Writing Resources from Fifteen Minutes of Fiction

Privacy - it ain't about HIPPA.

If you asked the regular Joe Shmoe on the street to let you accompany him into his doctor visits, chances are he'd think you're crazy. Nobody wants a stranger in their business; nobody.

Welcome to the delicate role of the interpreter.

I was interpreting for a young Guatemalan gentleman last month, in dermatology, for severe acne on his upper chest and abdomen. We were well into the doctor's interview when I realized either my communication was breaking down, or something was wrong. No matter how many gentle requests and hints the doctor dropped about unbuttoning his shirt to see the acne, he never got more than two buttons undone. She'd peek, and he'd button right back up. It took me a minute, but I realized that my presence must be embarrassing him. The next time we tried that number, I pulled the curtain, stepped a foot or two behind it - and what do you know, the shirt came off and stayed off! What was more interesting was the fact that a troop of about 10 medical students came in a few minutes later (with his permission) to examine the case with an attending, and I was the only one he needed behind the curtain. I think it's the lay clothes - I have no white coat.

Custody of the eyes is part of an interpreter's unwritten code of behavior. As we are not medical staff, and usually have no clinical reason to be looking at the patient, vision often become superfluous. I should probably be able to tell you the wall colors of most hospital clinic rooms - we spend a lot of time looking at each other. The ceiling and floor get a fair amount of attention, but the wall, particularly the one right behind a patient's head, is the usual center of focus. Day after day, appointment after appointment, I stare at them, either for the patient's comfort during a procedure or exam, or simply to get the patient and doctor to look at each other and build that rapport. I should know them all, every tone across half a dozen buildings. Funny though - I only remember a few. Labor & Delivery is a cool, light lavender; OB GYN has purple curtains and gorgeous light covers over the exam tables, depicting flowers, ocean scenes, or clouds; and depending on which room you get in the Outpatient building, they're either a rather mustardy yellow or a faded tan. But I don't remember the rest - mostly because no matter where my eyes are, I usually am not seeing. I am thinking, switching words, listening to patient hints in their tones and word choices. Processing, waiting for the silence that lets me know I need to look up for a facial cue to work with. So sometimes, a patient's embarrassment catches me by surprise. I don't really SEE their bodies, you understand - just their words.

I got gently (but definitely) kicked out of a room for the first time yesterday. A middle-aged Dominican came in with his English-speaking adult son, who was very fluent, but they opted to still use my services. Although patients do have a right to waive an interpreter's service by signing a form, choosing to utilize it is actually a really smart choice, and not because interpreters want job security. Fluent doesn't always mean bilingual, nor does it mean that the family member (who is suddenly thrust into the spotlight) is comfortable with medical terminology. Me, that's my specialty. I may not joke around very fluidly in Spanish sometimes, but I can sure interpret the ins and outs of just about any -ectomy or -itis there is. The son was more than happy to step back and let me help them. I keenly feel the privilege of a family member entrusting their father, mother, aunt, daughter, to my care, and while it makes me a little nervous to have them listening in, I'm glad for the opportunity.

We'd skirted around the issue of a prostate enlargement earlier in the visit, and the doctor finally let the patient know that yes, he needed a quick exam. I was getting ready, out of habit, to head behind the curtain, when this big, burly man turned, looked at his son and said, "Entonces, ella necesita salir, si?" "So then she needs to step out, right?" She clearly being me. The poor patient actually looked nervous, and very apologetic. I didn't even offer to stay behind the curtain - this man, who was a perfect gentleman and extremely friendly, just didn't need to be put in that uncomfortable situation. We agreed that he would be OK with the son giving him any positional instructions that may be needed, just during the exam, and I would be right outside the door when the doctor was ready to talk to him again. I could only smile to myself as I thought, If you only knew how many much more uncomfortable situations I've been in... But he hadn't been, and that was they key. While I was extremely used to talking about normally touchy subjects, my patient was not. For him, it may have even been a first.

Privacy isn't about HIPPA. We hear 'privacy rights' and everyone quickly scrambles through their brain files, looking for the rules and the right words, just in case an administrator asks. While that's all find and good, it isn't nearly a complete picture of what patient privacy means.

pri·va·cy
noun:
The state or condition of being free from being observed or disturbed by other people.
The state of being free from public attention.

Privacy is about making the patient comfortable - whether that's averting the eyes, turning slightly, or sometimes just ignoring behaviors in the room or untimely comments. To my mind, privacy is simply courtesy. Sometimes, I think we as medical professionals get so comfortable with the human body, so nonchalant about what is private, and sacred, and almost taboo. Thank goodness for it, as that calm air of experience can put a patient at ease, and actually more often takes the embarrassment out of a tough situation. But perhaps we forget sometimes that our patients haven't always had the advantage of that experience. Yes, we may have had this discussion a million times - but for a patient, there is always inevitably a first.

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