Ethics question

I am curious to see what people's response is to the following story. I have a good friend who was in the hospital a year or two ago. He is a good looking guy who is also in very good shape and he was 29 years old at the time. It was during visiting hours so I was hanging out in his room. Someone came by and said a nurse would be in to do something in a few minutes. Therefore, I stepped out in the hall and was leaning against a wall near the nurse's station. I heard them say he needed whatever it was checked and then one of them said, "ooh, we get to see him with his shirt off."

Was that inappropriate?

From a professional's opinion, yes, that was inappropriate. First of all because you were able to hear the nurses discussing anything about a patient, no matter what it is, is a violation of HIPAA. Secondly, whether a patient is good looking or not, doesn't matter, a patient is a patient, and no one should know any differently.

Mashie

Thanks Mashie,

That's what I thought but I wanted a second opinion from someone who wasn't involved in it. I have to say, it did bother me.

I'm with Mashie on this one. No patient should ever be treated like a piece of meat. Patients are vunerable enough without that going on behind their backs.

I am not a medical professional and I do not play one on TV, but I was an athletic director at the middle school I coached and taught at for many years. Our school district did not have group physicals, so every student had to go to their own doctor.

Sports physicals were turned into the office secretary, who recorded the physical as being turned in and then they were place in a file for me to go through. No other school personel(beside the school nurse) or outside individuals saw them.

I looked at each physical for a specific reason. Was it signed by a parent or legal guardian? Were there any limitations placedon the athlete involved? Now doctors made many notations and conducted some extremely invasive exams on students , but in all of my years as coach and AD, I never shared any of this with fellow teachers. If I had a question I asked the school nurse for clarification. There should be ethic involved at all levels.

I work in a helping profession that is governed by strict privacy laws so I fully understand that part.

Although I knew discussing the patient was against practice, it was them getting enjoyment from seeing him with his shirt off that really offended me.

Thank you both for your input.

Happens all the time. Dont think the nurses dont peep at you while your unconscious in the OR either. They do it all the time.

Nymedical, I can honestly say that at any place I have ever worked it has not happened. While I agree with you it probably does happen, I personally have never seen it happen, or heard of it happening with anyone I have ever known. But, I am not young and a new nurse anymore either to where I view bodies that way either, plus I graduated from a nursing school that was very "old school", very strict, not a hair out of place, never a scuff on your white shoes, and never a run in your white hose. Your cap was worn at all times while inside and it had better be strait too. It was and might still be the top nursing school in my state with a 99.998 percent pass rate on the NCLEX. Professionalism starts in nursing school. If it isn't taught, maintained, and inforced then, then it's graduates have to learn it on their own, and unfortunately, not all do.

Mashie

He should have been flattered. Not very profesional of the nurse but I can't see any harm done

Actually, from the description given it sounds somewhat flattering for the patient.

It would have been different if the nurses kept trying to hand it off to someone else or made remarks like 'yech ... what a sight with his shirt off ...'

Maybe a fellow in a hospital could use some flattery of that type from the nurses. It's not as if this is anything derogatory or insulting ... sounds more like a compliment to me ...

And moreover - it sounds like you were inadvertently eavesdropping on the nurses - not that they were talking in public ... I don't see how discussing something like this amongst themselves as nurses can be considered inappropriate ...

I'm sorry to disagree with you agracier, but under US law, this incident was more than inappropriate, it was illegal. The HIPAA statutes are very clear cut about what can be discussed and where it can be discussed. I will grant you that nurses and doctors are humans and not pillars of stone and they are certainly entitled to find patients attractive, or not. The entire matter here rests on reasonable expectation of privacy. If the nurses had held this discussion in a locker room designated only for medical personnel or in a private staff lounge, that would have been one thing. But to have had the discussion at a nursing station is hardly a private area. And speaking of that, how is overhearing a discussion at the nursing station eavesdropping? There is certainly no expectation of privacy there.

I understand these ladies may of found him attractive!! But that is not something to discuss where you no public can hear you!!! No matter what!!! and if they are just doing medical procedures to see him with his shirt off they shouldnt be working in the medical field.

[quote author=ladydocisin link=topic=63472.msg440985#msg440985 date=1336391145]

The HIPAA statutes are very clear cut about what can be discussed and where it can be discussed. I

[/quote]

Perhaps I misunderstand what a nursing station is? It sounds like a place where the pubic is not allowed, a room for nurses only where they discuss work and scheduling and whatever else people do while working as a nurse ...

If I am mistaken in a nursing station not being off limits to the public, as a place where the public is allowed to enter as they wish, then it would be a different matter ...but somehow it doesn't sound like a public area where visitors or family is allowed to wander in for a look around.

What about nurses discussing a patient's prognosis, whether (in an extreme case) they will survive a treatment or not. Doesn't that happen often amongst medical personnel and isn't that of much greater importance than simply mentioning that someone is good looking?

Agracier,

A nurses station at a US hospital is typically not private at all. It is usually in the middle of a floor of rooms and only separated from the aisles by a low counter. It is purposefully open like that so the nurses can see all comings and goings and encourages family members and other visitors to interact with staff.

Hope that helps.

[quote author=user264 link=topic=63472.msg441034#msg441034 date=1336402505]

agracier, A nurses station at a US hospital is typically not private at all. It is usually in the middle of a floor of rooms and only separated from the aisles by a low counter. It is purposefully open like that so the nurses can see all comings and goings and encourages family members and other visitors to interact with staff. Hope that helps.

[/quote]

OK ... totally different situation from what I took it to be ...

Agracier,

If you have never been on a hospital floor, picture walking into a bank and standing there while the tellers talk to each other one one side of a counter. That is essentially what a nursing station is. They were also not doing a procedure just to see him like that. They had to do something and it involved him topless so they got a little excited about that. It was more incidental than caused.

Quite frankly, this has happened to me. I know this good friend from sports. I am in ok shape now but when I was younger I was 5'11" and 190 lbs of muscle. I used to bench over 300 lbs. I once had mono and was sent for blood work and an ultrasound on my liver. I once when to have blood taken and my mother was hanging out with me because, obviously, it's not a big deal to sit there in a short sleeve shirt and have blood drawn. The phlebotomists were so overly friendly and possibly flirty that mother said, "do you know them? They seem extremely friendly with you." Then, after, I went for the ultrasound. I was only topless so it wasn't a big deal. However, there were 2 women in the room. One was doing the ultrasound and the other was just hanging out and talking with us. I'm serious, she seemed to have absolutely no reason to be there. I have since had many ultrasounds as part of exams and have never once had it where it was more than just a tech and myself in the room. Also, I have never had an ultrasound tech get into as much conversation about personal topics as I did with those two. At the time I sort of figured it out but I figured it wasn't a big deal because was only topless and was sort of flattered. I think I would have been pissed if it were a testicle ultrasound though. However, I think they may have not behaved like that if it were a testicle ultrasound. I think nobody thought it was a big deal since it was only my shirt that was off, including myself. However, like I said in another one of my postings, now that I'm older and wiser it was a bit messed up.

Please note that I am in no way saying I'm hot shit or that I think I'm all that. However, when I was younger I was a wrestler and had a wrestler's body as well as a nice tan at the end of the summer. To make up for it, I will say that I am now a washed up, bald, middle aged guy with a small belly, lol.

I will also say that I agree with Mashie about ethics and professionalism being taught. What I've noticed about medicine lately, in private practice especially, is that while the physician has to have strict credentials, it seems the assistants don't. I know many medical practices where they don't use RN's but use assistants who have minimal training. They can do bp, draw blood and help the doctor with whatever. However, they have nowhere near the training and qualifications of an RN. I think we can all figure out why... that's right, they're cheaper than RN's! I wouldn't be surprised if they did get ethics training at all. As the old saying goes, "you get what you pay for."

Ok, I really think this should be the last post from me. first, I mean't to say I wouldn't be surprised if they "didn't" get ethics training at all. However, I have met plenty of these assistants that have the common sense to realize these are sensitive matters and act accordingly.

I will say that I realize that medical professionals are human and sometimes it can be tough for them to separate. However, they really should be careful about how they deal with it. To me, being so blatant and saying in a busy hospital nursing station just showed very poor judgement. It's one thing to think it but to say it openly like that where others can hear just shows a complete lack of awareness.

Like I said, I know these things can happen because everyone is human. Furthermore, you're dealing with complex human interactions regarding imbalances of power. It's how they're handled that's the issue. For example, after the recent news event of that creepy 40 something teacher dating his 18 year old student, there has been a lot of discussion about teacher's ethics. One proposal was that if a teacher tells a therapist that s/he has an attraction to a student, the therapist must be mandated to break confidentiality and report it. An educational professional argued that if an educator cannot openly and honestly discuss these issues with a therapist, s/he would just keep it bottled in and may even act on it because it wasn't dealt with in a proper manner. To me, it seems that medical professionals sort of fall into this category as well.

Ok, I will put this to rest now. I have had these thoughts for a while but finally got the urge to discuss them here. I thank everyone for giving their honest input; especially the medical professionals for their perspective.

Talking about a guy with his shirt off is fairly mild although in the strictest sense it is unethical. But the nurses were just expressing a human emotion (lust) and you can't fault them on that level.

I mean if they were talking about his penis and who had seen it or how large/small it was, that would be more serious.

Doctor,

I agree with what you wrote. A blood draw is a fairly innocuous procedure where I am not exposed at all so I have no problem with them flirting. I was not so attractive as a kid and got made fun of for being fat and not so good looking. Therefore, ironically, I actually enjoyed the attention. The same goes for the ultrasound. I knew what was going on and was fine with it because it was just my shirt off. I also think that if had been something more private they would have been in strict professional mode.

In all seriousness, I actually did know of a female nurse who looked at an x ray in a patient's chart just to see his penis because he was a local celebrity.

I just took my required class on HIPAA for my continuing education credits. There were some interesting things that I learned actually that were new to the course this year. First of all, the entire country is going paperless, I am not sure if each state has their own separate dates that this has to be done by or if it's country wide, but I believe my states date is 01-01-13. With going paperless that means everything has to be done on the computer. So the class talked about how to keep and maintain privacy when working on a computer.

A nursing station is by no means a private place. Yes, it is off limits to the public, meaning that not everyone can just walk in and start looking at stuff, it usually is an open place, as someone mentioned earlier, so that nurses can see what's going on around them at all times. Which means, that if we are discussing a patient at the nurses station, we had better make sure there are not "ears" around of non-medical personnel, or even of medical personnel not working on that patient. We are not even allowed to discuss our patients with our co-workers if they do not or have not had direct contact with that patient. As a matter of fact, I can't even discuss a patients medical condition with their spouse if they (the patient) doesn't have their spouse listed as their first contact. As in my case, when I go to the hospital or what not, my first contact is Doc, not my husband, therefore if anything happened, the hospital staff would be contacting Doc, and then it would be up to Doc to contact hubby. It's all very complicated really.

Unfortunately medical personel are human, and we do sometimes say things we shouldn't. And yes, sometimes we do find a patient attractive, although I can't say that I ever have because I just don't view my patients like that, but I know not everyone is as old school as I am. For me, and those like me, a patient is a patient is a patient. They are there to be fixed, I"m the nurse, I'm the fixer, it's my job, no different than your mechanic changing out your set of spark plugs, a set of plugs is a set of plugs, is a set of plugs. Same sort of thing.

And totally off topic, and I am probably going to get dinged hard for this one, that whole student/teacher thing is an issue I feel strongly about, and I am guessing from comments from others, most people do not see the situation as I do. I sort of lived, in a round about way, that same situation. My thoughts are, at 18 you can vote, die for your country, and buy cigarettes, that means you are an adult and should be free to date and sleep with whomever you want to. There, I've said my peace, lol.

Mashie

Hey Mashie,

Thanks for the reply!! Also, thanks for sharing your training!

As I said, I am in a helping profession and have very strict rules about client confidentiality so I easily understand these concepts. Education is covered by FERPA, which is equivalent to HIPAA for medicine. I also hear professionals talking and hear things I'm not supposed to hear occasionally so I understand that too. Sometimes it's impossible not to hear private/sensitive information when you share an office. No outsiders hear and we are all professionals and are bound by the same ethics so it's not the worst offense.

I would like to thank you for addressing these things happen because people are human. I would also like to thank you for being candid about your opinions and experiences. I have seem some posts here like, "that never happens! (insert medical professional here) are professionals!" Again, as I said earlier, it's how it's dealt with that is the issue. For example, that one nurse who went to a patient's file (patient was NOT hers) just to see an x ray showing his penis was way out of line. I know I said I was going to leave it but I'm sorry, it really makes me angry so I'm having trouble letting go, lol. However, it's a different story when a healthcare practitioner comes across a patient they my find attractive, they acknowledge it, remember that they are a professional and then move on.

I have worked extensively with students so I will address your education point. Again, I would like to thank you for being very candid about your opinion. By being candid, we can have open discussions about these things. I can read between the lines on your post and I get your point! lol. I am not going to comment on your experience because I don't know the full details and I don't expect you to share them. The reason I called that teacher "creepy" and grossly unprofessional is because I very strongly believe he didn't start that when she was 18. Therefore, as we strongly suspect, when that relationship started, she could not vote, die for her country or buy cigarettes. You fill in the rest... lol. They came out with that like right after graduation or something. A bunch of educators and I were all talking and we all strongly believe that relationship started way before she was 18. Furthermore, you have to keep in mind that, just like medicine, there is an imbalance of power (ie. teacher/student) which should be kept in mind by the professional. These issues come up in many professions and I will give you an example from the field of therapy. I haven't checked in a bit but if I remember correctly, if a therapist and client want to date and/or develop feelings, the therapist must help the client find a new therapist. They then must not have contact for a certain amount of time (I can't remember how long), and, if still interested, can date without the therapist breaking any ethical rules.

Please note that I am in no way judging your relationship with whomever it was. I was speaking specifically about that one in the news. Again, myself and a bunch of other professionals who have worked in human behavior/counseling/education fields all agree that there is no way that relationship just started when she was 18 and just graduated. Of course we can't prove this. We are basing this on our training, experience and the specific details of that case. I wrote the response to your opinion so to give you an idea of ethics involved in education. Again, the same way there are strict ethics governing healthcare provider/patient relationships is the same way there are strict ethics governing relationships among teacher/student, therapist/client, etc.

I don't think I "dinged" you, did I? Again, that's why I appreciate your candor. It allowed us to have a mature, open discussion. I just wanted to give you a more well rounded perspective and help you realize that medicine isn't the only discipline with strict ethics due to privacy, intimate personal information, power imbalance, etc.

Again, I want to thank you for your candor and sharing your experience!

Brad, I loved your reply, and no, I don't think you dinged me at all. I do happen to agree with you that the relationship with the student and teacher probably started way before she was 18. And yes, as a mother with children the same age, a professional who's held to high moral standards, and as a tax paying citizen of these United States, I probably can't in good conscience justify that teachers actions.

Now, having said that, I will tell you my story, not that you really care or anyone else does for that matter, lol. Anyway here is the blunt and honest truth. I had the biggest crush on my high school history teacher. It was huge, everyone knew. I was the typical teenager with the typical crush. I'm sure you know how dorky we can be when we are that age, lol. Anyway, I took every class he taught. That was in tenth grade. Well by the time I became a senior, my feelings for Jeff still hadn't changed. By this time I had decided that I too would be a History/English teacher, and politically speaking, since he was the head of the Democratic Committee in our town, somewhere along the way, despite growing up in a house of only Republicans, and in a town with a lot of old money, and mostly all Republicans, somehow I decided I was a democrat. lol.

Well, about midway through my junior year, backing up a bit, it was becoming very obvious to myself and to others that there was a relationship brewing between Jeff and a student, but that student was not me. To my knowledge, and to everyone elses as well, nothing ever happened between those two until about 8 months after graduation. Was there flirting going on during school hours? You betcha there was, but never from Jeff, only from her the student. But it was never over the top or blatent. I saw it, but then maybe I saw it because I just might have been a little jealous, lol.

However, they dated for about 5 years the broke up, not sure why, and wasn't any of my business really. Jeff was young too, he was only 14 years older then we were. So for us women who love a slightly older man, well, he fit the bill for sure. Plus he was a very prominent figure in my home town, everyone knew him, everyone loved him, everyone respected him, even if they sat on the opposite side of the political arena.

Okay now to move foreward again, this time to about 10 years ago maybe? A woman came foreward and accused Jeff of flirting with her when she was still in high school. She claimed that he ruined her life, that she could never trust adults in a position of authority again and had to go to therapy. The media went crazy. The entire town, 40,000 people or so suddenly were in a frenzy. Jeff was immediately put on administrative leave. This woman had been out of school for 3 years already, and she decided to come forward then. By the time all was said and done, over a year and a half, 6 women came forward, one of whom was in my class, the same one I watched openly flirt with Jeff day after day after day, then dated for 5 years after that. It was so bad his case had to be tried in a different county in order for him to get a fair trial.

All 6 women admitted to flirting with him, all 6 women said that Jeff never touched any of them, or even offered to, some even admitted to try and seduce him and he declined until they were out of school. Jeff did admit to writing some of them letters while they were in school, but then all of the women, which I believe there were three of them who received letters while they were in school were 18 years old.

It was never mentioned how many of them he had relationships with, but what makes me so mad is that while I do understand that these women were students at the time the letters were received, and while some of the back and forth flirting was happening, all admitted that they were all 18 years old, and that all of them were flirting with him on a daily basis or as often as they could, and all admitted that Jeff never once touched any of them while they were still students.

When the judges hammer came down that final evening in court, Jeff was charged with multiple counts of numerous things and I can't even remember now what all they were, child endangerment, solicitation of a minor I believe, and probably a few other things too. His teaching license was taken from him, his life completely ruined.

I am still very very angry over this. All of these women were women, all 18 years old. For all intense and purposes, legal adults who admitted to multiple attempts of soliciting him and failed. Jeff lost everything while those 6 women walked away scott free, and were not held accountable for any of their own actions.

I am a strong and firm believer in our judicial system, however I whole heartedly believe that there was a severe injustice done the day they sentenced Jeff. Maybe I am biased and too close to the situation, but he was one hell of a teacher, smart, witty, funny. He made history real, he helped instill in us, his students, what America really is, why we should be proud, and how truly amazing (then in 1987) 200 years earlier a group of men got together and started putting words down on parchment, words that soon became paragraphs, that then became two of the greatest documents the world would ever know. Those men had no idea that their two documents, the Bill of Rights, and The Constitution would be of words so powerful, and so insightful, that 200 years later and then some, their new country would still be using and following the words those men set forth so long ago. This is how Jeff taught us. Everyday was like this. You walked out of his class with a feeling of awe almost, smarter, and with a feeling of pride in and of your country that ran so deep, he actually made you proud to be an American.

So that is my story Brad, the blunt honest truth. Oddly enough, especially after what happend to Doc and I, over the past 3 or 4 months I have had this overwhelming desire to go and see Jeff. I want him to know how much he taught me, and more importantly what he instilled in me, and probably even more importantly than that, is that he isn't alone, he made a difference. Sadly however, I have a feeling that he might not be as anxious to see me as I am him,lol. Maybe someday I hope.

Thanks for listening.

Mashie

Very interesting story Mashie. Again, thanks for sharing!

For Mashie:

The story is not only interesting, it is quite frightening as well.

However much I try, I cannot help but thinking of stories of witch trials and overt persecution. All of what you tell seems so much like spurned girls turning their infatuation with an (older) man who acts correctly and properly by refusing to give in to their advances, who then turn it into spite and slander. The classic phenomenon of love flipped over into hate.

And moreover it inspires even less confidence in that judicial system. It sounds more like caving in to an ugly and base form of mob justice.

There's an issue that you didn't address and which intrigues me: was the trial by jury or not? I know that Americans assume that virtually any trial will be by jury, but taken on a country by country basis, that is seldom the case.

And in this instance I think it has a bearing on the situation.

Agracier,

You know what, I do not even know the answer to that question. I would assume it was, but I am not sure. Now you have my curiosity peeked. I may have to do some digging into that.

That was not ethical IMO but it was normal human behavior and a bit of a double standard I say so too.

What if your friend was a female and the nurses males and said the same thing? You would have probably went and complained and they probably would have been severely reprimanded or fired.

Siege, thanks for the validation! lol.

Wow quite some feedback - to your initial message I believe that comment was totally inappropriate

Hey Mashie,

This poster started this thread again so I went back and looked at it.

Again, I want to thank you for sharing your story. That's an interesting case and I can see how you think he got railroaded. If they were over 18 and out of school for a few months when anything happened with any of them then I would say, in my opinion and probably the opinion of the profession, that it's unethical but I'm not sure it is illegal.

May I ask you a question? You mention that the students were 18 and just out of school. Therefore, here is my question: what would you think of a nurse in on a hospital floor that let the adult patients flirt with her and then went on dates with them after they were discharged? Would it be illegal, no. I am asking you, as a nurse, if that's professional and/or ethical. Also, can you see how that may get a nurse in trouble?

I hope you don't mind reopening this thread. I really like discussing ethics with you!

B

@fennf, maybe it's no big deal to you but given the privacy laws in the US, it IS a violation of HIPAA and if someone wanted to carry it to an extreme, the actions of the nurses in this case are punishable by pretty stiff fines and disciplinary actions. Doctor, nurses, and administrative personnel have lost their jobs, been fined, and faced prison sentences (see the case of Anne Pressly) for actions that were entirely unintentional but illegal nonetheless.

Hi Andrea,

I apologize if my comments came off offensive towards medical assistants. I was really speaking about the untrained ones. I am fully aware that there are programs that train and certify medical assistants at various levels. Because they are formal programs, these people get formal training and issues like privacy and ethics are discussed. Again, I was speaking specifically about untrained ones. I have known a few medical practices who hired people that they trained on the job how to take a blood pressure and do a few other things but weren't really given a full overview of everything. They may have started out as clerical assistants and then one day the doctor pulled them into the exam room as medical assistants because someone called out sick.

Does that make it more clear? Again, I'm sorry if that came out the wrong way and/or I've offended anyone.