Therapists and Client Interactions in Public: Did I Break Confidentiality?

Mental health therapists and other medical professionals are well versed in the rules of confidentiality and HIPPA while in the workplace. It is a no brainer that you should not share patient information. But what happens when you interact with someone outside of the workplace? And in my situation: what if you don’t realize it is happening?

A Series of Unfortunate Circumstances

This scenario starts off in an already tense situation: I was interviewing for a job. I am sure all of you can relate to this feeling: applying for a new job while you still have your current job feels sneaky and deceitful. You are on high alert, central nervous system activated, ready to flee at any sight of your boss that may or may not have followed you to your interview to catch you in the act.

Most of us also know that when you are applying for the new job, it is important to make small talk and be kind to everyone around. Coworkers talk, and the employer may even ask them how you behaved while waiting for the meeting. I usually try to be friendly and communicative, not over the top. Little did I know that some unfortunate circumstances were about to turn the situation sour.

First unfortunate circumstance

I recognized someone in the waiting room, but didn’t know know how I knew them. The greater Boston area is large and “thickly settled” but it is still common to occasionally run into someone you know. So I did the unthinkable: I said…deep breath, it’s dramatic… “You look familiar, do we know each other?” As far as I knew, we didn’t. But the train was on the tracks and the course was set.

Second unfortunate circumstance

Many minutes after the first interaction with the mysterious familiar face, someone else asked me a question, “You are interviewing for a job right? Where do you work now?” I shared with this person that I work at such and such clinic. The cliff was in sight, and it’s too late to hit the train’s breaks.

Third unfortunate circumstance

I was offered the job. I was so elated that I didn’t see what was coming. Off the cliff we go.

The Ramification the Following Day

What I didn’t see coming was so strange, and so inauspicious, that I still think about the situation and wonder what could have been done differently. The person I recognized, but didn’t know, happened to be a patient at the clinic I was working at! We had never interacted before this, I was not their provider. The small detail that I said something to them, and then in a separate conversation with another person shared that I worked at the aforementioned clinic, was enough for this individual to fear that I had exposed them in some way that they are a patient of that clinic. It was a stretch, but they were upset… and angry.
This person not only informed my employer that I breached confidentiality, but also told my employer that I was interviewing for other jobs. Turns out, I did not break confidentiality— it was a stretch by the imagination of that individual, but it was still very unfortunate. I don’t know what was more upsetting to my supervisor, the interaction with the patient, or that I was leaving the clinic. I worked my final days there in a very hostile atmosphere.

So How Should a Therapist Act in Public?

This interaction, with its consequences, made me fear any patient interactions outside of the workplace. Not long after that I saw another patient of that clinic at a gas station. We were both pumping gas, after a quick smile of acknowledgement we made no eye contact. I was anxiously waiting for the meter to click so I could get out of there. That person found me later that week and asked why I had been so aloof. She was upset that I didn’t acknowledge her more.

What it all comes down to is that you don’t want to initiate an interaction with a patient of yours, or a patient of your place of work, if they first don’t initiate the conversation with you. The idea behind this is that, as in the story above, someone may infer that if you know each other, and they know or find out you are a therapist, they could be your patient.

There are many people that do not care if someone they know finds out they are in therapy, but others may not be in that place. My advice is to be extra cautious, wait for their move and follow it. Confidentiality is our highest priority when we see a patient in public.

And wear a face mask and sunglasses when interviewing for a new job.