A healthy 28-year-old man comes to the office for a routine health maintenance examination. The patient is seen by his primary care provider, who has known him since childhood. The provider also cares for the patient's 26-year-old wife, who is currently pregnant. The wife is also followed regularly by a high-risk obstetrician for serial ultrasounds due to complications of Rh(D) alloimmunization. She is Rh(D)-negative; her husband is Rh(D)- positive. Her records indicate that she had been pregnant previously with another partner and had an elective termination of pregnancy. During the visit, the patient discusses how excited he and his wife are to become new parents. He mentions that he has done some research about Rh sensitization and has read about cases similar to his wife's. He asks how his wife could have this problem considering this is the couple's first child. Which of the following is the most appropriate response?

Question

A healthy 28-year-old man comes to the office for a routine health maintenance examination.  The patient is seen by his primary care provider, who has known him since childhood.  The provider also cares for the patient's 26-year-old wife, who is currently pregnant.  The wife is also followed regularly by a high-risk obstetrician for serial ultrasounds due to complications of Rh(D) alloimmunization.  She is Rh(D)-negative; her husband is Rh(D)- positive.  Her records indicate that she had been pregnant previously with another partner and had an elective termination of pregnancy.  During the visit, the patient discusses how excited he and his wife are to become new parents.  He mentions that he has done some research about Rh sensitization and has read about cases similar to his wife's.  He asks how his wife could have this problem considering this is the couple's first child.  Which of the following is the most appropriate response?

Quizplus · Accepted Answer

Explanation: The HIPAA (Health Insurance Portability and Accountability Act) law states that a provider may share a patient's health information with family members if the patient is present (or otherwise available prior to the disclosure), has the capacity to make health care decisions, and agrees (or does not object) to the information being given. In this case, there is no indication that the wife has been asked about her wishes regarding sharing information with the husband. Given the sensitive nature of the information regarding her past pregnancy and termination, it is particularly important not to make any assumptions about her wishes. Because the wife is not present to agree or object, the most appropriate course of action is to explain that no information can be shared without her permission. (Choice A) It would not be appropriate to advise the husband to make an appointment to discuss the issue with his wife, unless the provider previously obtained the wife's permission to do so. (Choices C and E) Rh(D) sensitization can occur in a first pregnancy in the rare instance of previous maternal exposure to Rh(D)-positive blood (eg, blood transfusion, needle stick). However, a provider should not knowingly mislead regarding the etiology of a family member's health condition or avoid the problem by referring the family member to another physician to address the topic. (Choice D) This statement, although accurate, implies that the wife had a past pregnancy and violates her right to privacy. If the husband's health or safety is not jeopardized by his wife's condition, the provider should not disclose any confidential information about her to him. Educational objective: The HIPAA (Health Insurance Portability and Accountability Act) law states that a physician may share a patient's health information with family members if the patient is present (or otherwise available prior to the disclosure), has the capacity to make health care decisions, and agrees (or does not object) to the information being given. This should be honored unless a situation jeopardizes a family member's health or safety. References: Respecting patient confidentiality. (http://www.ncbi.nlm.nih.gov/pubmed/25627535)

A Healthy 28-Year-Old Man Comes to the Office for a Routine