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Ethics in Healthcare

Years ago, I sat down in the dentist's chair for the first time at a new dentist and looked at a huge flatscreen right in front of me with all the names and numbers of the days' patients on an enormous digital calendar. I saw my name (usually the longest one) where it should have been (first slot of the day). It turns out I was in Chair 2. There were about 20 other names and numbers on the screen. Later the dentist used that screen to show me the results of my x-rays (no cavities).


That was also my last visit with that dentist because the dentist's first act was to display my medical information to everyone else in the office that day. This included all the other patients and the professionals who have nothing to do with my care, and thus, no reason to know anything about me. That was a huge ethical violation and said something clear to me about their professional competency. I found a different dentist immediately.


Videoconferencing has become huge. Recently I saw that someone canceled a quarterly meeting because they thought, rightly, that people had videoconferencing fatigue and the information at the meeting wasn't really all that important anyway. They wanted to give people a break. In fact, if you are receiving psychotherapy, you likely have met with your therapist using video or phone in the last year. It amazes me that I have been working with some people for over a year and never met them in person. Video is no longer new-it's mundane.


I had unfortunately noted that some practitioners had become complacent about protecting client information before they actually became competent in using teletherapy. The pandemic forced many of us to switch to teletherapy before we were ready, and this ethical oversight is a predictable outcome of that forced switch. To that end, I feel compelled to educate the public on some basics of confidentiality in teletherapy.


Make sure your clinician is using encrypted video or a medical-grade teletherapy service. The video services that come with your phone often don't meet security standards for transmitting medical information. Your clinician should never transmit medical information on an unsecured network or without proper encryption. For instance, they should never send you your Occupational Therapy Evaluation as an easy-to-open .pdf through Gmail. Even though I highly recommend clients don't share personal or medical information with me by email (I actually use Gmail), clinicians should never respond to such messages with additional clinical information. Clinicians should use a secure file transfer service, like a secure digital service or the US Post Office, or offer to talk with you on the phone or in person.


These are some of the basic digital standards of medical and mental health professionals, but this is not exhaustive. Also, the goal is not to eliminate security threats but to minimize them as much as possible. Even if the dentist had turned the screen away from me when I mentioned I could see everyone's information (which I did), I would have felt better. If you have questions, please ask your provider how they are working to keep your medical information safe and secure. It is their job, after all, and they are obligated to do it.

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