You are treating a 22-year-old for endometriosis and schedule a laparoscopy. Her father calls you to tell you confidentially that it is all a ploy to get narcotics. What’s your next step?
This calls into question HIPAA policies and your respect for them. This is not a matter between you and her father, but between you and her, so HIPAA requires that you respect that, even if it means risking naivety on your part. HIPAA trumps any refusal on your part to being 'no one's fool.' This is a tricky conflict (choosing between the law and being played), and a good answer will explain how you manage to be true to yourself while doing what's appropriate.
"First off, I would tell her father that I cannot speak to him about any patients and cannot even tell him if his daughter is a patient; but that I can listen to him. That would be the extent of our interaction. I would get a drug screen on her as part of the pre-op, which is a test that is justifiable on any patient for any reason. If the results indicated inappropriate drug use or doctor-shopping, her non-life-threatening surgery could certainly be put off for a week or two for purposes of psychiatric and addictionology consultation. If the drug screen were unsuspicious, I would document this, proceed on with the plans because endometriosis cannot be ruled out without surgery, but I would be careful to follow the state's guidelines on prescribing scheduled drugs postop. "
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Anonymous Answer
If I was at the point of taking this young 22-year-old to the operating room, I would have gotten to know her well and tried several other conservative measures first such as birth control pills and OTC medications. If I felt that we needed to confirm the diagnosis with laparoscopy due to previously failed conservative measures and the patient's background, I would not be so influenced by her father's claims. I would thank the father for his input and proceed with the operation at the patient's desire with cautionary thought.
Marcie's Feedback
Excellent! This is a strong answer. You come across as confident and secure in your actions and process. It also appears that you value getting to know your patients well, which the interviewer will appreciate. Your response is great; just keep in mind that given the state of the opioid epidemic in our country, you won't want to give the interviewer the impression that you would simply blow off the father's claim either. Mentioning that you will proceed with 'cautionary thought' is good and perhaps even emphasize that more to add further balance to your answer. Nice job!
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