"They" are some of today's top-secret employees. Whether they're tracking down terrorists, holding back hackers, protecting politicians or withholding this year's Oscar winners, these folks have all perfected the art of keeping information under wraps.This was the opening of a recent AOL fluff piece by Candace Corner on “top-secret” careers. The ten she listed included things like FBI agent, nuclear engineer, detective, and psychiatrist.
While "top-secret" may bring to mind memories of a jet-setting, James Bond, "shaken, not stirred, variety," not all duties for top-secret jobs parallel the exciting lives of spies and secret agents featured in mainstream media and cinematography. Still, there is something to be said for mystery and a job that in some instances can really mean a matter of life or death.
Oh, come now. What about any kind of therapist, any clergy, and any and all medical personnel? Have you even heard of HIPAA? You must have, because you’ve had to sign the fifty thousand pieces of paper at your doctor’s office just like the rest of us. Actually, I can’t think of many jobs that don’t involve some kind of access to privileged information, but I guess that’s not sexy enough for an AOL fluff piece.
I believe in patient privacy, really. But during my time at the hospital, I’ve gotten as fed up with HIPAA as anybody else in healthcare (and believe me, nearly every healthcare worker has at least one HIPAA rant). HIPAA’s why I won’t make phone calls for patients anymore, because I got so tired of having to say, “Hi, I’m the volunteer chaplain, and _____ asked me to call you to let you know that s/he’s in the ER, but no, I can’t tell you a blessed thing about why s/he’s in the ER, because of the privacy laws.” (I’ll help patients make their own phone calls, but won’t make calls for them.)
We’re only supposed to give information to immediate family. Yes, well, and even if the person by the bed says, “I’m this patient’s child,” how do we prove it? Ask for a birth certificate or a DNA test? What about the cases where the patient’s kids don’t care and aren’t at the bedside, and the person at the bedside is the devoted nursing-home caregiver who’s sobbing and hugging the elderly Alzheimer’s patient who will only respond to this person, and therefore firmly believes that this person is family? I’ve learned never to make assumptions about the relationships of people who come with patients to the hospital. Many are children, parents, or spouses, but I’ve also seen neighbors, friends, a surprising number of ex-spouses, and, yes, home healthcare aides and nursing-home employees. At what point do we define family as “the people who care enough to show up”? At what point do we define family as “the people the patient loves, regardless of law or genetics”?
Here’s an ethical dilemma for you: Sobbing, devoted caregiver of elderly Alzheimer’s patient has asked Volunteer Chaplain to try to ascertain diagnosis. Volunteer Chaplain approaches Nurse and says, “Patient X’s friend would like to know if those tests have come back.” Nurse narrows eyes and says, “You mean Patient X’s child, don’t you?”
Does the volunteer chaplain:
A. Say, “Oh no, they aren’t related,” and therefore put everybody involved into a HIPAA straightjacket;
B. Lie and say, “Oh, you’re right, of course I meant Patient X’s child,” or
C. Gulp, swallow, turn green, and refuse to say anything.
Yes, this happened. I’m not going to tell you what I did, although you can probably guess. What would you have done?
Meanwhile, meet Patient A, who’s been brought in very confused and possibly intoxicated and is frantic to reach her husband. She’s tried calling him. He’s not home. He should be home. Worrying about him isn’t helping her mental state. Volunteer Chaplain, concerned, asks Nurse if anyone else has been able to reach the husband; maybe he’s on his way to the hospital? Nurse says, “Oh, that would be Patient B, who’s actually in this same department right now. He's on the other side of the wall from Patient A, but we can’t tell her he’s here, because they aren’t actually married. He’s just her boyfriend.”
No, I’m not making this up. However, Nurse has said this suspiciously loudly within earshot of Patient A, who for some reason becomes much more relaxed. When Volunteer Chaplain next approaches the bedside, Patient A smiles, winks, and says, “Please go tell him I love him.”
True or false: I’m violating HIPAA guidelines by even telling you these anecdotes.
Well, I sure hope not. I’m trying really hard not to. The HIPAA guidelines, helpfully explained here at Protect the Airway, require that all patient information be “de-identified.” In other words, I’m not allowed to say anything that could be traced back to a specific patient or staff member. This means obscuring all time references, changing genders if possible, changing medical information. All those patient stories on medical blogs? They’re composites, fictions based on truth but disguised for legal reasons.
As a volunteer chaplain, I’m bound by HIPAA. But as a volunteer chaplain, I also -- to quote the famous Hebrew National ad -- answer to a Higher Authority. Please note that I'm not clergy; at least two readers have assumed that I am, so I feel the need to be very clear about that, and you’ll notice that I’ve now included it in the "About Me" sidebar. But it doesn’t matter if I’m clergy or only my humble lay-volunteer self: patient stories are sacred, and patients trust chaplains to keep those stories confidential.
In point of fact, I’ve been known to share some patient information with nurses and doctors when I think it’s medically relevant, but most of what I hear isn’t. (They share information with me when they think it’s relevant, too.) And so far I haven’t, thank God, been privy to any of the kinds of hospital stories that would make me a mandated reporter.
But all of this means that the most moving and life-changing stories I’ve heard, the ones that show up in my dreams and color my thinking, are the ones I can’t tell. If my hospital anecdotes sound vague, you now know why. If anybody brought this stuff into one of my creative-writing classes, I’d be all over it: “Add more detail! What are these people’s names? What do they look like? When did all this happen?”
I could lie about those details, but that would feel disrespectful to the real stories. For several reasons, I can’t tell the full truth. So I stay vague, which is my way of trying to be honest while maintaining appropriate legal and pastoral boundaries.
Does this mean I can keep a secret?