Intimacy Issues 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
On thebig day, as Dunham and the other receptionists gathered behind thecounter, a door burst open. A chorus of HIVers—10 men and two women,all clients at the center’s counseling group—cavorted in. Each wasdressed as a prototypical “problem patient.” The “Shy Guy” covered his head with a
blanket.“Overbearing Mother” henpecked and hovered. “LA Queen”—well, you getthe idea. Declaring themselves the Sisters Sludge, the 12 crooned aheavily medicated “We Are Family” that ended: “I got all the frontstaff with me / We are family / Get up every day and sing!”
Five keys to the
front desk’s heart
1.Barring an act of God, cancel any appointment at least 24 hours inadvance. And if you’re running more than 10 or 15 minutes late,remember our friend Mr. Politeness—and ask the receptionist if anothertime might be better.
2. Drop the inflexible act: You can’talways get the time slot you want. Mark some recurring free time forpossible 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 onlyenough of your medical history to justify an appointment. They’re notnurses—but they can help find one.
"They’dobviously thought this out and practiced it,” Dunham says. “It was verytouching.” Adds Griffiths, who helped coach the sisters and is positivehimself, “It was their way of thanking Jo and the others for thecomfort they’ve given them.”
While your HIV clinic and doctor’soffice may not be as freewheeling, it may offer opportunities todevelop receptionist relationships that exceed the typical “your copayis $15” exchange. Receptionist Jeana Giglio, for instance, who works atMy Doctor, in Cincinnati, met HIV patient Mark Reed, now 43 and aprevention educator, in 1995. “We clicked immediately,” says Giglio.“We grew up on the same side of town. I have a gay brother who came outabout the same time we met. I instantly felt Mark was like a brother.”This and other patient relationships have helped inspire Giglio tobroaden the warm-and-fuzzy skills she acquired on the reception frontlines. Though not a nurse, she knows her way around a stethoscope,expanding the therapeutic dynamic she and Mark share.
Suchdynamics reach far beyond the office. Tamela Hopkins, also a My Doctorreceptionist, recalls shopping with friends and bumping into twoclients, whom she immediately hugged. “My friends were surprised I didthat, but that man had brought me vegetables from his garden,” shesays. “Our clinic is small. We know everyone personally and care whathappens to them. The waiting room is so social.” Hopkins adds that shefills any lulls in her day by placing calls to elderly patients just tocheck in. She considers mind-reading part of her job description: “Whenpatients walk in, I can tell right away if something’s wrong.”
Thosewho haven’t met the earnest fresh-faced Hopkins may dismiss hercomments as Pollyannaish or self-serving—if her patients didn’t swearby her. And she’s hardly unique. In HIV clinics large and small, ruraland urban, doctors and clients alike often speak of their receptionistsin the reverent tones reserved for spiritual advisers (or personaltrainers).
The reasons are many, but Douglas Magenheim, MD,who runs My Doctor, pinpoints a huge one: “Many patients, not justHIVers, are stigmatized by their medical conditions. They may not feelcomfortable talking about many personal situations—especially sexualmatters. A first exposure to happy and energetic staff members makespatients feel more at ease, and more likely to talk with me as well.”
Justimagine most doctors, even the most personable, parroting the long-heldcredo of receptionist James Forney, a 30-year-old volunteer at theLight Foundation AIDS Service Organization in Oahu, Hawaii. “I’m a bighug person,” Forney says, “and like to greet everyone with a big one.”
Allthis love can include tough love, too. “Because the patients do trustme,” Dunham says, “I can speak my mind. When they confide that they’vedone something they shouldn’t have done, I say, ‘What the hell are yousmoking?’” Receptionists say this trust is vital—patients may feeluncomfortable telling their docs they’ve missed meds or had risky sex.Many patients rely on receptionists as a mediating third party, askingthem to convey sensitive information to the clinician.
Indeed,your HIV clinic or doctor’s office ignores receptionists’ power at itsown peril—as do you. Ken Howard, an HIV positive therapist who hasspent years working with fellow HIVers and observing front-deskers asthe point of first contact, says: “A sensitive and caring receptionistcan become a support system, but an abrupt, inappropriate receptionistcan undermine the good work of a therapist, doctor or nurse.” He adds:“Clinical administration must also realize that receptionists aren’tpaid or trained enough to be counselors in their own right. Unlike,say, law-firm receptionists, they need to be taught how to deal withthe impaired and difficult patient.”
In some instances, it maybe the receptionist who is impaired and difficult (for tips on winningover even the steeliest Nurse Ratchet, see “Five Keys to the FrontDesk’s Heart,” page 35). Beyond complaining to your doctor, you shouldalso know that your privacy and confidentiality, as well as yourmedical records, are protected by law (see “Intimacy Issues,” right).
Inrural areas, where access to treatment information may be limited, HIVdoc receptionists wield even more power. Judd Davenport, 31, who hasbeen HIV positive for nine years, lives in Hartshorne, Oklahoma, a90-minute drive from his Tulsa doc. “It’s horribly stigmatic for HIVershere in southeastern Oklahoma,” says Davenport. “This is the boonies,and AIDS isn’t treated here—it’s like all mention of it has beenblocked out.” He depends on his Tulsa receptionist, Dorinda Jones, forreferrals and med info, an abiding friendship and mutual respect.“Dorinda’s my everything,” he says. “You don’t know what it’s like tofinally meet someone who won’t whisper that you’re HIV positive behindyour back.”
Receptionists insist that the office environmentprovides more than a psychological lift. “If the patient loves theoffice, it’s sometimes one of the strongest reasons for them to hangon,” says Dunham. As Cincinnati’s Mark Reed was battling opportunisticinfections and weight loss, “Jeana would tell me how good I looked. Andwhen I called her on it, she said it was the real ‘me’ that made melook so beautiful.” When Reed and Giglio both turned 40, Giglio treatedhim to dinner and tickets to Rent. “I believe she’s added years to mylife,” Reed says.
As miraculous as such relationships can be,working at an HIV practice is often demanding and draining, even inthis age of “AIDS as a manageable disease.” Dunham recalls a patient,whose partner had just died, who slipped in through her clinic’s backentrance and insisted that the death certificate be signed immediately.“In his anger and grief, he screamed and yelled,” she says, “and scaredthe shit out of me. Eventually, he apologized, but we changed thelocks.”
Justbecause you and your receptionist play Uno every Wednesday nightdoesn’t mean the front desk can dish about your medical history. TheHealth Insurance Portability and Accountability Act of 1996 (HIPAA)created standards to protect personal medical information when newtechnologies 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.
information was wrongly revealed within the past 180 days. Drop by www.hss.gov/ocr/hipaa, or call 866.627.7748.
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