Your doc’s receptionist can be a secret weapon in the HIV wars. Here’s how to keep ’em on your side.
In her 17
years as a medical-desk receptionist, the unflappable Jo Dunham has
encountered every species of patient. So as April 21, 2004—Secretary’s
Day—neared, her colleagues at the Center for HIV Prevention and Care in
Santa Rosa, California, didn’t know how to surprise her. “But then,”
says case manager Brian Griffiths, “we figured it out.”
On the
big day, as Dunham and the other receptionists gathered behind the
counter, a door burst open. A chorus of HIVers—10 men and two women,
all clients at the center’s counseling group—cavorted in. Each was
dressed as a prototypical “problem patient.” The “Shy Guy” covered his head with a
Five keys to the front desk’s heart
1.
Barring an act of God, cancel any appointment at least 24 hours in
advance. And if you’re running more than 10 or 15 minutes late,
remember our friend Mr. Politeness—and ask the receptionist if another
time might be better.
2. Drop the inflexible act: You can’t
always get the time slot you want. Mark some recurring free time for
possible emergency visits.
3. Don’t wait until the last minute for a prescription refill. Again: 24 hours, please.
4.
Though caring and concerned, most receptionists need to hear only
enough of your medical history to justify an appointment. They’re not
nurses—but they can help find one.
blanket.
“Overbearing Mother” henpecked and hovered. “LA Queen”—well, you get
the idea. Declaring themselves the Sisters Sludge, the 12 crooned a
heavily medicated “We Are Family” that ended: “I got all the front
staff with me / We are family / Get up every day and sing!”
"They’d
obviously thought this out and practiced it,” Dunham says. “It was very
touching.” Adds Griffiths, who helped coach the sisters and is positive
himself, “It was their way of thanking Jo and the others for the
comfort they’ve given them.”
While your HIV clinic and doctor’s
office may not be as freewheeling, it may offer opportunities to
develop receptionist relationships that exceed the typical “your copay
is $15” exchange. Receptionist Jeana Giglio, for instance, who works at
My Doctor, in Cincinnati, met HIV patient Mark Reed, now 43 and a
prevention educator, in 1995. “We clicked immediately,” says Giglio.
“We grew up on the same side of town. I have a gay brother who came out
about the same time we met. I instantly felt Mark was like a brother.”
This and other patient relationships have helped inspire Giglio to
broaden the warm-and-fuzzy skills she acquired on the reception front
lines. Though not a nurse, she knows her way around a stethoscope,
expanding the therapeutic dynamic she and Mark share.
Such
dynamics reach far beyond the office. Tamela Hopkins, also a My Doctor
receptionist, recalls shopping with friends and bumping into two
clients, whom she immediately hugged. “My friends were surprised I did
that, but that man had brought me vegetables from his garden,” she
says. “Our clinic is small. We know everyone personally and care what
happens to them. The waiting room is so social.” Hopkins adds that she
fills any lulls in her day by placing calls to elderly patients just to
check in. She considers mind-reading part of her job description: “When
patients walk in, I can tell right away if something’s wrong.”
Those
who haven’t met the earnest fresh-faced Hopkins may dismiss her
comments as Pollyannaish or self-serving—if her patients didn’t swear
by her. And she’s hardly unique. In HIV clinics large and small, rural
and urban, doctors and clients alike often speak of their receptionists
in the reverent tones reserved for spiritual advisers (or personal
trainers).
The reasons are many, but Douglas Magenheim, MD,
who runs My Doctor, pinpoints a huge one: “Many patients, not just
HIVers, are stigmatized by their medical conditions. They may not feel
comfortable talking about many personal situations—especially sexual
matters. A first exposure to happy and energetic staff members makes
patients feel more at ease, and more likely to talk with me as well.” Just
imagine most doctors, even the most personable, parroting the long-held
credo of receptionist James Forney, a 30-year-old volunteer at the
Light Foundation AIDS Service Organization in Oahu, Hawaii. “I’m a big
hug person,” Forney says, “and like to greet everyone with a big one.”
All
this love can include tough love, too. “Because the patients do trust
me,” Dunham says, “I can speak my mind. When they confide that they’ve
done something they shouldn’t have done, I say, ‘What the hell are you
smoking?’” Receptionists say this trust is vital—patients may feel
uncomfortable telling their docs they’ve missed meds or had risky sex.
Many patients rely on receptionists as a mediating third party, asking
them to convey sensitive information to the clinician.
Indeed,
your HIV clinic or doctor’s office ignores receptionists’ power at its
own peril—as do you. Ken Howard, an HIV positive therapist who has
spent years working with fellow HIVers and observing front-deskers as
the point of first contact, says: “A sensitive and caring receptionist
can become a support system, but an abrupt, inappropriate receptionist
can undermine the good work of a therapist, doctor or nurse.” He adds:
“Clinical administration must also realize that receptionists aren’t
paid or trained enough to be counselors in their own right. Unlike,
say, law-firm receptionists, they need to be taught how to deal with
the impaired and difficult patient.”
In some instances, it may
be the receptionist who is impaired and difficult (for tips on winning
over even the steeliest Nurse Ratchet, see “Five Keys to the Front
Desk’s Heart,” page 35). Beyond complaining to your doctor, you should
also know that your privacy and confidentiality, as well as your
medical records, are protected by law (see “Intimacy Issues,” right).
In
rural areas, where access to treatment information may be limited, HIV
doc receptionists wield even more power. Judd Davenport, 31, who has
been HIV positive for nine years, lives in Hartshorne, Oklahoma, a
90-minute drive from his Tulsa doc. “It’s horribly stigmatic for HIVers
here in southeastern Oklahoma,” says Davenport. “This is the boonies,
and AIDS isn’t treated here—it’s like all mention of it has been
blocked out.” He depends on his Tulsa receptionist, Dorinda Jones, for
referrals and med info, an abiding friendship and mutual respect.
“Dorinda’s my everything,” he says. “You don’t know what it’s like to
finally meet someone who won’t whisper that you’re HIV positive behind
your back.”
Receptionists insist that the office environment
provides more than a psychological lift. “If the patient loves the
office, it’s sometimes one of the strongest reasons for them to hang
on,” says Dunham. As Cincinnati’s Mark Reed was battling opportunistic
infections and weight loss, “Jeana would tell me how good I looked. And
when I called her on it, she said it was the real ‘me’ that made me
look so beautiful.” When Reed and Giglio both turned 40, Giglio treated
him to dinner and tickets to Rent. “I believe she’s added years to my
life,” Reed says.
As miraculous as such relationships can be,
working at an HIV practice is often demanding and draining, even in
this age of “AIDS as a manageable disease.” Dunham recalls a patient,
whose partner had just died, who slipped in through her clinic’s back
entrance and insisted that the death certificate be signed immediately.
“In his anger and grief, he screamed and yelled,” she says, “and scared
the shit out of me. Eventually, he apologized, but we changed the
locks.”
Intimacy Issues Just
because you and your receptionist play Uno every Wednesday night
doesn’t mean the front desk can dish about your medical history. The
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
created standards to protect personal medical information when new
technologies threatened privacy. HIPAA guidelines prevent docs,
pharmacists and insurance companies from sharing your info with others.
It guarantees: Access to records: You can request copies of your medical records and correct errors.
Notice of privacy practices: Health plans and care providers must tell you how personal medical information is used.
Limited use of information: Your consent is required before identifiable information is shared or used.
Confidentiality: You can insist that your insurance and doctors ensure confidentiality.
Marketing restrictions: Pharmacies cannot use patient information for marketing purposes without consent.
Complaints: You can file a complaint if your health information was wrongly revealed within the past 180 days. Drop by www.hss.gov/ocr/hipaa, or call 866.627.7748.
Dorinda
Jones, who juggles schedules for 25 doctors and nurses and shuffles
files and paperwork, finds being a supportive, caring presence a second
full-time job. “I could happily chat with patients all day,” she says
warmly. “But after expressing my due sympathy and keeping things
upbeat, I sometimes have to cut them off so I can get my work done.
Sure, clearer boundaries would be helpful, but then it just wouldn’t be
the same.”
Jones hopes that as her office transfers to paperless,
computerized systems, she can spend more time with each patient. “I do
the work of several people—I’m overworked and underpaid.” Then she
pauses and smiles even more brightly. “But at the end of the day, I’m
here because of my patients.”
