I suppose sexuality questions can be part of the patient's history and intake, because it does touch on sexual practices and therefore exposure to certain diseases and/or injuries. Also, physicians frequently make note of spouses, domestic partners, etc. as part of not only the physical workup but as part of the overall picture of the patient's well-being, including emotional issues.

However, the receptionist's use of that data is a violation of HIPAA (Health Insurance Portability and Accountability Act). She has the right to access it as part of her job, but it is against the law to seek out or use patient medical data for anything other than the minimum required to do one's job. In other words, the receptionist can look at this patients history if she has to update it, or perhaps fax it to a specialist or an insurance company, but she may not make note of any of the contents of that record, nor may she act on any information contained therein unless those actions are part of her necessary job function.

Suing the insurance company is pointless since they have zero control over the behavior of individual staff members within a physician's office. She's just going for the money there. If I were her, I'd call the state's medical licensing board and the Attorney General, and get that woman fired and possibly arrested.

Just a clarification for Kate. It wasn't an office receptionist who gave the patient the offensive note, etc. It was a Physician's Assistant, who was the patient's health care provider for that visit. A PA is similar to a Nurse Practitioner. She had access to the patient's file in the course of her health care visit.

I'd be pretty irate about the whole thing too. Time to change physicians.

Thanks for that, I didn't have the article in front of me.

The law still applies even though she is a clinical provider (such as it is). The MA accessed PHI (Protected Health Information) for purposes other than the minimum allowed for her to do her job. Man, I'd have the AG's office *all over that doctor*.

K. (hey, guess what industry *I* work in!)

OK, time to brush up on my remedial reading skills.

PA =! MA

I'm less confident that HIPAA law applies in this case, although it might since the patient did not come into the office with a complaint about her sexuality.

On the other hand, if my hx shows that I have a different sexual partner each week(not a crime and not a disease), could the practitioner slip me some pamphlets about STDs if it's not materially related to the reason for my visit?

I'll let you know what our paralegal says!

Kate - I'm not a lawyer, but it seems to me there is a big difference between providing health related information (how to protect yourself from STDs) and providing information that is not remotely health related (being gay is wrong). A person might be offended if a health care provider gave him or her a pamphlet on STDs based on assumptions (i.e. "From what you've told me, I'm thinking you may be at risk for contracting a STD), but it's completely within that provider's professional capacity.

I was trying to think of a good analogy, and the STD thing isn't good because it actually is about health (although immaterial to my hypothetical office visit.) What if they slipped me pamphlets about abstinence?

I've asked someone in our legal department about this, whether it's actually a HIPAA violation (or some other legal violation) or simply legal-but-nosy-and-offensive behavior on the part of a busybody. I.e. can they offer counseling/judgement/treatment plans based on their *opinion* of your behavior, rather than a diagnosis or demonstrable problem?

Re sexual/romantic partners as part of a patient's history: I do remember going to the ER for pain from a particularly bad case of strep when my PCPs office was closed, and the nurse doing my intake grilled me about how I got there (car), who brought me there (my male roommate), were we in a relationship (no), where was he now (went skiing), and whether I had experienced any violence within that relationship (no). I thought they were extremely weird question to ask for a strep visit, but they might have thought I was using the ER to hide out. (I think hey also initially thought I was drug-seeking, but one look at the thermometer readout and speckled throat put that to rest.) Physicians also commonly write down the names of spouses, partners, roommate situations, etc. and make note of the patient's relationship to the person who carries the insurance (the patient relationship to the insured goes out on most medical claims.) They also note the person who has legal proxy for that patient, so a person's sexual orientation becomes apparent very quickly, even without asking "so are you into chicks or what?"

The presence of that information in your chart, on the main, isn't anything to be overly concerned about, but it should serve as a reminder that your medical records contain a *tremendous* amount of information about you even without scandalous diagnoses and procecures.

The physician assistant's office-distribution of religious literature was unprofessional and unethical - and as many writers point out, probably illegal. It's worth a harsh call to the medical facility that employs the evangelist and it's also worth considering changing doctors.

But when I read the patient was suing, I got even more pissed off. The physician's assistant probably shouldn't be practicing medicine if she can't keep her non-medical views to herself, but I'm not sure she owes the patient cash. The doctor that didn't seem sympathetic on the phone may be a prick, but he doesn't owe the patient cash. And the fact that she's suing her insurer (however evil insurers may be in other regards), is proof to me that the patient is a greedy punk.

The sense of entitlement that leads some to believe they should tie up the courts and get paid whenever they encounter idiots is the kind of crap that gives right-wing "tort reform" assholes traction. The judge's time and the public's dollar is better spent weighing cases involving real damage - getting fired for being gay, kids dying because of pollution, loans denied because of ethnicity, etc.