Too much information

A reporter’s trip to ER raises privacy concerns

Published on January 27, 2016

Eastern Health has a policy against disclosing patients’ personal information, but at St. Clare’s emergency room, patients have been routinely publicly asked for phone numbers, addresses, birthdates and other details.

Birthdates are requested, even though they are on the MCP cards patients have already handed over. This practice has gone on since the emergency room was renovated in 2014, until this week, when Eastern Health changed its procedures in response to a Telegram inquiry.

But here’s what this reporter found out last week on my own trip to emergency, not for a story, but for an urgent medical matter.

The clerk who checks in patients sits behind a glass window, with the patient sitting outside the wicket, within easy earshot of other patients in the snug waiting room.

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The space between the front row of waiting room seats and the window behind which staff work is barely wide enough for a wheelchair to be pushed through. So, when any patient at the wicket is asked for details, including next of kin and identifying information, anyone in the room can hear it.

As I took my seat to wait for medical attention in the chair furthest from the check-in wicket, I could hear the questions and replies of the patients who checked in after me.

Each patient was called by name and, in one case, an elderly lady was asked for her birth date, phone number and address. Another was asked and gave details about next of kin.

Why is this too much information? Because many fraud and identity theft websites warn against giving out such personal details publicly.

Eastern Health’s privacy and confidentiality policy states, in part: “It is the responsibility and obligation of all employees, agents and/or those affiliated either directly or indirectly with Eastern Health to ensure that information to which they have access is kept private and confidential.

“All information obtained in the course of an affiliation with Eastern Heath must be held in the strictest confidence. … Understanding the environmental limitations inherent in the health care setting, information that is considered confidential and private is not to be discussed in any public location (elevators, lobbies, cafeterias, off premises, etc.) where others, not entitled to receive that information, are present and likely to overhear.”

Such confidential personal information includes: “the individual’s name, address or telephone number, the individual’s age, sex, sexual orientation, marital status or family status.”

In the ER waiting room, people openly use their cellphones even though there’s a sign on the wall advising they should be turned off. Relatives and friends of patients flow in and out and no one seems to question the presence of anyone who hasn’t been called up for registration or triage.

The renovations at St. Clare’s did improve the medical facilities inside. Once a patient is called to see the triage nurse they are taken behind sliding doors to give medical information and, later, when their turn comes to see the doctor, they are treated in private exam rooms.

The medical treatment I received there was superb, but in recovery I was curious as to whether too much personal and medical information can be overheard in health-care settings.

Absolutely, says the province’s access to information and privacy commissioner.

Ed Ring has not done a formal investigation, but says so based on his own and others’ experiences, including those who have mentioned the issue to him in his official capacity.

“It’s a problem,” Ring said, adding that in 90 per cent of doctors’ clinics in the province there’s not enough privacy.

From doctors’ offices to hospital and clinic wards and rooms where beds are separated by curtains, with patients obliged to answer questions about medications and past medical history, there isn’t much room for modesty, he acknowledged.

Some people don’t want those details shared and others simply don’t want to hear them, Ring said.

He said it’s not unique to this province, as many health facilities around the country were designed long before privacy and confidentiality concerns ramped up.

So while it’s a bad situation, it’s also a hard nut to crack. As new facilities are built, privacy can be taken into account, but it might not always be the case during renovations that must work around old construction, Ring said.

Prior to being renovated, the St. Clare’s ER had a waiting room well away from the rooms where clerks and nurses took information from patients.

Accreditation Canada, which audits the performance of the nation’s hospitals, has mandated in its emergency room standards that patient privacy must be respected. But it hasn’t exactly told the hospitals how to achieve that, a spokeswoman said.

It revised emergency department standards in 2014 and the next year began evaluating how hospitals ensure patient privacy is respected during registration at the ER.

It’s up to the hospital — based on logistics such as layout as well as provincial and federal legislation — to interpret how it complies with the standard.

While hospitals often take basic information at registration and detailed medical information in private, they need to respect a patient’s wishes, Geneviève Brisson, a communications specialist with Accreditation Canada, said in an email response.

“If a patient does not feel comfortable with the way a hospital has defined public versus private information within a physical space, then he/she can request privacy,” Brisson said.