Clinicians Lament Invasions of Their Personal Privacy: Poll

Marcia Frellick

October 29, 2019

Top personal privacy concerns among healthcare providers differed in a Medscape poll by clinical role, age, and gender.

The top concern for physicians, for instance, is that patients would record their appointment conversations. The largest percentage of physicians overall (32%) chose that as the potential invasion of privacy that worried them most.

Fewer nurses were concerned about such recordings (18% ranked it first). Instead, their biggest concern was that a patient or family member would take an unauthorized photo of them and post it online. Almost one quarter of nurses and advanced practice registered nurses (APRNs) chose that potential violation among a list of possible worries.

That varied significantly by age. While 29% of nurses/APRNs ages 35 to 54 chose that as the top worry, only 12% of nurses 65 or older did.

Taking Photos/Videos Without Permission

The next greatest worry for nurses/APRNs, chosen by 20%, was a patient or patient's family member taking a photo without permission, regardless of posting.

Half as many physicians (12%) as APRNs/nurse practitioners said their top worry was that a patient or family member would take a photo and post it.

The poll, first posted July 3, included responses from 329 physicians and 285 nurses/APRNs.

More than a third of clinicians said they feel their privacy is always or often violated in a professional setting (39% of physicians and 36% of nurses felt that way). Among clinicians, the group least likely to feel their privacy was violated was the 65-or-older age group.

Secret Recordings

A cardiothoracic surgeon who commented on the poll said he's not against all recording by patients; it's recording secretly that worries him.

A recent story published in Medscape Medical News reported that as many as 26% of patients say they secretly record appointments, and in all but 11 states that's perfectly legal.

"I don't mind patients recording such advice/recommendations for personal reference later as long as they disclose it during the visit. What I believe many physicians are worried [about], is that a patient (perhaps with a paranoid personality disorder) will be covertly recording a visit (wearing a wire let's say) and then take some snippets out of context and run to a bottom-feeder lawyer to get a settlement going. Currently there aren't many protections against such actions that involve a malicious intent," the surgeon commented.

A critical care physician agreed, saying: "Patients should just ask for permission to record their team, just as we ask permission to examine or photograph or otherwise record our patients. They should not share these on social media/YouTube without permission just as we are legally bound to protect their privacy per HIPAA."

An anesthesiologist commented on the survey that he felt "deceived and violated" when a particularly sick child needed an intravenous line and the parents, "instead of comforting the child were busy video recording," despite him previously asking them not to.

The complaints providers reported went as far as threats of bodily harm.

A plastic surgeon reported that a female patient wanted surgery, but her husband didn't want her to have it.

"The husband threatened me with bodily harm if I did the surgery and said he could easily find where I lived," he said.

Laws to protect the privacy of nurses and physicians are limited. Clinician privacy concerns beyond photo taking and recording can include things such as a patient selling data on practice patterns, such as prescription data, and personal and invasive questions when clinicians interview or apply for a license, and online reviews.

"I Saw the Lights Were On"

Some physicians noted on the survey that patients came to their home or asked them to "diagnose a rash on the sidewalk." One said a patient said in a 10:30 PM phone call, "I saw the lights were on at your home, so I called you."

Online reviews were seen by a substantial number of providers as the number-one threat to privacy. One in 10 physicians said they were a top privacy concern, while 7% of nurses/APRNs said they were a concern.

The poll was taken after neurologist Andrew N. Wilner, MD, and psychiatrist/medical ethicist Ronald W. Pies, MD, discussed clinician privacy in a question-and-answer session published recently in Medscape Medical News.

In that article, Wilner gave the example of states requiring fingerprints and a criminal background check before a medical license can be granted.

"Information may be demanded regarding criminal charges, even regarding cases that were dismissed or expunged. Hospitals may require a 'voluntary' drug test. Physical and mental health disorders must be disclosed," he noted.

"In addition, while all of this information is supposed to be kept private, the number of agencies and departments given access is extensive. What's worse is that physicians have absolutely no recourse. If they refuse to answer personal questions, their applications can simply be rejected as 'incomplete,' " Wilner said.

Employment Privacy

Among providers in the poll, 8% of physicians and 12% of nurses/APRNs said personal or invasive questions when applying for a job were their top concerns regarding privacy.

A nurse practitioner, who listed her age as 55-64, commented when she responded to the survey that she was "asked questions in a job interview about retiring and my age."

Concerns about personal interview questions pointed up some gender differences among physicians. While 11% of female physicians chose personal questions in the job application process as their top privacy concern, fewer than half as many of their male colleagues (5%) saw that as their primary privacy threat.

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