Patient Confidentiality: An interpreter’s biggest responsibility

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Let me preface this by saying it is my biggest hope and expectation that this post is the biggest waste of time because the statements are so obvious and clear to every professional medical interpreter that it’s like telling a cab driver to start the car’s engine before driving onto the road. Duh! But here’s a little back story on how this topic bubbled up for me. . .

I was having breakfast at a restaurant one fine Saturday morning. The patrons were quite boisterous and everyone seemed to be having a good time. There was a small group of diners at the next table, and one person was dominating the conversation. Because of her volume and my proximity to the conversation, I could understand everything she was saying. 

She was talking about her challenges and stresses in her work as a nurse at a healthcare facility. On the one hand, I felt for her. It seemed like she was really run down. On the other hand, I thought, gosh, I sure hope she’s not my nurse if I’m ever in the hospital. Mostly, I was thinking that the conversation might not be a HIPAA violation – no individually identifying information was revealed, but it was in bad taste.

I imagine she was operating under the false presumption that her conversation was somehow private. I have no idea who the other two individuals were at the table or their relationship to her. But if they were nurses as well, I’m guessing they thought they were in the same fictitious privacy bubble. If they weren’t, I’m guessing they were either oblivious to the awkwardness of the topic, or they were silently thinking what I was thinking. Who knows.

I’d be willing to bet a pretty penny (I’m not a big gambler) that if she were in the hospital cafeteria, she would not have been having that same conversation. 

Interpreters are no different than nurses or other medical professionals with regard to their legal and ethical responsibility to maintain patient confidentiality. Interpreters, however, are possibly in an even more precarious and demanding situation when it comes to confidentiality of the cases they encounter, especially if they live in a small community where everyone knows everyone and especially if it’s common practice within the community to talk about other people’s situations. 

Because of this, it is even more critical that interpreters don’t share inadvertent comments about their work and end up contributing to a false belief among the community members that interpreters don’t keep information confidential.

Do not talk about your work at all. Not even in the most vague of terms. If you do, you are demonstrating that you are willing to talk about the cases you see. The people who hear you won’t care that you haven’t identified an individual. They will just know that you are willing to jaw about people’s personal lives. Not cool. Not confidence-inspiring. 

It doesn’t matter if your comments are positive. The nurse in the restaurant example was talking about a lot of negative stuff. That was off-putting, but it wouldn’t have been any less inappropriate had she been making positive comments. The problem isn’t talking bad about people. It isn’t talking good about people. The problem is talking about people. Don’t. 

Don’t think that no one around you will know whom you’re talking about anyway. As I stressed earlier, that’s not the point. What’s more, you might be flat-out wrong. 

I’ll give this example of a non-medical conversation wherein the identity of the individual was inadvertently revealed:

The other day I had an in-passing conversation with the property manager where I live. He mentioned that a tenant had urgent business that Saturday morning, and knocked on their residence door at 7:30 AM. His tone was dripping with sarcasm, and it was clear he was annoyed by the early morning visit. The urgency? The tenet wanted to report that there was no longer a cat in the unit. It was clearly not a maintenance emergency. He didn’t say who it was, and it was considerate of him to withhold the person’s identity. His intention wasn’t to throw any one under the bus; it was to let off a bit of steam. 

Later on my husband said a neighbor visited and mentioned she got rid of her cat.

Coincidence? Maybe. But I’m pretty sure I figured out who had annoyed the manager at 7:30 on a Saturday morning.

For a little perspective, there are 90 units in the complex. I know the names of families in three units. Chances were pretty good I wouldn’t have even known the person had the manager said the name. But, through the grapevine, it was revealed.

Can this scenario happen with medical information? You bet it can. So. Don’t. Share. Any.

If you are on a voyage to planet Mars with one other person and have no hope of returning to planet Earth and there exists no possibility of remote communication with any Earthlings, even then do not discuss the cases you have encountered while interpreting. Not. Even. Then. 

Yes, there are provisions for appropriate and confidential debriefing with a supervisor. This is not the type of communication I’m talking about, but even these professional debriefing sessions respect the confidentiality of the individuals. 

After a particularly challenging day you might not have a supervisor or colleague with whom you can debrief right away. You might be tempted to decompress with a family member or friend. This temptation might creep up in a private space, like your living room, or in public area, like a restaurant. You might have every intention of protecting the identity of the patient, and you might be successful in doing so. . . as far as you can tell. But you will be wrong. 

Don’t vent to family or friends. Don’t say, “I’m not saying who, but someone really had a difficult labor yesterday. They finally did a C-section.” Someone will know exactly whom you’re talking about.

Be very careful to never give anyone the impression that you’re willing to discuss information you’ve learned while interpreting. No possible good can come of that. 

As Shawna Stevenoski says, “Interpreters are paid to forget.”

Now that’s a phrase worth remembering.

Posted on October 13, 2015 and filed under Interpreter.