Confidentiality and Chaplains
Posted by Kacey (+3161) 12 years ago
I learned - after the fact - that when you speak with a hospital chaplain that what you say is all documented. When my father was critical I spoke with two different chaplains about my feelings. What a wonderful surprise to find DETAILED records of our conversations in my father's medical records. I had been under the impression that there was confidentiality when speaking with clergy. So if you have a relative in a hospital be cautious. Know that there is no confidentiality. Whatever you say about the patient goes in the patient's file. And here's the catch 22...the file is the patient's supposed private information. Yet there it is. Commentary about you, your feelings, your fears. It has now been put down in black and white for anyone to read.

And...if you are the patient...well....

This website says it better than I can.

http://www.medscape.com/v...e/552447_7
What we fear is that a chaplain will not simply write "patient seen and spiritual needs discussed" but will record some portion of the content of such a discussion, a discussion held without the patient's awareness that what he or she says may be entered in the record to be seen by physician, nurse, or anyone else entitled to see the record. Patients may tell chaplains information that they would not tell their doctors (eg, an episode of childhood incest that the patient believes led to damnation and illness). Whether or not such information may be useful for a doctor to know, it is really a patient's choice whether, and to whom, to reveal it. In short, healthcare professionals have neither right nor privilege to access what a patient presumes to be a privileged conversation between himself or herself and a chaplain -- or, for that matter, anyone else.

[This message has been edited by Kacey (4/13/2009)]
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Posted by Sheryl (+22) 12 years ago
Kacey, you may be thinking about clergy, your local pastor, or your father's pastor, etc. Those individuals indeed are bound to confidentiality. If you are talking about a chaplain that is employed by a medical facility, the play a valuable part in the medical care of the patients. Thus, they must document or chart their findings from the pastoral visit.
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Posted by Kacey (+3161) 12 years ago
But the point is that most people are totally unaware of the complete documentation. This is simply to let others know the hospital protocol.
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Posted by Bart Freese (+928) 12 years ago
That certainly seems like something that should NOT be written into a medical record. I can't imagine what good it would do to record this material.
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Posted by Wendy Wilson (+6167) 12 years ago
Confidentiality regarding medical records is a joke as far as I'm concerned. Hours after a relative of mine was diagnosed with cancer it was all over town. If you live in a small town it's one of the facts of life.
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Posted by Sheryl (+22) 12 years ago
Wendy,
You can't blame the Medical Records professionals for the leak of information. Like you said, if you live in a small town people are concerned about each other. If you relative told one person about his/her diagnosis, then the person they told immediately picked up the phone to start a prayer chain or something like that, then it spreads like wildfire. Or maybe he/she told a neighbor. Please don't blame the medical professionals in your community.
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Posted by Donna Kingsley Coffeen (+400) 12 years ago
I agree strongly with Kacey that people assume a chaplain will keep their confidence. I am appalled to learn that is not true. I think people should be told before they say a thing to the chaplain that he will be recording it into their written record.

As for confidentiality, I found out my very good friend had "likely fatal cancer" because I was sitting in a room at a clinic and overheard the doctor tell the nurse this in the hallway---loudly. My friend has a very, very unusual name so it was no mistake. Then I had the burden of knowing this and knowing my friend was in distress and I could not go comfort her. I did write a letter to the clinic manager about this.

I was in a doctor's office one time and a stack of charts were left on the desk and they included charts of several people. Anyone could have looked in them.
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Posted by Kacey (+3161) 12 years ago
We all at one time or another will be in the position of being family member or patient so please let your friends and family know about this lack of confidentiality. From now on my only contact with a chaplain in a facility will be if he or she offers a prayer where I say nothing other than amen.
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Posted by Derf Bergman (+585) 12 years ago
We have several different issues floating around on this thread.

One is privacy, which is strictly regulated by HIPAA laws. The charts left out in plain sight and the conversations overheard are violations of the law. Once the chaplain entered details of your conversation into the medical record they also are goverened by HIPAA law. To read them, you would need the permission of your father. Believe it or not, as I understand it, without his written permission, you would be in violation of the law.

The chaplain may have considered herself an employee of the medical facility and considered the information you shared one piece of the care plan for your father. In this point of view, she is part of the care team and the doctors and staff need this information to provide proper care.

Just because you have talked with a chaplain, you would be wrong to think you have talked with a clergy-person. Because someone is providing spiritual care in a facility doesn't mean they are well trained or professional or even ordained. They may even be a lay volunteer.

Some facilities are required to show they are caring for the whole person. One part of that care puzzle is spiritual care and that requires some documentation.

There are time when professionals share information with one another and it is fully realized the information is still kept in confidence, one professional to the other, as part of their responsibilites. (Ordained clergy who have met certain educational requirements consider themselves professional). The same information shared by one of those same professionals with his spouse, at home, would be a gross violation of ethics and trust.

Not all information shared with a clergy person, even in confidence, is always to be kept. Threats of harm to others or self or revelations of current physical or sexual abuse of minors are examples. Sometimes, information needs to be shared for the greater good. Very nearly always, confidences are kept.

Whenever I am asked to document visits, because I am serving the church and and family members and not the facility, I am only willing to give the sparsest of information. "Visited, talked, prayed," maybe "served communion" is as much as anyone would need to know.

I think there's some good advice on thie thread. Make sure you know who you are talking to and who they work for. Make sure you are talking to your own clegy/counselor/confidant about your own issues. Those confidences will remain right there, held as a sacred trust.
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Posted by Wendy Wilson (+6167) 12 years ago
Sorry, Sheryl. The only person who knew about the diagnosis was the medical staff and my relative's wife. They had told absolutely no one yet. They were still in shock. I have found that small towns are great for many things but as far as secret keeping goes, forget it.
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Posted by Sheryl (+22) 12 years ago
This scenario happened to me: My relative told a neighbor that they have a biopsy on Tuesday and they think it may be cancer. Tuesday comes, the biopsy is done. The neighbor calls to see how things went with the procedure and the response is "We don't know yet. We will get the results tomorrow". The neighbor calls their friend and says "I'm really worried about so-and-so. He had a biopsy today and they think it is cancer". The next day the friend of the neighbor is in the clinic for an appointment. They see my relative come from the doctor's office. My relative is obviously upset, tears running from his face, etc. My neighbors friend automatically "knows" that the diagnosis is bad. So his neighbors friend calls his neighbor and says "I don't think the diagnosis is good. I just saw him leave the office very upset." So then his neighbor calls her friend to say "Can you watch my 2 year old? I need to go be with my relative who just found out some bad news following a biopsy". Confused yet? There are so many ways that "the word" gets out it is unfair to blame it on the medical community every time. In this case the diagnosis was only discussed with my relative yet people in the waiting room started speculating and drawing conclusions about the situation. It happens all the time and unfortunately the medical community gets a bad rap for breaking those confidences. Can I say that a confidence was never broken by a medical professional? No, I don't know that for a fact. But it is unlikely and it is not normal for such confidences to be broken by medical professionals.
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Posted by Kacey (+3161) 12 years ago
Derf,
Your reply is full of important information. I would like to add that I didn't say anything that would impact my father's care. I simply was very worried. I love my father and he had been improperly medicated. The man I said goodnight to was not there the next morning when I returned. I was sad. I was grieving. I felt like I had the wind knocked out of me.

The sad thing is that the one chaplain who wrote the extremely detailed notes visited three times....and not ONCE did she offer even a prayer for my father.

Both chaplains I am speaking of have Master of Divinity degrees. They have been chaplains for years and have gone through thorough training.

One chaplain had been my friend for several years which makes it even worse. Apparently loyalty to the employer comes above friendship even for a man of God. Sad.
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Posted by Donna Kingsley Coffeen (+400) 12 years ago
I deal with chaplains as a part of 3 different volunteer situations in medical/nursing facilities. I will never feel quite the same around them since reading this thread. It is not their fault, but I now know confidentiality is not there.
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Posted by Sheryl (+22) 12 years ago
Everyone,
That's alright. For every 1 person who is disappointed in a Chaplain or Pastoral Care Worker, there are probably 20 that are grateful that they were present and helpful during a time of illness, tragedy, or death. Chaplains/Pastoral Workers are Godly people. They are people who feel called to serve in the capacity to tend to the spiritual needs of each person (just like your clergy). They are there for the good of the patient and their family. And there job doesn't stop there. They also serve the healthcare worker who is caring for the critically ill, dying, patient. To the Chaplains reading this: Bless you all. Thank you for all that you do.
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Posted by Kacey (+3161) 12 years ago
Chaplains bring comfort...if they actually do their job. As I said, the one chaplain didn't offer a word of comfort or even a prayer. She apparently was so busy mentally scribing our conversation that she couldn't wait to get back and write it up. She kept asking me questions about how I felt. She didn't talk about my father. After she left I turned to my husband and said it was the most bizarre conversation I'd ever had with a minister.

I just wish that chaplains in facilities would say....please realize I am an employee here and am bound to record our conversation.

Then they could go back to just offering a prayer and suppport.
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Posted by Donna Kingsley Coffeen (+400) 12 years ago
I have known some amazing chaplains---very good people. I just had no idea that they were not held to confidentiality rules as pastors are.
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Posted by K.Duffy (+1812) 12 years ago
That is good to know! I, too would have ASSUMED confidentuality, maybe if he charted something you said pertaining to your father's habits or background, but certainly not YOUR personal life.

On another note: I am shocked and a little hurt you would choose to open up to a Chaplain when you have all the warm fuzzies floating around here at MC.com!
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Posted by Kacey (+3161) 12 years ago
The sad thing about this is that I didn't see a chaplain until the doctor had given my father medication he wasn't supposed to have. My dad almost died. He was catatonic and developed pneumonia. Suddenly the chaplain is there. She was busy trying to make excuses for the doctor's actions. Why aren't any of her statements in the chart? It scares me senseless.
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Posted by Brian A. Reed (+6093) 12 years ago
I generally only confide in people I trust. I rarely trust people I don't know. To me, a chaplain is a poor subsitute for a close friend or a relative (or even a journal).
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Posted by Buck Showalter (+4462) 12 years ago
I have a hard time believing this is happening, but then I don't - it's Miles City. That is not an acceptable practice by any standard.

[This message has been edited by Buck Showalter (4/16/2009)]
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