Filed under: HIPAA, MSW, boundaries, hospital, hospital social work, job, social work, social work ethics, social work practice | Tags: acquaintance, disclosure
Generally, my general practice is, when I realize I know a patient or their close family members, to not get involved in their case. I think this is generally accepted as the correct thing to do, ethically. It’s probably als wise, in order to avoid comitting a HIPAA violation.
An issue arose for me, sort of anyway, this past weekend. One of my colleagues requested I follow up on a patient. It wasn’t anything urgent, just providing some ongoing emotional support for the patient and their family. I was aware they were from a certain geographical area that I am very familar with. But, when I saw the family from a distance and recognized them. They may or may not have recognized me, had I approached them. It’s been a number of years and my name is different these days.
Nevertheless, I did not approach them. I was somewhat uncomfortable, since I had some prior knowledge of them from a different setting. Nothing negative, just some prior knowledge. Plus, I was incredibly busy so I wasn’t really able to attend to people who already had had an initial assessment. But, I wonder if, had the family been in crisis, it would have been appropriate to intercede.
Certainly, if it would have been a family I knew well, I wouldn’t. At least I wouldn’t as a professional or employee of the hospital. But, only knowing them slightly, is it ever OK to get involved? And if they don’t recognize them, do I inform them that I know them and how, in the interest of full disclosure?
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I “knew” one of my counseling clients from seeing her in the drunk tank. She was adamant she didn’t drink… talk about awkward!
In a crisis situation, I’d just go with it and if it comes up, it comes up. If you were going to enter into long term work with someone, it’s something to consider.
I just remember this, it’s a small world. Sometimes we’re going to know people. It’s just going to happen. We do our best, but we can’t prevent every little time.
this really doesn’t make sense does it, my comment I mean… boy I hate mornings
Comment by Still Dreaming May 26, 2009 @ 5:44 amI think it’s appropriate to make the family aware that you know them and explore whether they are comfortable with your helping them on a short term basis (if you only know them on very limited basis and they aren’t friends/colleagues, etc.). If the family is comfortable and you’ve established some ways to ensure ongoing comfortability on their part, you can document and proceed. This is only if they aren’t close friends or colleagues though, of course.
If it had been a crisis situation and you were the only social worker available, I think it would have been appropriate to approach them.
Comment by Brandice May 26, 2009 @ 9:44 amOh, and by the way, I’m fairly new reader of yours and enjoy the blog. I’d highly recommend (as a geeky social worker who has also worked in online media, etc.) using Disqus for your comment system. If you ever need tech advice from a fellow social worker, let me know!
Comment by Brandice May 26, 2009 @ 9:46 amI would think that if there was no other option for support for them, you could simply be up front about it, inform them who you are and let them decide. I guess that would depend on the situation.
It’s mighty different knowing them professionally to knowing them personally.
Comment by antiSWer May 26, 2009 @ 11:12 amI recently did some research on this issue when it comes to practice in a rural setting. Out here in Eastern Oregon, the prospect of knowing a client or a member of their close family is more often than not, possible. In the agency where I work, if at all possible the clinicians trade clients when there is a possible ethics breach. If it is not possible, then the issue is brought up in the initial meeting in order to give the client the option of of how to proceed. Since it is a rural setting, most people, no matter their profession, are familiar with boundaries.
As far as my research goes; surprisingly it is the MSW’s in urban locations who have more of a problem with personal boundaries. In rural communities the people are familiar with the chance you may see a client/patient in the produce department at Safeway or at your childs’ sports practice.
it’s just a way of life.
Comment by John May 26, 2009 @ 1:14 pmTread softly and establish your boundaries early on if there is no way around it.
Okay, I know you posted this ages ago, but I just found your blog. I too have been in a similar situation wherein one of my neighbours arrived in the hospital program (Oncology) where I work. I explained to Mum my role in the program (providing resources to the families) and asked her how she felt about it, letting her know that if she was uncomfortable, I would let the senior social worker deal with it. Then I also asked the patient as she was 13 years old at the time, and lots old enough to have an opinion about it. They were both okay with me doing my thing (I had assured them that confidentiality would be kept) and so we proceeded.
Comment by Carolyn Preston June 29, 2009 @ 3:06 pmFor me, the situation hasn’t come up again…surprisingly. But I think that’s exactly how I’ll handle it…reassure them about confidentiality and make sure they feel comfortable and go from there.
Comment by oregonamy1972 July 2, 2009 @ 8:19 pm