Screw HIPAA: Here’s a Look at My Doctor’s Office

Screw HIPAA: Here's a Look at My Doctor's OfficeA few months ago, I complained about the layout of one of my doctor’s offices. There’s a rough layout drawing of the office waiting area to the side there. I’m standing just in front of the number 1, while people are sitting along the wall behind me.

Do you see the problem?

After I identify myself with both my date of birth (Seriously, this is the first thing the “medical secretary” asks you for when you walk in — already setting the tone for the visit — you’re just a number to them) and then my name, I have to discuss the reason for my visit. Just about 6 feet away from all the other patients sitting in what passes for a “waiting room” (really just a hallway with some uncomfortable chairs in it).

I’m not concerned about HIPAA. I’m concerned about how little my doctor cares for my privacy in their own office.

I walk in and stand waiting in front of the two “medical secretaries” desks (labeled 1 and 2 in the drawing). Both are on the phone when I come in, because apparently both are on phone duty as well as addressing the actual people standing in front of them. Awkwardly. Waiting. With a sample.

Another person comes up and stands next to me, oblivious to the fact that I’m also waiting for the first available secretary.

The first secretary finishes with her phone call, ignores me, and starts talking to the person who stood next to me. Zero awareness of who was there first, and a look that says, “Don’t bother me with your petty problems, menial patient!”

After about 5 minutes of standing there, waiting, the second secretary finally finishes up with her phone call.

“Date of birth?”

No, “Hello, how are you?” No, “Hi! What’s your name please?”

Nope, my first interaction is simply regurgitating my number. How utterly dehumanizing. I sputter out my date of birth, heard easily by a half dozen patients in the waiting area.

“Your name?”

I say my name, realizing that if someone is into identity theft, they are pretty much halfway there with me just wanting to check in with the doctor’s front desk.

Type, type, type… She types furiously at her computer terminal, never cracking a smile, never saying a word of welcome or encouragement. The amount of typing she’s doing just to pull up my medical record is worrying.

I look beyond these medical secretaries and notice that other office personnel (A and B in my drawing) — oblivious to the growing line behind me — are easily also within earshot of my discussion with the front-desk folks. One woman looks at me as she’s having a great conversation with a co-worker, laughing.

Are they talking about me? I hope not, but given my lack of privacy here, I have no idea. I try and put my ridiculous paranoid thoughts aside.

“What brings you in today?”

“I’m here to drop off this sample for Dr. Smith,” I say.

Back to the computer screen. Type, type, type. Ignore the patient again for a minute or two, while all this data needs to be entered. A few minutes later, she actually looks up at me as she hands me a printer-generated label for my sample.

“Place this on the sample, and then put the sample in the tray.”

“Umm, where’s the tray?”

“The tray is around the corner. It’s labeled “urine samples,” but put it there anyway.”

The tray is the starred item in my haphazardly drawn office layout. Walk by the other patients nonchalantly…

“Don’t mind me, just dropping off my sample…!” I think.

Around the corner I arrive and see a tray with two urine samples in it. Ewww. Okay, place my sample on the tray next to them.

Walk back up to the medical secretary’s desk, but she’s no longer there. Gone.

Just like me, never to return to this particular medical practice. Because if this is the way patients’ privacy is treated — non-existent — then I think I’ll take my business elsewhere.

The lesson in all this? If you’re a doctor, your actual office environment matters. Designing a waiting area with no regard for your patients’ privacy sends a clear and unfortunate message — their health concerns are public knowledge within your office environment, and not subject to any sense of privacy or basic human modesty.


Posted in: e-patient stories | general | hc's problem list | policy issues





19 Responses to “Screw HIPAA: Here’s a Look at My Doctor’s Office”

  1. Jeff says:

    Very consistent with many offices I have visited. Yes, I wonder what my doctor thinks of my privacy and the process you describe seems to be more the norm than the exception, a very cold approach to the task of intake. Intake?

  2. Teresa Masters says:

    I have long said/observed, that physicians are not in charge of their own offices. They are unaware of the often less than private or personal interaction with “the front desk.”
    Apparently an often used computer software program’s search begins with the birth date for data storage. Sadly this is for every department within the same office. Dehumanizing to say the least, redundant, and seemingly goes downhill from there.
    In the university based physicians group I participate within, even the doctors are obliged to toe the line. I personally am pleading to be put back together, specialists rarely reconstruct Humpty Dumpty. I am still a part of an incomplete puzzle. Help.

  3. Marge Benham-Hutchins says:

    The best registration process I have ever seen was in a university health center. The system had been developed by a grad student. This was in the 1990’s. You registered yourself! Could update your information and a variety of other tasks. Once your registration was submitted a person behind the window acknowledged you and indicated the approximate wait time.

    So why can’t doctors offices have kiosks for registration?

    • Some do, Marge, though I can’t point to them. Anyone?

      What university? Warner Slack, who has famously said “patients are the most under-used resource in health information,” was in Madison back in the 1960s.

  4. MBH says:

    University of Texas at Arlington. Yep Texas. I wrote a paper on the system during my masters program. I think about 1999.

  5. I feel your pain, John. I futilely try to lower my voice when stating my personal information in the very public waiting areas at a large medical center in New York City. The kiosk idea is wonderful! Private check-in kiosks are ubiquitous at airports; why not at doctors’ offices, or at least at major hospitals?

  6. Bob Swann says:

    Sounds like you need a new doctor! There are still doctors out there who care about their patients and their privacy, albeit they are hard to come by.

  7. Mighty Casey says:

    During rads treatment for cancer, the checkin system at the where I got tx-ed was based on a keytag very like the one you use at the supermarket as a “preferred shopper.”

    It had a barcode on the back (the same one I’ve said I’d get tattooed on my neck to avoid having to fill out another flippin’ health history form), which I scanned when I arrived at the hand scanning station next to the Window Of Administration. If said Administration wallahs needed to talk to me for some reason, the window would open and they’d say “Ms. Quinlan?” and we’d discuss whatever was on their docket.

    I was also called to the Glow Room by a “Ms. Quinlan” on the blower. Why can’t all medical offices use that low-tech level of data capture/flow? One of my Disruptive Women posts asks that very question:

  8. Jennifer Pawlowski says:

    Very insightful article. Thank you.

  9. Kristin Oaks says:

    My office has a thing called a phreesia pad, it’s like an orange laptop that the patient can check in on, fill out a brief questionaire and pay their copay by swiping a card. They barely ever use it though because we try to see the patient at their appointment time. We also know all our patient’s usually by their first name. I can’t even imagine asking for their birthdate. I do have 2 sets of patients with the same first and last name, and I do look at their birthdate when I am documenting on their record, but I don’t have to ask, I know which one is the older of each pair and I just added the middle initial to that patient in their record. For those of you frustrated by what you are finding, you might try looking at the Ideal Medical Practices website. We are a group of physicians who value the relationship based care we practice.

  10. Chris says:

    Ugh, Kristen, I recently had to use Phreesia at my GP’s office, and nothing felt more dehumazing and invasive than using a third party to check in. I felt badly for the elderly struggling with it. I didn’t know what entity was going to have my medical info or credit card data. Further, the market research questions and advertising were unexpected and obnoxious, especially in a medical professional’s office. To me, Phreesia is part of the disconnect between office and patient – humans. I hated it.

    • Sam says:

      Chris…I felt your pain today at a medical appointment. I was so stunned by 1) the time it took to answer Phreesia questions (the basics I don’t mind, but what the heck does race have to do with today’s appointment); 2) I answered a question about medication I’m currently on…a few screens later an ad appears (which I couldn’t not bypass) for symptoms associated with my medication. That’s when I lost it. Made a small scene with the front desk and doctor. The doctor said they’ve had numerous complaints about the invasive questions/ads – and planned to dump Phreesia. I sure hope so. A third-party vendor interfering with my medical appointment STINKS!

      • Sam, sorry for the delay in clearing your comment- my notification widgets have not been working. :-(

      • Peggy says:

        Regarding the comments about the Phreesia pads. Yes, they are dehumanizing and I understand the questions seem irrelevant to your chief complaint, but the questions and format are simply following CMS (Medicare/Medicaid) guidelines which most insurance companies have adopted. Documentation for patient visits must include a history, exam and assessment and plan. Understand too, that medical records are considered legal documents and must stand up in a court of law should there be a malpractice suit.

  11. Doris says:

    I had my first experience with the Phreesia pad yesterday. After thinking it over for a minute, I decided it is a good idea. No more going over my meds (I take 16 different ones) with someone at each visit. I can review, and make changes myself. No more filling out forms every six months like at one doctor’s office. And no more having to remember to bring a check or enough cash because certain Dr.’s don’t take credit cards. And no one over hearing why you are here today. They all should have this.

  12. Kevin says:

    Indeed de-humanizing. It’s time to find a different Doctor.

  13. jt says:

    I know what it’s like to be on the other side of the desk.

    EMR systems make it really hard to maintain eye contact with patients when you need to go through dozens of mandatory “clicks” and questions before actually “arriving” a patient. Any mistakes made by the front desk can turn into a nightmare fairly quickly, and the EMR technology is extremely cumbersome, so this makes it impossible to “move on” to the next patient before updating the previous patient’s information, entering the order, scanning the documents for that first patient, etc.

    Most of the receptionists have 0 control over their working environment, have 0 control over the office space they work in and 0 control over how packed the waiting room is. The front desk is at the mercy of what the MDs, nurses, and managers want and expect. I believe the trend by the bean counters and administrators who run hospitals/medical offices currently is to cut so deeply into front office staffing as to make the front desk staff completely burned out and stretched to the max.

    I’m not excusing office staff for rudeness, but trying to explain why these things appear the way they are, and I doubt it’s going to get any better.

  14. overexposed says:

    Don’t forget the violations of medical privacy that happen when the patient can only contact the doctor’s office during office hours!

    There’s a small risk of a hacker reading my private medical info if I go home after work and send my doctor/health insurer/etc. an email for him to read when he gets into work the next day.

    There’s a LARGE risk of my coworkers or even my boss HEARING my private medical info if my doctor/health insurer/etc. doesn’t take email and instead I have to call him when he is at work the next day, which is the same time I’M at work. Calling at lunch is no good either because my lunch break could be over by the time I’m not on hold anymore.

  15. Peter J. Liepmann MD FAAFP says:

    Primary care is broken after being systematically starved for 70 years. Yes, your health insurance and health care suck. Your insurance company designed it that way because good primary care reduces costs, and ins co profit is a % of gross, so their profit goes up when…
    Employers, employees and primary care interests are aligned. Better primary care saves money and improves outcomes. But that’s not what the payment systems promote. Self funding plus DPC….

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