C*****D 发帖数: 1299 | 1 还是探讨一下工作中的实际问题吧。
今天医院risk management 的律师给我们讲一实例。
现许多病人喜欢用email联系,过去医院不主张,但现在大事所趋。有一女病人和丈夫
公用一email帐号用来和医生联系。有一次做完PAP smear 后,护士就把报告结果email
病人:CIN1。(cervical intraepithelial neoplasia), please come by to pick
up the report and your contraceptive pills.
悲剧了:丈夫读到这个mail, 且他已vasectomy。 一对质,原来是红杏。离婚。病人
就把医院告了。问:医院有liability 吗? |
N*G 发帖数: 217 | 2 CIN怎么就的出墙呢?如果是STD还说得通嘛。HPV感染是很重要因素,但HPV可以是以前
就感染上的。 |
C*****D 发帖数: 1299 | 3 contraceptive, vasectomy
【在 N*G 的大作中提到】 : CIN怎么就的出墙呢?如果是STD还说得通嘛。HPV感染是很重要因素,但HPV可以是以前 : 就感染上的。
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A*******s 发帖数: 9638 | 4 你让我联想起mitbbs的夫妻ID, Dr.Newbie的ID好像就是这样滴。
不过医院是不能用E-mail通知病人的, 因为这违反HIPPA。
有一个问题请教,CIN1一旦诊断了, 一定证明有STD吗? Vasectomy不能生育, 传播
STD应该还是可能的吧? |
C*****D 发帖数: 1299 | 5 少于1/3是。without HPV high risk virus positive, 不因该确证,但一般都会怀疑
。也要随访。 |
N*G 发帖数: 217 | 6 vasectomy后只是不能生育,CIN还是可能的。
【在 C*****D 的大作中提到】 : contraceptive, vasectomy
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C*****D 发帖数: 1299 | 7 可以。但要病人intiate and sign the release form
【在 A*******s 的大作中提到】 : 你让我联想起mitbbs的夫妻ID, Dr.Newbie的ID好像就是这样滴。 : 不过医院是不能用E-mail通知病人的, 因为这违反HIPPA。 : 有一个问题请教,CIN1一旦诊断了, 一定证明有STD吗? Vasectomy不能生育, 传播 : STD应该还是可能的吧?
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h**s 发帖数: 1757 | 8 以前看HIPPA不觉得什末,前几天刚被组织又看了一遍HIPPA。 觉得这些法律写得真好
。。。 |
A*******s 发帖数: 9638 | 9 你抱怨的日子在后面呢。 :)
【在 h**s 的大作中提到】 : 以前看HIPPA不觉得什末,前几天刚被组织又看了一遍HIPPA。 觉得这些法律写得真好 : 。。。
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a**e 发帖数: 5094 | 10 晕倒了,这个故事的核心不是CIN,而是"contraceptive pills refill"
【在 A*******s 的大作中提到】 : 你让我联想起mitbbs的夫妻ID, Dr.Newbie的ID好像就是这样滴。 : 不过医院是不能用E-mail通知病人的, 因为这违反HIPPA。 : 有一个问题请教,CIN1一旦诊断了, 一定证明有STD吗? Vasectomy不能生育, 传播 : STD应该还是可能的吧?
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I****a 发帖数: 407 | 11 I am fooled. You are special, Acne.
【在 a**e 的大作中提到】 : 晕倒了,这个故事的核心不是CIN,而是"contraceptive pills refill"
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C*****D 发帖数: 1299 | 12 嘿. 我还以为是显而易见滴. 看来米虫和老美attendings一个level. 当时会上,哄堂大
笑, 每个人都似乎明白了.这就是差别啊. LOL
俺贴出来是讨论legal issues, 楼不能歪. 到底有无liability? 怎样避免? 谢谢.
【在 a**e 的大作中提到】 : 晕倒了,这个故事的核心不是CIN,而是"contraceptive pills refill"
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A*******s 发帖数: 9638 | 13 LOL. I was fooled too. But it is Chiusmd's fault. He is a pathologist who
is supposed to have a CIN. :)
Still she could use BCPs for other purposes.
【在 a**e 的大作中提到】 : 晕倒了,这个故事的核心不是CIN,而是"contraceptive pills refill"
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A*******s 发帖数: 9638 | 14 I think hospital has the liability.
1. The confidentiality is broken by the E-mail. This is a fact.
2. Hospital could blame the couple sharing the account, but the fact is that
E-mail is not HIPPA protected, EVEN the hospital has the consent.
Yesterday a CS guy just told me E-mail is like a open/unsealed letter, no
security at all.
How to avoid? No more E-mail conversation with patients. Send out a letter,
and you are protected.
【在 C*****D 的大作中提到】 : 嘿. 我还以为是显而易见滴. 看来米虫和老美attendings一个level. 当时会上,哄堂大 : 笑, 每个人都似乎明白了.这就是差别啊. LOL : 俺贴出来是讨论legal issues, 楼不能歪. 到底有无liability? 怎样避免? 谢谢.
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a*********1 发帖数: 872 | 15 Does the hospital still have liability if the pt chose to get medical
results through email?
In fact, contraceptive pills can be used to treat some Gyn diseases. Too bad
the woman didn't know it.
that
letter,
【在 A*******s 的大作中提到】 : I think hospital has the liability. : 1. The confidentiality is broken by the E-mail. This is a fact. : 2. Hospital could blame the couple sharing the account, but the fact is that : E-mail is not HIPPA protected, EVEN the hospital has the consent. : Yesterday a CS guy just told me E-mail is like a open/unsealed letter, no : security at all. : How to avoid? No more E-mail conversation with patients. Send out a letter, : and you are protected.
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A*******s 发帖数: 9638 | 16 Yes.
Consent is nothing but a rule for physicians to follow. If something has
happened, you are still liable.
很多人认为家属签了字就没事了, 在美国,基本就是废纸一张。 不过医生如果没按要
求做, 执照都会有问题。
另外, 对这个女的来说, 既然IQ到了跟丈夫共用的地步, 让她理解vasectomy后她就
不用吃避孕药确实有点要求过高了。
Dr.Chiusmd, do you agree?
bad
【在 a*********1 的大作中提到】 : Does the hospital still have liability if the pt chose to get medical : results through email? : In fact, contraceptive pills can be used to treat some Gyn diseases. Too bad : the woman didn't know it. : : that : letter,
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C*****D 发帖数: 1299 | 17 Email communication is fine but with some restrictions. Mainly for
scheduling, notice, reminder and occasional negative results.
Never send a positive result, always ask the patient to come face to face.
The email should said: have PAP smear result to discuss and pick up
prescription drug (not mention the contents).
【在 A*******s 的大作中提到】 : Yes. : Consent is nothing but a rule for physicians to follow. If something has : happened, you are still liable. : 很多人认为家属签了字就没事了, 在美国,基本就是废纸一张。 不过医生如果没按要 : 求做, 执照都会有问题。 : 另外, 对这个女的来说, 既然IQ到了跟丈夫共用的地步, 让她理解vasectomy后她就 : 不用吃避孕药确实有点要求过高了。 : Dr.Chiusmd, do you agree? : : bad
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A*******s 发帖数: 9638 | 18 我们是禁用E-mail的, 没有商量的余地。
【在 C*****D 的大作中提到】 : Email communication is fine but with some restrictions. Mainly for : scheduling, notice, reminder and occasional negative results. : Never send a positive result, always ask the patient to come face to face. : The email should said: have PAP smear result to discuss and pick up : prescription drug (not mention the contents).
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C*****D 发帖数: 1299 | 19 Nowadays, most physicsians email address can be found thru various search
engines. Phone calls always end in receptionists or nurses hands, and most
physicians won't be able to answer the phones.
Also other physicians ask you the questions.
What if the patient send you the email and ask for some simple questions:
such as my lab results ready? negative or positive?
You all say "no"? That is not good for PR.
【在 A*******s 的大作中提到】 : 我们是禁用E-mail的, 没有商量的余地。
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A*******s 发帖数: 9638 | 20 I'll let my nurse deal with it。
【在 C*****D 的大作中提到】 : Nowadays, most physicsians email address can be found thru various search : engines. Phone calls always end in receptionists or nurses hands, and most : physicians won't be able to answer the phones. : Also other physicians ask you the questions. : What if the patient send you the email and ask for some simple questions: : such as my lab results ready? negative or positive? : You all say "no"? That is not good for PR.
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a*******g 发帖数: 2813 | 21 没明白,避孕又不是堕胎,怎么证明她出墙了?她完全可以说别的理由啊。
比如黄体功能不全什么的也会用避孕药治疗 |
a*******g 发帖数: 2813 | |
C*****D 发帖数: 1299 | 23 那就一普通病人, 哪搞得清这么多.
一般正常夫妻, 选择vasectomy,是因为另方不愿避孕.再说这种事情,一般是没想到,
真查,很难瞒.
【在 a*******g 的大作中提到】 : 没明白,避孕又不是堕胎,怎么证明她出墙了?她完全可以说别的理由啊。 : 比如黄体功能不全什么的也会用避孕药治疗
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a*******g 发帖数: 2813 | 24
懂点医学知识很重要,哈哈哈
【在 C*****D 的大作中提到】 : 那就一普通病人, 哪搞得清这么多. : 一般正常夫妻, 选择vasectomy,是因为另方不愿避孕.再说这种事情,一般是没想到, : 真查,很难瞒.
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