Anonymous inappropriateness

mrsconn23

Dear Prudence,

I have a friend who loves to tell work stories. This would not be a problem if she were an actress or website developer, but she's a marriage, family, and child therapist and she talks about her clients. I’m not a fellow therapist, and she’s not asking me for assistance helping people resolve their problems. These stories are told purely for entertainment. She claims this is not a violation of confidentiality because I “don't know them.” Frankly, I'm horrified! She is betraying her clients by telling me their personal details. Worse, years ago I saw a therapist for a short while and believed that what I shared would never be revealed to anyone, not just to people who “don't know” me. Now I thoroughly regret ever going and would never, ever recommend therapy to anyone. Do all therapists blab like this? Am I being oversensitive, or is she being unethical? Most importantly, how do I make her stop?

–Heard Enough

CharmedPam

nope. nope. nope.  I would hate going to this woman! I don't know if you CAN make her stop.   you can tell her you're uncomfortable listening to the stories that were told in confidence, I guess. Hopefully she gets the picture but she's probably telling other people these stories too.

kimmiinthemitten

Telling your patients dirt for entertainment on a regular basis is a violation of trust, IMO.

My sister is a MSW, and I know of some of her patients, by story only.  Moreso because they've reached out to her when she's been off and we've been together, or because they were terminal and she needed an outlet for that stress in order to be her best professional self for the family, or on occasion a light hearted story (the guy who didn't realize she was pregnant two weeks before she gave birth - my sis is tiny this was funny).  But I have never felt like she shared anything given in confidence or with the intention to humiliate these people.  It sounds like that's LW's concern and if she's right, that's super shady at best and unprofessional at worst.

OliveOilsMom

If LW's friend is certified by an organization or state board, I would report her anonymously.

I would also tell friend I didn't want to hear the stories that people are telling her in confidence.

kvruns

This might be the unpopular opinion, but I guess I'm not really surprised by this. Maybe it depends on what exactly is being told, but I know our therapist would mentioned other clients, vague details, though I suppose it was in a vain of understanding and not entertainment. 

CharmedPam

kvruns said:

This might be the unpopular opinion, but I guess I'm not really surprised by this. Maybe it depends on what exactly is being told, but I know our therapist would mentioned other clients, vague details, though I suppose it was in a vain of understanding and not entertainment. 

Mine says "I have a client who is in your shoes..." and will associate my dilemma with theirs, but like you said, it's vague details and of course no names.  I'm OK with that, and I don't think mine would be gossiping about my situation outside the room either.

kimmiinthemitten

CharmedPam said:

kvruns said:

This might be the unpopular opinion, but I guess I'm not really surprised by this. Maybe it depends on what exactly is being told, but I know our therapist would mentioned other clients, vague details, though I suppose it was in a vain of understanding and not entertainment. 

Mine says "I have a client who is in your shoes..." and will associate my dilemma with theirs, but like you said, it's vague details and of course no names.  I'm OK with that, and I don't think mine would be gossiping about my situation outside the room either.

Exactly.  It doesn't sound like the therapist is violating HIPPA, but motive to me is the discerning factor in appropriate vs inappropriate behavior.

MissKittyDanger

I have mentioned our clients in vague description - more like "wow someone came in my age with so much debt" or if I had a rude client, or client who I had to essentially 'talk of a ledge' {debt is very stressful}

It's never out of entertainment, but I think it's normal to talk about work things to people.
THAT BEING SAID I think this person is walking a fine-line and slightly going over the line on how she is referring to her clients.

missJeanLouise

Idk, I come from a family of ER nurses and have heard A Lot of stories. I used to wait up for my mom to come home when I was little so she could tell me gory stories. (Like the guy who showed up because he was making a salad and cut his finger off but forgot his finger so the emts had to go get it.)  As long as identifying info is withheld, and HIPPA isn't violated, I want to hear stories. Therapy is a little different because it is people deepest issues but sharing silly little things are normal. 

OliveOilsMom

missJeanLouise said:

Idk, I come from a family of ER nurses and have heard A Lot of stories. I used to wait up for my mom to come home when I was little so she could tell me gory stories. (Like the guy who showed up because he was making a salad and cut his finger off but forgot his finger so the emts had to go get it.)  As long as identifying info is withheld, and HIPPA isn't violated, I want to hear stories. Therapy is a little different because it is people deepest issues but sharing silly little things are normal. 

My mom was a nurse, so I also hear lots of stories like this during dinner.  But I think the big difference is that LWs friend is a therapist who is hearing about deeply personal problems in someone's life in a seemingly gossip-y way.  The person is coming to the therapist expecting privacy.  I guess much of this would depend on the story that is being told and how its being told.  Is it the saga of Patient X and their attempts to eat broccoli?  Could be, but it could also be married Patients A&B and their marriage problems.

baconsmom

Maybe this is why I never have gone to therapy, but I assumed all drs. did this. Not violating any actual confidentiality, but yeah, why wouldn't they share stories? 

Am I just a terrible cynic or something? 

southernbelle0915

Actually I DO think this is a violation of HIPAA (two A's, not two P's....sorry pet peeve of mine) if the person actually is a psychotherapist and bills electronically. 

I know several therapists and they NEVER talk about their patients. So to me, this seems like an anomaly...I hope if LW ever really needs therapy, she seeks it.

I would report this person to HHS OCR (they'll figure out if she's bound by HIPAA or not), her licensing board, and I would tell her I'm uncomfortable listening to her stories. I have no tolerance for people in healthcare (mental or physical) violating patient trust - especially when they're at their most vulnerable.

missJeanLouise

Redacted because I reread the letter and I was wrong. 

short+sassy

I'm not sure how to feel about this.  On the one hand, I could understand a medical professional telling a very generic story about an unnamed patient.  People spend so much of their time at work, it's hard (though not impossible) to not mention interesting/unusual things that happened.  Or, like @CharmedPam mentioned, helping another patient gain insight by mentioning a similar issue another unnamed patient experienced.

An example, an ER nurse used to rent the other side of my house.  During the Mardi Gras season, my H and I were hanging out on the front porch with him and asked if he had any crazy ER Mardi Gras related stories.  He told us a hilarious one.  But it was generic enough that, even if he had unwittingly been talking about my BFF, I would have had no idea. 

But the LW is making it sound like her friend is being derisive/making fun of her patients.  Or is perhaps mentioning very specific things, even if it isn't their names.  I see a lot of "wrong" with that, even if it is more on the moral as opposed to legal side.

On the idea of "specific things", I participated in a mock jury awhile back.  We had to sign non-disclosure agreements to participate.  One of the lawyers talked about this at the very beginning.  He pointed out that, even if you don't "name names" when chit chatting with a friend/family member about the mock jury case you participated in, a story or a detail from what is talked about can easily clue someone in...either then or later...as to the parties involved in the lawsuit.  Or...ya never know...maybe that person actually finds themselves on the real jury and partway through the case a lightbulb goes off and it's, "Oh s**t, I've already heard a lot about this trial from my mock jury friend."

ei34

I'm NOT as important as a therapist- but as a guidance counselor, I don't talk about my students to family and friends. A students' individual teachers are made aware of certain things (ex: Jack's parents are getting divorced, so if he's been distracted in class lately, cut him some slack) but it's very need-to-know.  

What rubs me especially the wrong way is the fact that LW's friend is telling stories for entertainment.  Sure I've let some of my friends/family with tweens (kids close in age to my high school students) know about pharm parties, lean, etc., just so they can be aware, but it's more for safety reasons.  Not interesting anecdotes to share with friends.

MissKittyDanger

eileenrob said:

I'm NOT as important as a therapist- but as a guidance counselor, I don't talk about my students to family and friends. A students' individual teachers are made aware of certain things (ex: Jack's parents are getting divorced, so if he's been distracted in class lately, cut him some slack) but it's very need-to-know.  

What rubs me especially the wrong way is the fact that LW's friend is telling stories for entertainment.  Sure I've let some of my friends/family with tweens (kids close in age to my high school students) know about pharm parties, lean, etc., just so they can be aware, but it's more for safety reasons.  Not interesting anecdotes to share with friends.

Even as a 'need-to-know' basis are you able to just tell teachers that X-Child is having a rough time at home, so if he's distracted etc etc or do you have to explain the situation? I'm just curious

kvruns

southernbelle0915 said:

Actually I DO think this is a violation of HIPAA (two A's, not two P's....sorry pet peeve of mine) if the person actually is a psychotherapist and bills electronically. 

It could be if the person was sharing enough detail that someone could figure out who the patient was. If the therapist is in a small town it might make them more likely to share information with someone who could know the patient, thus making it identifiable health information. Although if it is stories about marriage problems and no true health information that wouldn't violate HIPAA

ei34

@MissKittyDanger
Whenever I see a student, I tell him or her that I'll be letting their teachers know what's going on, if it's a situation that needs that.
Sadly, Jack's parents divorcing is "he's having some troubles at home".  Jill being sexually abused by her stepfather is "she's having an extremely difficult time at home".  Some students request that you're vague, others want the full story out, most are somewhere in between. 

MissKittyDanger

eileenrob said:

@MissKittyDanger
Whenever I see a student, I tell him or her that I'll be letting their teachers know what's going on, if it's a situation that needs that.
Sadly, Jack's parents divorcing is "he's having some troubles at home".  Jill being sexually abused by her stepfather is "she's having an extremely difficult time at home".  Some students request that you're vague, others want the full story out, most are somewhere in between. 

Fair enough. I was curious on protocol on that

VarunaTT

missJeanLouise said:

Idk, I come from a family of ER nurses and have heard A Lot of stories. I used to wait up for my mom to come home when I was little so she could tell me gory stories. (Like the guy who showed up because he was making a salad and cut his finger off but forgot his finger so the emts had to go get it.)  As long as identifying info is withheld, and HIPPA isn't violated, I want to hear stories. Therapy is a little different because it is people deepest issues but sharing silly little things are normal. 

There was a Knottie back in the day who was an ER nurse and had a blog about all of the crazy stories.  She said it was HIPAA compliant, but I wasn't ever sure.  It was funny AF though (and might've been totally made up too).

charlotte989875

I now (very newly) work indirectly with survivors of domestic and sexual violence, and I had to sign all kinds of confidentiality agreements, about their identities, stories, anything I heard or observed. Not exactly the same but if the LWs friends is not self employed there's a chance the practice has additional confidentiality agreements. We can only share stories with explicit agreement from the individual, it must have a specific and detailed purpose, and they can revoke consent at anytime. 

ernursej

As an Emergency Nurse, I have seen and heard a lot of things. I will share stories but it is always without identifying information. I fully expect my therapist to use my sessions in a way to create links for others. I don't have a problem with sharing.

justsie

I used to work in inpatient psych, admissions, so I would typically see people at their most unstable. There were quite a few times where I was attacked and had busies/cuts from interactions with specifically difficult clients, and when people asked I would answer honestly. Obviously, no detailed information was given, and I lived at that time in a very large city that took clients from a 300 mile radius. I think it is typical for people to share things that happen in their workplace, we spend a majority of our lives there, but if LW feels like friend is sharing too much she can report it to the licensing board and let them decide. She also needs to speak up and tell her friend that it makes her uncomfortable.

charlotte989875

ernursej said:

As an Emergency Nurse, I have seen and heard a lot of things. I will share stories but it is always without identifying information. I fully expect my therapist to use my sessions in a way to create links for others. I don't have a problem with sharing.

But the intent here is vastly different, no? I totally agree that sharing can create helpful analogies for other patients, or show examples, but that's different than what's LW describes as purely for entertainment. I would be fine with my therapist using my experiences to help someone, I'd be pissed if they were using them to get a laugh at a party. 

ernursej

charlotte989875 said:

ernursej said:

As an Emergency Nurse, I have seen and heard a lot of things. I will share stories but it is always without identifying information. I fully expect my therapist to use my sessions in a way to create links for others. I don't have a problem with sharing.

But the intent here is vastly different, no? I totally agree that sharing can create helpful analogies for other patients, or show examples, but that's different than what's LW describes as purely for entertainment. I would be fine with my therapist using my experiences to help someone, I'd be pissed if they were using them to get a laugh at a party. 

I think the intent is different but would be no different than stories that I (and most professionals I know) have told that wouldn't be for any other reason than entertainment value and to blow off some steam. I think how the stories are told may be what needs to change. I never start stories with "Holy crap friend, x just happened and the dude is a moron". It would be more like, "Wow, today was a weird day. x came in and I found it interesting/horrible/palm to face etc". I think that perhaps the friend needs to just be told to be more respectful when telling stories.

Edited to add: I find that without sharing my day, I carry too much of an emotional load to function. I think that tone is what changes how I perceive my sharing (and most of my colleagues) to be different than the therapist in question. I have certainly talked to colleagues about how they frame stories and that there still needs to be respect when sharing.

*Barbie*

i think that the woman needs to tell her friend that she's uncomfortable hearing these stories and ask her to stop. i think that reporting her to a licensing board is taking things way too far, provided the woman is not violating HIPAA/giving names/enough detail to identify patients. 

I can absolutely understand the need to blow off steam in a high stress job and share some of the stories from your day. I have friends and family in therapist, psychiatrist, and SPED jobs where there is a level of confidentiality that needs to be maintained. These people all share stories, but do not do so in a way that I find inappropriate - e.g. I don't know the patient/ couldn't pick the patient out of a lineup. 

short+sassy

I don't know how common this is, but I was shocked to casually hear what I am assuming was a HIPAA violation.  I was sitting on a bench in a valet area.  Waiting for my car.  A doctor sat down next to me and got on her phone.  I assume she was listening to her messages.  She then called her service and said something like, "Hi, this is Dr. (her name).  I'm calling to retrieve a message from one of my patients, (Full name)."

I remember thinking to myself, "Wow.  Well, I guess it is a good thing I don't know Patient Full Name."

levioosa

short+sassy said:

I don't know how common this is, but I was shocked to casually hear what I am assuming was a HIPAA violation.  I was sitting on a bench in a valet area.  Waiting for my car.  A doctor sat down next to me and got on her phone.  I assume she was listening to her messages.  She then called her service and said something like, "Hi, this is Dr. (her name).  I'm calling to retrieve a message from one of my patients, (Full name)."

I remember thinking to myself, "Wow.  Well, I guess it is a good thing I don't know Patient Full Name."

That might not actually be a violation. For example, it's not a violation to call out names in a waiting room. The same principle might apply here. Now, if he started talking in detail about the patient's condition with the name, age, etc, that would be a violation. 

short+sassy

levioosa said:

short+sassy said:

I don't know how common this is, but I was shocked to casually hear what I am assuming was a HIPAA violation.  I was sitting on a bench in a valet area.  Waiting for my car.  A doctor sat down next to me and got on her phone.  I assume she was listening to her messages.  She then called her service and said something like, "Hi, this is Dr. (her name).  I'm calling to retrieve a message from one of my patients, (Full name)."

I remember thinking to myself, "Wow.  Well, I guess it is a good thing I don't know Patient Full Name."

That might not actually be a violation. For example, it's not a violation to call out names in a waiting room. The same principle might apply here. Now, if he started talking in detail about the patient's condition with the name, age, etc, that would be a violation. 

Thanks for the feedback.  I've never worked in the medical field, so I don't really know the ins and outs of HIPAA rules.  She did not speak in any more detail than her name and the patient's name.

charlotte989875

ernursej said:

charlotte989875 said:

ernursej said:

As an Emergency Nurse, I have seen and heard a lot of things. I will share stories but it is always without identifying information. I fully expect my therapist to use my sessions in a way to create links for others. I don't have a problem with sharing.

But the intent here is vastly different, no? I totally agree that sharing can create helpful analogies for other patients, or show examples, but that's different than what's LW describes as purely for entertainment. I would be fine with my therapist using my experiences to help someone, I'd be pissed if they were using them to get a laugh at a party. 

I think the intent is different but would be no different than stories that I (and most professionals I know) have told that wouldn't be for any other reason than entertainment value and to blow off some steam. I think how the stories are told may be what needs to change. I never start stories with "Holy crap friend, x just happened and the dude is a moron". It would be more like, "Wow, today was a weird day. x came in and I found it interesting/horrible/palm to face etc". I think that perhaps the friend needs to just be told to be more respectful when telling stories.

Edited to add: I find that without sharing my day, I carry too much of an emotional load to function. I think that tone is what changes how I perceive my sharing (and most of my colleagues) to be different than the therapist in question. I have certainly talked to colleagues about how they frame stories and that there still needs to be respect when sharing.

I think that's the key, the respect and framing part. I agree that sharing is important for self-care, but it seems different to me to share among colleagues or other professionals who understand the need for respect and privacy of information and telling a story about a patient at a party just to get a laugh.