about HIPAA" yet post this self-righteous stuff about "NO room for that kind of nonsense" "None" "inexcusable" blah blah about a neurosurgeon who states that a patient with likely no change of recovery is a "waste of equipment".

His statement is likely said as a fact, not being insensitive.

And you are wrong about HIPAA, the facebook post definitely could be construed as a HIPAA violation if it could lead to the patient being identified. I've known attendings/RNs/techs fired from hospitals for much less..

if you post "Saw a crazy gunshot wound last night in the ED hope he makes it" on facebook after a night shift and your hospital IT sees you (they have spies who do this for a living) you will likely get fired.

true life facts, not yellow-brick road PC BS.

 

[Law2Doc]

Agreed that posting a Facebook thing perhaps wasn't the best call, though no personally identifying information was posted so I don't get why everyone is getting all righteous about HIPPA compliance. The OP's post is no different than you talking to a peer about a case with a CC and no other info, which I'm sure everyone does relatively frequently. It's just part of being in medicine and having peers also in medicine. You talk about interesting things....

You don't have to actually use the patients name or record number to violate HIPAA. If it's clear from your Facebook page where you are a med student, and your post suggests when this happened, eg "last night...", that perhaps narrows the pool of patients with brain injuries to a very small group. if the Facebook post contained additional info (young vs old, that you were working in the ICU, etc, that would make it even more concerning). Talking to a peer in medicine is hugely different than posting it online, because anyone who is a friend of your friend can see the post and your replies and so on. you are essentially broadcasting to a very large audience. Maybe even some people not on te treating team who could put two and two together. So yeah, it's potentially a HIPAA violation and not just talking about interesting things with friends (which btw can sometimes also get you in trouble if others are in earshot, as they always are on Facebook).

 

[NickNaylor]

You stated that sharing patient information on a public forum when the patient could be identified is "getting all righteous about HIPAA" yet post this self-righteous stuff about "NO room for that kind of nonsense" "None" "inexcusable" blah blah about a neurosurgeon who states that a patient with likely no change of recovery is a "waste of equipment".

Then the attending should have said that there was "no chance of recovery" rather than "a waste of equipment." You call this "yellow-brick road PC BS," I call it having a basic sense of integrity and referring to people as people, nothing less. Let's put it this way: how do you think it would go over if you made a similar statement in front of a superior? Exactly.

His statement is likely said as a fact, not being insensitive.

The fact behind is statement is true, the way in which it was delivered is the definition of insensitive.

And you are wrong about HIPAA, the facebook post definitely could be construed as a HIPAA violation if it could lead to the patient being identified. I've known attendings/RNs/techs fired from hospitals for much less..

Our hospital has similar policies, but that in and of itself doesn't make it a HIPAA violation. These policies are likely in place to dissuade people from doing things like this as hospitals independent of the individual involved can face not insignificant penalties for violations. Is it possible that this person could be identified? Sure, if the stars aligned, and that's why I agree that posting stuff like this on Facebook is a bad idea. Is it an inherent HIPAA violation? No, at least not in the same way that saying "John Smith at the hospital has a brain bleed" would be.

if you post "Saw a crazy gunshot wound last night in the ED hope he makes it" on facebook after a night shift and your hospital IT sees you (they have spies who do this for a living) you will likely get fired.

true life facts, not yellow-brick road PC BS.

2edgy4me

 

[NickNaylor]

You don't have to actually use the patients name or record number to violate HIPAA. If it's clear from your Facebook page where you are a med student, and your post suggests when this happened, eg "last night...", that perhaps narrows the pool of patients with brain injuries to a very small group. if the Facebook post contained additional info (young vs old, that you were working in the ICU, etc, that would make it even more concerning). Talking to a peer in medicine is hugely different than posting it online, because anyone who is a friend of your friend can see the post and your replies and so on. you are essentially broadcasting to a very large audience. Maybe even some people not on te treating team who could put two and two together. So yeah, it's potentially a HIPAA violation and not just talking about interesting things with friends (which btw can sometimes also get you in trouble if others are in earshot, as they always are on Facebook).

Agreed that this could potentially be a HIPAA violation if the stars aligned (as stated above). And I agree with the distinction you draw between posting things on Facebook vs. a discussion between peers in person. As I mentioned, I think the med student made a regrettable decision that he/she hopefully would not make again, but I disagree with it being inherently unprofessional, particularly when compared to the purported (which I'm taking at face value) actions of an attending that has many years of experience and who, frankly, should know better.

 

[Raryn]

HIPAA pretty clearly covers only Protected Health Information that could be used to explicitly identify the patient. Name, DOB, age if > 90, address, SSN, etc. Posting "I saw a gun shot wound" is frequently a violation of *hospital policy*, but not a violation of HIPAA itself. Doctors are allowed to discuss patient care anecdotes quite legally, and frequently do so in settings ranging from public meetings to the freaking newspaper. All the explicitly protected details must be left out or edited, but if that is done (and we have no indication it wasn't in this case), it is NOT a federal law violation.

I'm surprised L2D thinks otherwise on this point.

 

[NickNaylor]

HIPAA pretty clearly covers only Protected Health Information that could be used to explicitly identify the patient. Name, DOB, age if > 90, address, SSN, etc. Posting "I saw a gun shot wound" is frequently a violation of *hospital policy*, but not a violation of HIPAA itself. Doctors are allowed to discuss patient care anecdotes quite legally, and frequently do so in settings ranging from public meetings to the freaking newspaper. All the explicitly protected details must be left out or edited, but if that is done (and we have no indication it wasn't in this case), it is NOT a federal law violation.

I'm surprised L2D thinks otherwise on this point.

Yeah, this was my understanding as well. And I can understand how individuals would be held liable for sharing factual information that, while not PHI, leads to someone being identified as a patient (e.g., by some twist of fate someone on a person's Facebook friend list knows the circumstances surrounding a person's admission to the hospital but doesn't actually have the authority to know that person's health information). I don't know if the latter is actually a part of the HIPAA statute, though.

 

[Law2Doc]

HIPAA pretty clearly covers only Protected Health Information that could be used to explicitly identify the patient. Name, DOB, age if > 90, address, SSN, etc. Posting "I saw a gun shot wound" is frequently a violation of *hospital policy*, but not a violation of HIPAA itself. Doctors are allowed to discuss patient care anecdotes quite legally, and frequently do so in settings ranging from public meetings to the freaking newspaper. All the explicitly protected details must be left out or edited, but if that is done (and we have no indication it wasn't in this case), it is NOT a federal law violation.

I'm surprised L2D thinks otherwise on this point.

People have gotten in big trouble without explicitly using name, DOB, MRN. The privacy rules cover all individually identifiable health information. If you commented on the status of the middle aged F who you saw at St Elsewhere hospital for a stroke on 1/20 at 11pm, and we are talking about a very finite number of people who could fit that bill, you are probably in trouble.

Use of dates, geographic information, and any information that alone or with other provided information could be used to identify the individual is really not allowed.most "hospital policies" are drawn from the privacy rules of HIPAA which are much broader than you guys are suggesting.

 

[neusu]

That seems like a silly thing to get frustrated over. I would imagine many times that's precisely why you're being consulted, to document that nothing can be done.

Sorry if I wasn't clear with my post. We are frustrated when we are asked to evaluate the patient and say there is nothing can be done, and then that answer is unacceptable.

 

[Elisabeth Kate]

People have gotten in big trouble without explicitly using name, DOB, MRN. The privacy rules cover all individually identifiable health information. If you commented on the status of the middle aged F who you saw at St Elsewhere hospital for a stroke on 1/20 at 11pm, and we are talking about a very finite number of people who could fit that bill, you are probably in trouble.

Saying you treated a gunshot wound without any other identifiable information is NOT the same as saying you saw a middle aged female at St. Elsewhere for a stroke on 1/20 at 11 p.m. Apples and oranges. HIPPA is pretty explicit in this.

 

[Law2Doc]

Saying you treated a gunshot wound without any other identifiable information is NOT the same as saying you saw a middle aged female at St. Elsewhere for a stroke on 1/20 at 11 p.m. Apples and oranges. HIPPA is pretty explicit in this.

The OPs example placed a patient into a specific ER of a specific hospital on a specific date with a Brain bleed. That's apples and apples.

 

[Elisabeth Kate]

The OPs example placed a patient into a specific ER of a specific hospital on a specific date with a Brain bleed. That's apples and apples.

I was referring to the gunshot wound example, not the OP.

 

[Law2Doc]

I was referring to the gunshot wound example, not the OP.

Then you meant to reply to raryn's post, not mine. He gave an example that didn't fit the OPs scenario.

 

[Akali]

Wouldn't it be deliciously fun to print a screen shot of it , comments and all, and slip it into the neurosurgeon's office?

 

[Nasrudin]

I don't get the drama. The patient could very well have been a waste of resources to treat. And if I understood the situation the comment was within a conversation between a primary team and the neurosurgery consultation service. The patient's family was not talked to in this way.

What do you think is gonna happen people when all this fake money the fed is printing up wears too thin and the Chinese get anxious and try to dump their assets here. Well be the ones riding bicycles to the factory and you won't even get to talk to a neurosurgeon for the privilege of being appalled at their frank assesments. We're spending all our resources on old people with no quality of life to begin with and little hope for improvement as L2D said.

Frankly, this is what you get when you let sanctimonious premeds get backstage where the real **** is happening. And for what? Useless whiny little bastard blabbing on Facebook....nice.

 

[Elisabeth Kate]

Then you meant to reply to raryn's post, not mine. He gave an example that didn't fit the OPs scenario.

Raryn specifically cited the gunshot post in his/her post and you replied to that, so I don't think my response was unwarranted. But whatever.

Nasrudin, I got the impression the person who made the FB post was a third year, not a pre-med.

 

[Nasrudin]

Raryn specifically cited the gunshot post in his/her post and you replied to that, so I don't think my response was unwarranted. But whatever.

Nasrudin, I got the impression the person who made the FB post was a third year, not a pre-med.

Holy crap! wtf is wrong with people and their Facebook profiles. I missed this generation's acculturation into taking ****s online. It blows my mind how casual the use of the Internet is. No wonder why deans give lectures about social media these days. How does this elude the common sense of a 3rd year medical student? I just...it's so...I...idk what to say.

 

[sanityonleave]

We had a patient brought in by helicopter a while back from an OSH with a 14cm x 8cm IPH with a good 3cm of midline shift and a neurologically devastated exam. Sometimes the patient is going to die and everyone knows it but consults are called anyway for a variety of reasons ranging from ass covering to placating the family to incompetence. What NSGY said was poorly worded but the sentiment was something that anyone who has spent time in the hospital can appreciate.

Your classmate is an idiot for posting it on facebook. If it gets back to your school's admin she's going to be harshly disciplined. I would encourage your classmate to delete the post and lay low.

 

[Nasrudin]

We had a patient brought in by helicopter a while back from an OSH with a 14cm x 8cm IPH with a good 3cm of midline shift and a neurologically devastated exam. Sometimes the patient is going to die and everyone knows it but consults are called anyway for a variety of reasons ranging from ass covering to placating the family to incompetence. What NSGY said was poorly worded but the sentiment was something that anyone who has spent time in the hospital can appreciate.

Your classmate is an idiot for posting it on facebook. If it gets back to your school's admin she's going to be harshly disciplined. I would encourage your classmate to delete the post and lay low.

Yeah. The phrasing is bad. But if it was understood in context to be futile treatment then it might have been something contextual between services. It's hard to judge intent, context, irony, and subtlety from 3rd and 4th hand tellings of a story. Particularly if automatic nimrod status is gloriously achieved by the facebook poster.

You get what the patients and family needs to hear from a palliative consult or from the primary team. The guy who cuts open skulls gets to talk how s/he wants to among others in the shop room. Violators of this covenant have no place in the circle of trust.

 

[sobored]

I think the biggest problem with all of this is that the student is now subjecting the neurosurgeon to the opinions and commentary of the lay public who really have no idea how things work in medicine. Without context and medical training, what he said just sounds terrible and people will run with it. And with social media as it is these days, it could get ugly for that neurosurgeon really quickly. Would you really want to potentially ruin someone's career like that over something that was, at worst, poorly phrased? Highly immature by this med student.

 

[sbuxaddict]

Interesting discussions on SDN. I've been gone for a while but I knew this was the right place to talk about it. I originally posted because I was shocked at the comments she got from it, but like another person said, without context and medical training it sounds terrible to the non-medical person.

I'm not exactly certain if this would be a HIPAA violation, but I really don't think it would be hard for a fellow 3rd year to find out which neurosurgeon she was talking about.

 

[Thespunger]

Now I personally wouldn't have posted that on Facebook myself because I know med students are supposed to be spineless, quite and subservient, and that is the way the world of medicine works. However, there is clearly no HIPPA violation here ... doctors write books and articles about their patients all the time, change the name or call the patient Jon Doe, don't use any personal information and voila no HIPPA. Doctors also talk crap about other doctors, about the state of medicine, etc, in published books and articles all the time. Don't forget there is still something called freedom of speech, just happens that apparently as med students we are not allowed to have it if it would upset any attending. I personally think what the neurosurgeon said was callous, arrogant and disrespectful to a dying patient. If they don't want to be held accountable for saying something like that they shouldn't say it, even if it's just among other medical professionals . Not everyone in medicine might be ok with that ..

 

[Winged Scapula]

It's spelled voila.

 

[Thespunger]

Ok

 

[SouthernSurgeon]

It's also spelled HIPAA...

 

[evilbooyaa]

Now I personally wouldn't have posted that on Facebook myself because I know med students are supposed to be spineless, quite and subservient, and that is the way the world of medicine works. However, there is clearly no HIPPA violation here ... doctors write books and articles about their patients all the time, change the name or call the patient Jon Doe, don't use any personal information and voila no HIPPA. Doctors also talk crap about other doctors, about the state of medicine, etc, in published books and articles all the time. Don't forget there is still something called freedom of speech, just happens that apparently as med students we are not allowed to have it if it would upset any attending. I personally think what the neurosurgeon said was callous, arrogant and disrespectful to a dying patient. If they don't want to be held accountable for saying something like that they shouldn't say it, even if it's just among other medical professionals . Not everyone in medicine might be ok with that ..

There is a massive difference between doctors talking about patients from months/years ago in a book and a med student discussing a patient with a specific diagnosis in the local ED LAST night. You have many more identifying factors, including exactly what time all this happened, when compared to articles written by physicians.

I still agree that this is technically not a HIPAA violation, but it could theoretically come back and bite the student in the ass.

However, I HIGHLY doubt that NSG said directly to the patient (or the patient's family) that 'patient is a waste of equipment'. If a doctor said that to me about my family member in the hospital, I'd be really pissed off. He probably said it to the ED doc (away from the patient) and the med student overheard and got emotional. That being said, it WAS callous. I don't know what's 'arrogant' about it.

This sounds like another one of those posts about 'woe is me, the poor med student who has no freedom of speech to criticize my superiors'. This is not a unique position. The only reason you'd really care is that the doctors can make your life hell. In the non-medical field, you'd never call your boss (or his friends/associates) an arrogant dingus who is dragging the entire company into the ground to his face (unless you were quitting). This is similar.

 

[Winged Scapula]

Ok

Sorry to be such a language "Nazi" but this particular one annoys me as it is so commonly misspelled by intelligent, well educated people for reasons that escape me.

 

[Thespunger]

I actually don't disagree, like I said I wouldn't say anything or post anything on Facebook myself. I'm not complaining about anything just pointing out the way it is. Posting anything about patients or colleagues is professionally inappropriate in my opinion. And agreed these situations are not specific to medicine obviously. I mostly disagree that someone could be punished for hipaa for posting that on Facebook as some of the other ppl suggested. I don't think there was enough personal information given. But I'm not an expert. Anyhow, just wanted to point out another side of this discussion since I can understand why it is a bit disheartening to hear your mentors speak about dying patients like that. Maybe I'm naive ..

 

[TwinsFan]

This is a great example of where some actual clinical experience prior to med school would help. If it is so shocking to hear an off color comment on a tragic situation that you have to drag someone's reputation through the mud then you have obviously haven't been around much medicine. Skin thickening will be required to survive training at the very least.

Also giving a little grace to let your future colleagues vent isn't the worst thing in the world.