The privacy of your patient records is assured by a federal law known by the acronym HIPPA. In general, this law declares that your records remain your property with the treating physician or institution as the custodian of those records. This is an important legal point of which most patients are unaware. You may have access to your records upon request and within reasonable business parameters (e.g., during office hours, does not obstruct the usual flow of business, physician not responsible for copying costs). You may review your record and file an addendum to these records but you nor the physician may alter the already recorded record. The access to your records, except for some special conditions listed next, is restricted to your treating physician and you. There are several notable exceptions. The first exception is for an order from a court of appropriate jurisdiction. This will require and order from the judge. Attorneys will often seek a release of records when you are involved in litigation, usually a divorce proceeding. Your attorney may have access to your records and will most certainly send a HIPPA compliant release since he or she has a fiduciary responsibility to you, as does your physician. As an aside, this is a major difference in the privacy with your attorney and the privacy with your physician. Your attorney cannot be compelled to release what is known as attorney work product, your physician can be compelled to release his work product. Opposing attorneys will sometimes send a subpoena duces tecum. In and of itself, this is not enough to compel a release of information. However, if the attorney notices you or your attorney and within the 10 days allowed by law you or your attorney does not file with the court an order of protection or a motion to quash the subpoena, then the records must be released.
Another exception is the law enforcement exception. We will in most cases vigorously defend the privacy of your records but the fact is that if the DEA has you targeted for drug diversion or doctor shopping, they can compel the release of limited amounts of your record without your consent.
If you have assigned insurance benefits to your provider then the provider may release the amount of your record to adjudicate the claim without obtaining a release from you each time. Workman's compensation claims are another exception to HIPPA. Even if your treating physician is not filing with workman's compensation for payment, your employer's workman's compensation carrier may obtain your records without your consent to adjudicate your workman's compensation claim.
The most important exception is for clinical care. Your physician may communicate freely with your other treating physicians or other providers to deliver needed medical care.
These are the only exceptions to the HIPPA privacy law. This brings us to the second part of the title; How does a concerned relative or friend communicate with your physician if the physician is forbidden from discussing your case with them without your explicit consent. Although most all communications of this type emanate from a deep and legitimate concern on the part of the third party, our office has seen numerous cases of third parties seeking information to gain an advantage in some personal agenda involving my patient. This is the reason I wish to avoid even the appearance of release without consent. Although I cannot release any information, even the information that you are a patient without your consent, I can receive any information.
For the last many years I have utilized two means of receiving this information. The first is to write me a letter detailing your concern. Please include your name, address, and phone number (in case the patient later gives consent to discuss the case with you) and the patient, patient's birthdate, and patient's address (you would be surprised how many patients I have with the same name). Also, include the location where I have treated the patient, e.g., the hospital, my office, etc. Write down all of your concerns regarding the patient. I utilize this method so that there is no chance of disclosing privileged information inadvertently in a phone call or a face to face meeting while obtaining information that may be beneficial in the patient's care. This information will be reviewed and discussed with the patient.
The other method of relaying your concern, and the preferable method, is to come to the patient's appointment with the patient. This method allows us to address all pertinent issues and make a unified plan of treatment. Many issues may not be solely medical and require the support of friends and family.
A third method, which has only recently become available, is to leave a voicemail on the office phone. Please include all of the information that would be included in the letter referenced above.
Unfortunately, an email mode of contact is not available for either patients or third parties. This is actually my preferred mechanism of communication. At this time I have not been able to locate a reasonable email service that meets the stringent HIPPA security requirements.
I hope this is helpful to advise you of your rights as a patient and ways you can relay your concerns as a concerned third party. These are simply one set of legal parameters within which we all live. In the end, there is only one goal--- healthy patients.
October 17th, 2016
Andrew Bishop, MD FAPA