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Evaluation and Management of the
Sexually Assaulted or Sexually Abused Patient
Chapter 6
Privacy and Confidentiality
Ralph Riviello, MD, MS, FACEP
Confidentiality is important in the emergency department and is especially important in treating sexually assaulted
patients. Privacy is legally defined as “the right to be left alone.” It is characterized by freedom from exposure to or
intrusion by others. There are three usages of privacy:
Physical Privacy
Informational Privacy
Decisional Privacy
Physical privacy is the freedom from contact with others or exposure to one’s body to others. Patients give their
caregivers access to their bodies for medical examination and procedures, however they expect caregivers to protect
them from unnecessary or embarrassing bodily contact or exposure. This is especially important in sexual assault
Informational privacy describes the prevention of disclosure of personal information. Patients disclose a lot of
personal information to their health care providers and they expect that access to it will be severely restricted. This
form of privacy is most closely related to Confidentiality.
Decisional privacy is the ability to make and act on one’s personal choices without interference from others or the
state. Decisional privacy is closely linked to the concept of respect for autonomy and the doctrine of informed consent.
These principles are paramount in treating sexually assaulted patients.
Confidentiality as mentioned is closely related to informational privacy. Health care workers may breach
confidentiality both intentionally and unintentionally. The Health Insurance Portability and Accountability Act of
1996 (HIPAA) require physicians and health care institutions to adopt new procedures to protect patient privacy.
In 2003, the regulations of HIPAA require providers “to protect the confidentiality, integrity, and availability to
patients of ‘‘individually identifiable personal health information’’ in any form, whether electronic, written, or
oral. Personal health information includes information that relates to a person’s physical or mental health, the
provision of healthcare, or the payment for health care.”
HIPAA Exceptions
Under the HIPAA regulations, emergency physicians may use and disclose personal health information (PHI) without
the patient’s written consent under certain circumstances:
1. PHI may be given to the patient himself or herself
2. Caregivers may use and disclose PHI for their own treatment, payment, and health care operations activities
3. With patient’s “informal permission” caregivers may disclose PHI to family members or in facility directories
4. Caregivers may use and disclose PHI for “12 national priority purposes.”
Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient | ACEP
Privacy and Confidentiality