The day arrived for my long-awaited procedure, just like any other — at a specialty clinic with a trusted physician. I entered the waiting room just as the patient before me was escorted through the open door, down the corridor, and into the procedure room. I realized my rush to be on time for my appointment would result in waiting another hour to be admitted. After processing my intake paperwork, the lady at the check-in desk left as well to assist with the ongoing procedure. I had the whole front of the clinic to myself with a few scattered issues of celebrity gossip rags and outdated financial magazines to keep me company. I tried to put my brain in hibernation mode while patiently waiting for my time with the physician.

My zen moment was interrupted by a conversation in my head. The doctor would ask a question, and my response would echo back. Then the doctor would ask if I had concerns, and my concerns would then be revealed. Then the doctor would discuss the procedure and ask if I understood. Other light-hearted discussions would then ensue.

I opened my eyes when I realized this role-play wasn’t happening in my head. This private conversation was coming from the occupied procedure room, through the open door, down the corridor, through the open waiting room door, across the room, and into my ears. I was hearing the details of someone else’s procedure. I felt unjustified embarrassment for eavesdropping on someone else’s conversation.

I was mortified. What if I had been that patient and had my privileged discussion broadcast throughout the clinic? What if I hadn’t been the last patient of the day? Would other people in the waiting room hear my conversation?… my questions?… my concerns as well?

In time, the nurse appeared at the doorway and invited me to follow her back to a vacant procedure room. I was prepared to request a different room if it was close to the lobby, but she walked me to a farther procedure room. When the doctor asked if I had any questions, I smiled and said he had already answered them… “I know what’s going to happen, and I’ve had an hour to think about it.” 

As a practicing architect with over 16 years in design, with many dedicated solely to Healthcare Design, I try to be sensitive to the role my designs play in the lives of those who inhabit these spaces. Sometimes the most valuable lessons learned are when the designer steps into the shoes of the nurse, the doctor, or the patient.

So I ask myself, how can I use this opportunity for professional development? How can I learn from this and apply the experience to my designs? How do I ensure the highest level of patient confidentiality to protect not only the patients but the clinic as well from HIPAA complaints?

A Critical Self-Audit

The next time I opened up my plans for the pediatric clinic under construction… my eyes went straight to something I hadn’t seen before, despite countless times reviewing it in the past. I saw a chair in the middle of the waiting room. From that chair, a straight line could be drawn out of the waiting room, across the corridor, and into the patient exam room where the exam chair was sitting in direct line-of-sight of the waiting room! How had I not seen this before?

Had it not been for the experience in the clinic and understanding real-world conditions of a functional clinic, I would not have noticed that a simple, self-closing, swing door was not enough to ensure patient confidentiality.

With the design already having entered construction, I knew my window to act would be short. I immediately contacted the construction time to check on the feasibility of my request and together we ensured no additional materials, costs or delays would impact the project.

By mirroring the design of the room, we were able to adjust the location of the door and the direction of the swing so that any visual contact with the patient was no longer possible. This information was relayed to the contractor, and the walls were framed the next day. In the two days that followed, the plumbing, electrical, and HVAC designs had to be updated as well and relayed to the trades to result in a fully coordinated room flip. The team realized that if we had waited even a few days longer, the opportunity to influence the design without incurring substantial costs or delays would have passed. Fortunately, my own experience as a patient was perfectly timed for me to make a critical improvement to my design.

Today, I am glad to report that when standing in the waiting room looking through the open door into the pediatric clinic, a beautiful site can be seen… a single, solitary wall. I am comforted knowing that by having patients out of the line of sight of the public and being separated by a self-closing door, I have helped preserve the privacy of the young patients that will soon be visiting this clinic on opening day.