Editorial: Isolationist Remodeling

A few months ago, I returned from a 10-day vacation to discover that our receptionists were now separated from the waiting area by sliding-glass windows. As a result of my poor attendance at meetings, this bit of isolationist remodeling caught me by surprise. When I sought an explanation, "noise," "HIPAA," and "germs" were mentioned most frequently by those few who could remember the informational meeting that preceded the change.

I agree that bidirectional noise transfer has been a prominent feature of every office/waiting-area arrangement in every practice where I have worked. Screaming babies, whining toddlers, and the buzz of parents trading war stories can get loud. And it wouldn’t be pediatrics without the din.

However, all is not quiet on the receptionist front, either. Most of the time, we hear laughter as providers and support staff share those humorous scenarios that are part of everyone’s lives. Stories of how spouses do the strangest things and quiet debates about who shouldn’t have been voted off "American Idol" dot the few lulls between patient visits. Occasionally, it is the crunch of chips consumed out of sight but not out of earshot. For the most part these are happy sounds, and in a professionally run office there is no reason that a few understandable words and phrases shouldn’t float into the waiting area. As long as the office staff can seamlessly shift to a "we take your child’s health seriously" mode when the situation demands it, an office that bubbles with happy noise is more comforting to both patients and parents.

Germs? Unless I have been reading the wrong journal articles, it seems to me that fomites have fallen out of favor as major culprits for most contagious pediatric disease. Sliding-glass windows aren’t going to protect the receptionist from germy hands. An array of alcohol-based hand sanitizers on the counter makes a more evidence-based statement.

And HIPAA? I’m not sure a glass cage is going to make a teenage boy more comfortable when he comes to see me about a problem with his privates. This kind of information exchange can wait until the exam room door has closed behind him. Unless we spray paint a "wait behind this line" strip 10 feet into the waiting area, I don’t think a glass window is going to substantially reduce the risk that random demographic data will be purloined by the nefarious few.

The key ingredient in deterring the inappropriate transfer of information is a staff that is well trained and frequently reminded to consider how they would like their own personal information to be handled.

What the glass barrier does promote is the all-too-prevalent impression that the providers are the "we" and the patients are the "they" – and that somehow, we physicians need to be protected not only from the patients but also from parents and their many questions. Whenever I visit a doctor’s office in which the receptionists are encased in a glass fortress, I don’t get the warm, "I’ve come to my medical home" kind of feeling that I am seeking.

Yes, there needs to be a barrier to protect the privacy of patients, and the one that works the best is the exam room door, policed by support staff who know when, where, and how to ask the correct questions.

Sliding-glass windows be damned, I will continue venturing into the waiting room every now and then to call my own patients and catch up on things with old friends. It’s my home, too.

This column, "Letters From Maine," regularly appears in Pediatric News, a publication of Elsevier. Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at pdnews@elsevier.com.