I see a psychiatrist once every three months or so, mainly to get refills of medications that help me survive with depression and PTSD. He isn't the most insightful dude on the planet, but he has those magic letters behind his name that allow him to write prescriptions. (For real therapy, I see a regular therapist whom I would trust with my life.)

Anyway, the last time I went to see this doctor, there was some woman sitting at his computer desk. No introductions, no explanation as to why she was there, and what I considered the worst offense: NOBODY ASKED WHETHER I MINDED HER BEING THERE.

I was so shocked at what I considered a violation of my confidentiality that I asked, very coldly, "And you are. . .?"
She said a name. I asked, "Why are you here?" She said, "I help the doctor with his typing." I told the doctor, "I need refills of the usual medications, please." He gave them to me.

I refused to pretend she wasn't there and discuss anything. I just stood up and left after getting the prescriptions. (I said "Thank you," but that was all.)

With any number of other doctors, I've had the regular doctor come in along with somebody else, but they always say something like, "This is Dr. So-and-So, who is doing his/her first-year residency with us. Do you mind if he/she is present for the exam?"

HECK, NO! When approached in a respectful way, I'm very cooperative. I usually thank the student/resident for having gone into medicine, because we need them. If they can learn anything useful from this battered old body, good for them!

Just do me the courtesy of asking whether I mind the other person's presence!

Is that too much to ask? Could this person's presence - without my consent - be considered a HIPAA violation?

Most definitely! And there should be a number that you can call to report it.

I wonder if she's his medical transcriptionist. In my former physician's office, the physicians typed up their notes as we were speaking. They used to write them on your chart, but nowadays everything is computerized. It sounds like the psychiatrist has hired someone to do this task for him.

This person should have been introduced to you. You had a right to know why she was there.

Hopefully, the doctor will take a hint from your reaction and improve his office courtesy procedures.

I work in the Medical field in the USA.

Absolutely you had a right to ask and even ask for that person to step out of the room if you were uncomfortable.

You probably encountered a trained scribe, but that person should have been professional and explained their role up front! They are still obligated to be under HIPAA (mandated by law of your private medical confidentiality) but how they explained this to you was unacceptable.

If this Dr is under a medical group and they have a patient advocacy office or phoneline...let them know you are NOT happy.

I have access to a LOT of personal information and I am privy to many private conversations. I value that trust with our patients and each and every time I remind them of the law and personal ethics I am under.

You have the right to question how your personal information is being processed, viewed, etc.

RMM

http://www.hhs.gov/ocr/privacy/psa/complaint/

Here is the link you need to follow to file a HIPPA privacy violation.

Trust your feelings. They are usually right.

You were not out of line to be upset.

If the psychiatrist is so lazy they have to have the transcription done instantly and can't say a few words into a phone later, he is pretty lazy.

When I go to the doctor, I expect the assistants to come in and take my vitals, etc., and they input something, but then the doctor comes in alone or tells me who the assistant is. I've gone to a therapist for YEARS and not once was anyone else in the room, same with the psychiatrist I used to go to. There isn't much the psychiatrist has to dictate if he is just refilling your meds. My visits were only 15 minutes back when. Sometimes it seems technology has set us behind many years rather than ahead. I don't see any reason why the "typist" had to be in the room, but if she was, you should have been introduced and asked if it was okay.

not exactly. Many physicians spend around a third of their day transcribing. Medical transcriptionist allow for better notes, and more patient appointments.

It may be uncomfortable, but it is not a sign of laziness.

My last visit to a cardiologist included a person taking notes. She was introduced.

It also made me somewhat uncomfortable, even though I had nothing personal to report.

I have hated how doctors lately just spend my whole appt reading and typing. It's about like taking my son to a restaurant and he just pulls out his phone to entertain himself.

I am not sure a stranger in the room is an improvement.

Just a note on this: if you speak in front of that third person, later you may not be able to claim a right to privacy about anything you discussed in their presence.

And my motto is: two people can keep a secret, if one of them is dead.

I would explain to the doctor that you are uncomfortable with the presence of a third party in the room during treatment, particularly someone who is not medically trained, so much so that you do not any longer feel free enough or secure enough to share intimate details of your life with the doctor, or to share information essential to your therapy/healing/whatever the issue is, with that third person in the room. Ask for an alternate arrangement for the next visit, well ahead of time. Insist on it. If this doctor says I am sorry, I cant treat you, tell him this is not acceptable and tell him to refer you to a colleague or other practice where this does not occur.


I know that transcriptionists are given your complete record after the fact, I worked in the medical field and in hospitals and surgical suites for 20 years and did grant writing for NGOs and billings for internists and eye doctors, after that. Billers/coders, grant writers, peer reviewers, charge nurses and file clerks and many others unknown to you have access to your patient record as well; but to me, this is a different thing entirely.

Therapy depends on forging a bond and trust between therapist and patient. If you feel uncomfortable telling your story in front of a third party you are unfamiliar with, who is not a therapist or doctor, who is medically untrained and in the room and facing/staring/looking at you, then you are simply not getting the medical treatment you are entitled to, and for which you or your insurer has paid.

She was most likely a medical scribe. This is a new trend in medicine. Doctors originally wrote their notes on your chart. Then they began dictating into tapes and having a medical transcriptionist transcribe it and insert that in your chart - either a paper copy or now most likely electronic chart. As some have said here, some doctors sit at the computer and type directly into your chart themselves during the exam.

The upside to scribes is the doctor is not reliant on his memory if he dictates the encounter later in the day. If he was one that input it directly himself, he now can focus on you the patient and not on his computer screen.

The downside is that, as you stated, it is disconcerting to have someone else in the room during the exam.

The scribes (as transcriptionists have always been) are obligated to abide by HIPPA rules just as the doctor, nurse, and receptionist and any other office personnel are obligated to.

There was no HIPPA violation if that was her role. However, it was extremely rude of the doctor and the scribe not to tell you who she was and why she was there. If you do not feel comfortable with her there, you could have asked her to leave and the doctor could have dictated his notes later or entered them directly himself.

After only reading subject line, my answer to your question about whether you were out of line to be upset was "NO".

If you are upset, then you just are. In what way could your feelings be wrong? They are natural responses. If other people don't react the same way to similar situations, it's because they are different from you and haven't had the same experiences that you have. That doesn't make your feelings wrong.

Someone I know who has been in relationships where their thoughts and feelings have been dictated, invalidated, or abused is constantly asking if they 'should' be upset by something that clearly bothers them. The conversation has been changing to ask WHY they feel that way, or what their gut or their feelings are trying to tell them.

In nearly every case, when hear what bothered her, I think the other person involved was out of line. But I do think it helps her to ask, because she needs that validation (because she was invalidated for so long).

BTW, I would have been bothered to have an extra person in the room, too. When you have a trusting relationship with a person, whether it's close friend or a doctor, it does put a damper on the conversation to have another person there. In the future, I'd let them know ahead of time that you don't want her there. That would be less awkward than objecting if she walks in.

It was a terribly upsetting situation, and I have decided that if it happens again, I won't go back to that doctor any more.

I asked my regular therapist for a recommendation to a different psychiatrist, and she gave me the name of a doctor whom she respects highly.

imaworkinonit, your comments are totally on-point. I was raised by a parent who always discounted my feelings and viewpoints, and then married a person who did the same thing. That sort of treatment doesn't stop the feelings; it just keeps you from expressing them.

There's a big difference between a medically trained assistant, or a secretary, being present during an exam or consulation.

My surgeon dictated into a recorder during the exams. No invasion of privacy, and I felt fully informed. No mystery what was going into the record, no surprises later.

Doctors are in a bad situation. They are being mandated to use computers for charting. Many get complaints that they spend the whole visit typing and not Looking at the patient. And, it takes time away from the patient. I think the scribe is a great idea. One of my doc uses one and I'm ok with that. I just took my kids for check ups and the visit was painfully long as doc had to chart everything himself as he went..

Many doctors don't even know the charting system. In the hospitals the docs often make the residents be their scribe. Scribes are probably here to stay where practices can afford them.

I work in a practice that still uses dictation, but that practice is not up on physician charting yet. They will be soon and dictation will be a thing of the past.

Having said that, you should be introduced and procedures explained. A discussion should have happened including your comfort level. And this is why physicians SHOULD have to learn to use the systems for cases patient don't feel comfortable. But, then he would be charting while you are talking and that can feel impersonal to many...It is unreasonable in these days for doctors to see patients and then spend hours at the end of the day computer charting nor is it safe.

HIPPA of course applies.



Edited 2 time(s). Last edit at 05/22/2015 04:29AM by ladybug.

It's weird because my prior physician went from hand-written charting to typewritten charting. For some reason I've found the latter to be far more intrusive although he probably spent about the same amount of time writing. It just seemed like he sat at his computer for most of my visit. I never noticed the hand-written charting nearly as much.

I would be worried if I was trained as a scribe. Sounds like something a robot will be doing before the decade is out.

than with their patients.

Doctors are trained to notice nuances of whatever ailment they are looking for, right? A flick of an eye can indicate that the patient is veering off the truth, for example. And yet, how likely is the doctor to see this when he has his eyes on the keyboard?

This is disconcerting, when you are accustomed to having the doctor's attention. But given a choice, I would rather have the doctor fumbling with the keyboard than having to put up with a third party in the exam room. Still, especially in therapy settings, I view this as a lose/lose situation. Non-verbal cues are very important in that setting, and a practitioner with his eyes glued to his computer screen is doing his patient a HUGE disservice.

Very early in my adult work life, I, too, did work as a medical transcriptionist. But we just got the recorded report. We never, EVER, presumed to join the doctor and the patient.

Thank you again, everyone, for the feelings of validation. I felt violated and angry, that without so much as a by-your-leave, here was this woman I didn't know, sitting in on what was supposed to be a PRIVATE conversation.

In situations like this, I have learned to become ICY-angry, rather than OUT-OF-CONTROL angry. That way, it still looks like you are totally in control of yourself and they can't accuse you later of having gone off-the-wall, bat$hit crazy. Quite the opposite - you are calm, composed, articulate, and COLD. "They" (whoever), can't use that behavior against you later. Some of us had to learn stuff like that the hard way.
It's actually a double-violation, when they do that.

First off: you had every right to ask the person to leave. You are there to talk to the doctor not a secretary/typist. I've never had that happen but I would not be a happy camper if it did and would ask them to leave.

The only time something like that happened is when I went to a clinic with eye doctors. He dictated while doing an exam and she typed. I thought it was odd, but apparently it was common practice. I don't go there anymore either!

The really odd thing about the big clinics putting everything on computer is where they place the computer and where the doctor sits to use it. He/she types away sitting sideways or with part of their back to you. How is that a reasonable approach to doctoring? The only exception is when they use a laptop.

I decided I needed a new doctor close by (for a variety of reasons) and chose one that opened a new smaller clinic (only a few doctors) with it's own lab. Bingo. Hand written notes - doctor faces me. They bring in specialists also for more extensive tests. Finally medical care that names sense and is personal.



Edited 1 time(s). Last edit at 05/22/2015 04:36PM by SusieQ#1.

Edited 4 time(s). Last edit at 05/23/2015 10:01AM by cl2.

You have every right to be upset. Unfortunately, most people aren't vocal with their physicians when they have concerns surrounding the methods of their practice. Given the nature of this situation, being a psychiatric consultation, a good practitioner would have introduced the third party in the room. Many teaching hospitals have physicians present who are fully qualified (fellows) yet they are introduced and you are given the choice of whether they can remain in the room.

If you are uncomfortable with the way this was handled, I would strongly suggest that you speak directly with the physician who made this error in judgment. Like any busy professional, such feedback could make him better at what he does.

Does the doctor get paid your visits? Or, does the doctor just renew your prescription for free. Whether or not the doctor gets paid makes a big difference. Maybe he kept his girl there, to keep you from asking him for free advice.

Regardless of the doctor's intent, I agree that you should find another doctor.

When you feel upset, it is for a reason, and you need to listen to your heart. You can trust your gut instincts enough to act upon them, even without getting all the facts. You might never know what the girl was doing there, and it doesn't matter. You were right to leave.

Change doctors.

what do you think?