Mum's the word

I was listening to some rap music today. Not that I had a choice - it was coming out of a Jeep four miles away. - Nick DePaulo

I was listening to an elderly lady's medical history and vital signs today. Not that I had a choice - it was coming out of a paramedic student four metres away.

The young man was presenting his patient's medical history to his supervisor and an ER nurse. I had nothing to do with that patient, but the student's booming voice gave me an earful of her life story. Everyone else in the ER, including patients and their families, could hear him clearly.

The thing that bothered me most about this situation was that no one called him on it. Neither his preceptor or the nurse suggested moving into a more private location to have this discussion of confidential information. Their acceptance of this potential breach of privacy validated this behavior for the student.

Certain hospital environments make it difficult for staff to preserve patient confidentiality. Crowded, multi-patient areas such as ERs, recovery rooms, critical care units and 4-bed rooms (yes, we still have them at my hospital!) are particularly challenging.

For example, when patients are brought into the recovery room after surgery, it's critical that the OR nurse and anaesthetist inform the recovery room staff about the details of the surgery, the patient's medical history and current condition, as well as plans for the immediate post-operative period. This is done in a room where patient beds are separated only by a thin curtain. And it's sometimes done in a loud voice, in order to be heard over other conversations and the noise of monitors and other equipment.

I can hear the excuses and objections now. "You can't expect us to leave the room to sign over a patient. I've got to watch 3 or 4 other patients." Or perhaps, "We're using medical jargon anyway. Laypeople wouldn't understand what we're saying."

Well, yes, I understand the constraints of the work environment. But if we're committed to respecting our patients' privacy, we should at least try to solve this.

If you're a healthcare worker in one of these hospital areas, ask yourself these questions:

- Do I keep my voice quiet when discussion patient information in patient care areas?

- Where possible, and safe for my patient, do I insist that private information be discussed away from other patients and staff?

- Do I model ethical behavior to students and trainees?

And, most importantly:

- How would I feel if I were the patient? Would I want my personal information made public without my expressed permission?

I wonder what people think when they hear us bellowing patient histories across a crowded ER. Does it affect their confidence in our professionalism?

But, back to the paramedic student. What should I have done? Point out what he was doing? Suggest they find a private spot to discuss the case? Probably. But, I didn't know any of the people involved and they didn't know me. I couldn't think of a tactful way to raise the matter without them mentally labelling me a nosy, know-it-all, arrogant physician. So I did the next best (or perhaps, better) thing.

I mentioned it to one of the senior ER nurses. She has an easy, personable manner and I thought the comments would be well-received from her. She agreed that the problem was too common in the ER and that she would mention it to the student.

I love when someone else does the dirty work.