Polices are needed to Limit Access to Clinical Information for “Grateful Patient” Programs

Main Points:

American medical institutions should voluntarily adopt policies to mitigate activities that can create tension between a physician’s role as caregiver and fundraiser according to an Essay published in this week’s PLOS Medicine.

Study Further:

The Essay, which was written by Julian Prokopetz and Lisa Soleymani Lehmann from the Harvard Medical School, Boston, MA, focuses on “grateful patient” programs that are common in American medical institutions.

Donations are commonly solicited from wealthy individuals, and physicians are often encouraged to assist in these programs because their existing relationships afford them insights into each patient’s clinical history, personality, and financial situation. However, the practice of physicians fundraising from their own patients raises concerns that patients may feel an undue pressure to contribute, and may raise expectations of preferential treatment from donors, as well as concerns about patient confidentiality and trust.

The authors note, “[d]epartment and physician information… is primarily intended to aid targeted fundraising efforts. We recommend that, as under the prior Privacy Rule, development staff access this information only when authorized by the patient. Similarly, we recommend that physicians secure consent before referring one of their patients to development [staff].”

Restrictions on access to clinical information have been loosened in a recent update of the Health Information Portability and Accountability Act (HIPAA) Privacy Rule in the United States in January 2013. This means that fundraising staff can view basic patient outcome information as well as a patient’s department of service and treating physician without requiring patient consent.

The authors of the Essay support access to basic patient outcomes because it allows fundraising staff to avoid reaching out to patients who have died or experienced other severe health consequences. However, the authors raise concerns about the greater access to other aspects of patient information and recommend that medical institutions implement voluntary standards to protect patient confidentiality and trust.

The authors conclude, “[w]hile our discussion focuses on the specific example of the [United States’] HIPAA Privacy Rule, we note that the concerns raised in this article are relevant in other nations as well. Grateful patient programs exist in other countries where medical institutions are privately owned, such as Canada and Australia.”

Funding: No funding sources to declare.

Competing Interests: The authors have declared that no competing interests exist.

Citation: Prokopetz JJZ, Lehmann LS (2014) Physicians as Fundraisers: Medical Philanthropy and the Doctor- Patient Relationship. PLoS Med 11(2): e1001600. doi:10.1371/journal.pmed.1001600

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001600

Contact: Lisa Lehmann, Brigham and Women’s Hospital, UNITED STATES, llehmann1@partners.org

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