In these days of HIPAA regulations, with all the accompanying agreements to read and sign to protect patient privacy, my clients often tell me that they are not always sure just how private their information is. Their concerns about how their doctors are maintaining confidentiality begin in the waiting room.
A client I’ll call Marty described a situation that occurred in his physician’s waiting room.
Marty was waiting to see his doctor. He couldn’t help but overhear a telephone conversation that one of the doctor’s support staff was having. The staff member was apparently calling a patient at her place of employment. She asked for the patient by name. When the patient answered, he went over her test results with her.
Marty didn’t know this patient. But he couldn’t help but wonder if she would have appreciated knowing her test results were being broadcasted to the other patients in the waiting room. Most likely not. And, Marty could also help but wonder if his own confidential information was being made public whenever he received a similar call.
“On one hand, I was happy for her. She’s undetectable. On the other hand, I don’t know if she wanted her news to be shared with a roomful of strangers.”
Another client I’ll call Anna told me a similar story.
She goes to a physician who specializes in HIV, though she treats other conditions as well. Still, when Anna goes to her doctor, she basically assumes that many of the other patients in the waiting room are also HIV positive.
First, Anna has a unique last name. So it concerns her when a staff person steps into the waiting area and uses her full name to summon her for her meeting with her doctor. Anna fears that another patient will look her up on social media, or ask other people about her. This has happened to Anna in non-medical situations.
“I wasn’t born here, and my last name is not a typical American name. If fact, if you Google my name and my city, it’s only me who pops up.”
Sure, Anna is concerned about HIV stigma. But more important, “where I go for medical care is my business alone. I don’t want it spread around.”
Recently, when Anna was checking out after her appointment, she witnessed another privacy issue. Some printouts of lab reports were laying on a counter she passed, with patient names clearly visible.
Maintaining Your Privacy is Your Doctor’s Responsibility. But It’s Also Yours
Both Marty and Anna expressed concern not only about confidentiality, but also about whether they should bring this up with their physician. Neither wanted to “ruffle their doctor’s feathers” or otherwise create conflict with a physician they trusted with their healthcare.
Most important, they didn’t know how to have this conversation.
Have you ever had concerns about how confidentiality is practiced day-to-day in your doctor’s office? Whether or not your privacy is being adequately respected and protected? While not feeling comfortable about the best way to bring this up?
Here are some ideas to get this conversation going:
First, give yourself permission to be concerned. One of the ways humans avoid conflict is to talk themselves out of their own legitimate thoughts and feelings, to tell themselves that it’s really no big deal, that you are just being “paranoid.” That’s like “gaslighting” yourself. Regardless of how much you “love” your doctor, your patient privacy is important, and should not be carelessly placed at risk.
Discussing confidentiality does not have to result in conflict. You can address this issue in various ways, some more direct than others. But also, don’t assume that bringing this concern up with your doctor is going to make them angry or defensive. Most medical offices make confidentiality a priority, even if certain aspects are falling through the cracks, as with your physician. And keep in mind, confidentiality is mandated for healthcare providers. So bringing up a gap in confidentiality will ultimately be doing your doctor a favor.
When you see something, say something. Confidentiality issues are best addressed in the moment. So, in Marty’s case, he might have stepped up to the front desk and in his calmest and friendliest voice, said something like, “Hey, I couldn’t help but overhear your conversation with your patient about her lab results. That made me really uncomfortable. I don’t think she would like it either. Just wanted you to know.” And Anna, also in a calm and friendly voice, might have said something like, “Would you mind not using my last name when you call me for my appointment? I am really concerned about protecting my privacy when I am here.” Why calm and friendly? Because the people you address your concerns to are more likely to be able to hear, and take in what you are saying, if you avoid speaking out in anger.
Be proactive. When you check in at your physician’s office, you might also want to remind them that you are concerned about your privacy, and ask the staff at the front desk to please not use your last name when they call you for your appointment. Sure, they may not remember. But at least you tried.
Let your doctor know about any concerns regarding their staff. Here’s where my clients express discomfort. We often look to our physicians as authority figures, and it’s hard to call out someone in authority about something you don’t think they are doing well. But again, you can introduce this conversation in a positive manner. Say something like, “You know I value our relationship. And I appreciate the efficiency and friendliness from your front desk staff. But I have to tell you something that occurred that has left me feeling uncomfortable.” And then calmly describe what happened. Follow up by emphasizing how important confidentiality is to you. “It’s really important to me that other people not know about my health unless I want them to, and I am sure your other patients feel the same way.” Again, raising this issue with your doctor is helping them to stay in compliance with federal mandates.
Also consider speaking with the office manager. Your doctor may be delegating privacy compliance to their office manager. If so, speak directly with this person, using a similar approach as I suggested for your doctor. However, you might also want to let your doctor know you had a talk with their office manager regarding patient privacy.
Your physician’s reaction will tell you a lot. Your doctor may show concern, apologize for the confidentiality lapse, and promise to address the issue. Your doctor may also become defensive, even discount your concerns. Whether or not your doctor is willing to respond to your concerns will tell you a lot about their commitment to confidentiality.
Letters and email are also effective. You may be uncomfortable about having a direct conversation with your doctor. Or your appointments may be so brief, due to their schedule, that you hardly have time to talk about anything. If so, you might consider writing a letter or an email, detailing the event and expressing why this was a concern. You might also want to back up a conversation with a written response. If you write it to the office manager, also consider sending a copy to your doctor.
The law is on your side. If you feel your doctor’s office is blatantly ignoring patient confidentiality, and consequently placing you and other patients at risk from a confidentiality perspective, this may need to result in a formal complaint. As a patient, you have a right to report this to your state’s medical board.
Of course, you can also vote with your feet. You don’t have to stay with a medical practice that does not appear to be committed to keeping private patient information confidential. So if you witness repeated violations of your private information, or the private information of other patients, and your attempts at rectifying this situation don’t seem to be taken seriously, then it might be time to do some doctor-shopping and take your healthcare elsewhere. But if you do, you might also want to consider letting your doctor’s office know, in person or by letter, why you have chosen to leave.
You and your doctor. Keeping your private information confidential is the responsibility of your physician and his staff. If you don’t feel comfortable that confidentiality is being taken seriously, then raise the alarm. This benefits you and it benefits other patients. And it benefits your doctor. And after all, you’re a team.
Gary McClain, PhD, is a therapist, patient advocate, and author in New York City, who specializes in working with individuals diagnosed with chronic and catastrophic medical conditions, their caregivers, and professionals. He maintains a website, www.JustGotDiagnosed.com.