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School of Medicine

VCU School of Medicine

Welcome to VCU School of Medicine

Standards and Policies

Welcome to Standards and Policies

Maintain Patient Confidentiality

Faculty, housestaff, and students should:

  • Maintain patient confidentiality.
  • Be respectful of the privacy of all members of the medical campus community and avoid promoting gossip and rumor.

Cases for teaching and discussion

Case 1

You are a third year student on your first day of the outpatient Hem-Onc Clinic. At pre-clinic conference, as you review patients, one of the names is familiar and you suddenly realize that the patient is a female classmate, Susan. She does not end up being your patient in clinic that day, but you learn she has Hodgkin’s Disease and is receiving chemotherapy and radiation. One of your closest friends is also a close friend of Susan’s, and you are sure she does not know she is sick. Susan has been struggling academically all year and now you realize why. You are concerned and feel that if she had some more support from friends helping her by fixing meals and doing errands for her, she’d have an easier time, but as far as you know, she has never asked anyone for help. You’re tempted to tell your best friend about her illness so that you can both help Susan out during this time.

Developed by Kathy Kreutzer and Laurie Lyckholm, Bioethics and Humanities, VCU School of Medicine.

Case 2

You are working in a local family medicine office for your FCM preceptorship. On Thursday, one of your patients is a young woman with clinical findings consistent with a sexually-transmitted disease (STD). She receives counseling and tests are run for chlamydia, gonorrhea, syphilis and HIV. The results will be ready for her follow-up visit in one week. On Friday night you go to a cookout at your preceptor’s house. A friend who is also a medical student from VCU is there, and his date is the young woman you saw in the office the day before. You know that the test results are not back, but you feel sure she has at least one STD. What, if anything, do you do?

Developed by Laurie Lyckholm, Bioethics and Humanities, VCU School of Medicine.

Case 3

You hear from a fellow student that there are conjoined twins in the NICU. They are not expected to live for more than a few days, and the parents are keeping vigil around the clock at the incubator. You learn that quite a few medical students with no responsibilities in the NICU have donned their white coats and IDs and gone up to see the twins, saying they want a chance to see this unusual case. You are tempted to do the same as you plan to go into orthopedics and might never have another chance to see conjoined twins in person.

Developed by Kathy Kreutzer and Laurie Lyckholm, Bioethics and Humanities, VCU School of Medicine.

Case 4

While at the coffee cart, you overhear two residents talking behind you.

“How was your night?”

“Brutal! That breast patient on North 6 is a nightmare. Going down the tubes. I was up all night.”

“Oh, that’s rough, I hate that.”

“And her family is such a pain, too. I just hate dealing with them all—a huge time suck.”

What are the problems associated with this conversation being overheard? What, if anything, should you do to address this?

Developed by Kathy Kreutzer and Laurie Lyckholm, Bioethics and Humanities, VCU School of Medicine.

Case 5

Nancy Nosey is an undergraduate psychology major who works part time as a research assistant for a substance abuse study. Study participants are given a confidential, self administered questionnaire that asks questions about demographic characteristics, including employment status and occupation, as well as questions about past and present substance use/abuse. The questionnaire does not ask for any identifying data such as name, social security number, or date of birth. As part of her position, Nancy is responsible for subject recruitment, obtaining written informed consent and data entry.

One afternoon Nancy recruits a woman who looks very familiar but Nancy can’t remember from where she recognizes the woman. The woman gives no indication that she recognizes Nancy and goes on to sign the consent form and completes the questionnaire. After the woman hands in the questionnaire and has left the area, Nancy reads her responses to the questionnaire. In it the woman had admitted to past use of marijuana and cocaine. She also reported that she was employed in childcare. Nancy then looks at the signed consent form and recognizes the woman’s name as the head teacher for her three-year-old nephew’s daycare class. Nancy becomes alarmed and wonders whether this woman is endangering children at the daycare. She believes that she should report the teacher to the daycare.

Nancy approaches the study’s principal investigator for guidance. How should she advise Nancy?

Anika Alvanzo, 2003; used with permission. Developed as part of course requirements for MICR510, Scientific Integrity.

Case 6

Dave Hart has completed a research study using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI) on serum specimens that had been routinely tested for prostate specific antigen (PSA) as part of patients’ ordinary medical evaluations. After the routine clinical testing and storage for a few weeks, the specimens would otherwise have been discarded without further testing. Hart had obtained approval from his local institutional review board (IRB) for the additional MALDI research testing as a pilot study to determine if there was any correlation between PSA values and protein patterns. Because the study was to be done retrospectively on pre-existing specimens not collected for research, because the specimens were to be stripped of patient identifying information, and because no medical records were to be reviewed to collect additional clinical information, the IRB approved the project without informed consent from the patients (exempt protocol).

The study revealed a striking correlation between total PSA concentrations and a few molecular fragments, although some specimens showed marked deviation from the general pattern. Hart thought the discrepancies might be due to treatments the patients had received or to prognostic factors for prostate cancer. He hoped that he could develop a new test for prostate cancer with better accuracy than PSA; however, he needed clinical information upon which to evaluate efficacy of his new approach. Although the specimens had all been anonymized for use in the research laboratory, Hart had not yet destroyed the master list of patient names and specimen numbers that he had used to select specimens while excluding duplicate ones from the same patient.

After Hart presented his findings and need for more information to a meeting of his research lab, several of the senior investigators ridiculed him for not proceeding immediately with a search of patient medical records for information about treatment and outcome that could strengthen his application for further research funding. They reasoned that Hart would perform no interventions on the patients, and so they should not have to give consent, and besides, studies like that had been going on for years without patient consent or IRB approval.

Hart was not certain that he should be limited only to those things specified in his original proposal and comes to you for advice.

Richard McPherson, 2003; used with permission. Developed as part of course requirements for MICR510, Scientific Integrity.