A clinical nurse specialist (CNS) in an outpatient psychiatric clinic evaluated a patient who presented with several psychiatric complaints and an extensive history of major medical problems, including many surgeries and chronic pain. The patient had previously been receiving treatment from another provider and was also being treated at the pain clinic in the same building. A patient service assistant (PSA) who worked in the psychiatric clinic happened to be passing by the pain clinic one day and saw the patient and recognized her from the psychiatric clinic. She asked a pain clinic staff person why the patient was receiving treatment there and learned that the patient had chronic pain. The patient was in a wheelchair, which shocked the PSA because she had seen the patient outside the clinic, coaching a youth sports team, clearly not in a wheelchair and not apparently in pain. At a subsequent sports event, the PSA took a video of the patient to prove that the patient was not using a wheelchair, and she brought the video to the pain clinic as evidence. The patient was also observed going to her vehicle, standing up from the wheelchair, and effortlessly putting the wheelchair into her vehicle. Because of the patient’s extensive medical history and unsolicited information relayed by the PSA, the CNS diagnosed the patient with Factitious Disorder and met with the collaborating psychiatrist to discuss treatment options. The psychiatrist concurred with the diagnosis. The PSA’s information influenced the providers’ diagnosis of the patient; however, the CNS believed that she had a duty to perform the most comprehensive assessment possible, including collateral information from others, to arrive at the best diagnosis and treatment plan for the patient. This breach of confidentiality had the potential to benefit the patient if the diagnosis was accurate and treatment was successful.

Questions for Discussion:

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1. Do therapeutic ends ever justify unethical means? Do they justify the ends in this case?

2. Where, when, how was patient confidentiality breached? Was it? Would it be different if the pain clinic was in a different building?

3. Is it legal/ethical to film someone without their permission?

4. Should the patient be told about the breach?

Discuss healthcare trends and their relationship to medical assistant practice. Identify medical specialties and specialists certified by the American Board of Medical Specialties (ABMS). Recognize the duties of various allied health professionals with whom medical assistants may work.

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