Gaining Access While Preserving Anonymity in Medical Settings
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Hi, everyone. Welcome to Sound School, the backstory to great audio storytelling from PRX and Transom. I'm Rob Rosenthal. I'm sure you've heard this writing maxim before. Show, don't tell. Basically, it means let the events in a story reveal what you're hoping to convey rather than explaining it. For instance, I could explain to a listener that dairy farming is difficult work.

I could tell you it's strenuous, the hours are long, the weather can be unforgiving, or I can take a listener to a dairy farm, record a scene where it's a, I don't know, I'm going to make this up, a bitter cold day in February. It's 4 a.m., the sun's not up, and we hear a dairy farmer struggle to convince a stubborn cow to come inside for milking. In that case, I don't need to say that it's difficult or

I'm letting the description and the sound make the point. But how does show don't tell work in a story about health care, especially given how privacy is so highly guarded in medical facilities? How can a reporter gain access to a clinic and preserve the anonymity of patients in order to show listeners what's being reported on? By asking nicely.

Selina says, by asking nicely, sure. But she'll also tell you there's more to it than that. Selina Simmons-Duffin reports on health for NPR. And what prompted me to reach out to her to ask about access in a medical facility was a story she reported in June. Seven Hills Family Medicine is in downtown Richmond, Virginia. It's an unassuming storefront kind of clinic.

Hello. Hi. And inside, it's cozy. Selena visited this doctor's office because of a trend in family medicine. She actually described it to me as a movement, something that started decades ago. More and more primary care doctors are offering abortion services at their clinics, especially after Roe v. Wade was overturned in 2022.

Doctors like Stephanie Arnold. Dr. Arnold reads through the printed copies of the schedule for the day. I'm doing chronic condition management via telehealth in five minutes. At 10 a.m., I'm doing a follow-up on diabetes, and then I'm seeing a knee pain visit.

and an ADHD follow-up, and then we have three aspiration abortion appointments. So three procedural abortion appointments alongside all the other appointments. A little bit of everything today, which is very typical for family medicine. Dr. A, as her staff calls her, is 37 years old. Listening to the story on the radio, I figured Selena would take listeners on a tour of the clinic and we'd hear interview tape with the doctor, maybe an expert or two, and that would be it.

I assumed privacy rules would prevent her from recording anything more, like an actual appointment with a patient or something. I was wrong. The

The day gets rolling. And it really is a little bit of everything. A patient walks in and scoots onto the exam table with a suspected yeast infection. Alright, I'm going to do a quick little swab so I can look at it under the microscope. In the doctor's office, there's a follow-up for a patient with GI issues. So your labs came back and honestly are looking pretty good. There was no evidence of celiac. Later in that same appointment... Alright.

All right, let's talk about your chronic back and hip pain. Another patient comes in for gender-affirming care and sits at the edge of their chair with excitement to start on testosterone. There's like kind of two extremes on the dosing approach. Fast track or the scenic route. We're going in the middle. Yeah. All right. Is this riveting tape? No. But Selena felt it was important to show listeners this was not a standalone abortion facility, that everyday medicine is practiced here.

She told me it's different for a listener to hear these appointments than to hear about these appointments. You don't really get how, in some ways, like,

Very surprising it is to see a doctor treat knee pain and ADHD and abortion in the same day until you actually see it. But my question remains, how did she get permission to record? Not only from the doctor, but the patients.

Here's what she told me. When she initially started reporting, she reached out to primary care offices in Pennsylvania and elsewhere who have recently begun providing abortions. Now, these are clinics who don't advertise the service given the stigma and the current climate around abortion. Which means that the only people who are getting abortions there are people who

stumble in with a positive pregnancy test and don't even know that they have options there at the clinic or you know when patients come and are talking about birth control options a doctor can say like just so you know abortions are also provided here at this clinic

Those clinics told Selena, no, they didn't wish to be public about what they were doing. So Selena thought, oh, I need to find a clinic that is public about what they're doing. That's how I found Seven Hills Family Medicine. They were like, hey, if you need abortion, come here to our primary care practice because we do abortion. There was even Google reviews about abortion experiences at this practice. So what's typically your approach to

What do you say when you write or call and you want to report in person? In fact, you know what? Selena, why don't we do this? I'm a physician. Convince me. Okay, well, usually I wouldn't just go to you and start pitching you. Usually I would interview you first. So we would develop a rapport and you would get an idea of the things I'm interested in and the things I want to explore. And then I would say, okay, Rob, we've just had this really interesting conversation and

I am so interested in this practice that you've done that is different than anyone in the world. And I would love to be able to show people what that looks like. And to do that, I would need to come, right?

And so I'm wondering how you feel about me coming with my recorder, spending a day, you know, your patients would have the chance to say they don't want me anywhere near their appointments or not, so that I could really illustrate to people. And it's not just talking about it, but it's really like seeing how it plays out. I was under the impression that HIPAA was an obstacle to recording in medical facilities. HIPAA is the Health Insurance Portability and Accountability Act.

It includes regulations regarding patient privacy. And I asked Selena what kind of challenge it poses. HIPAA is kind of a thing that scares reporters more than it should. I mean, it definitely creates some challenges, but really the patient is in charge. I think as a reporter, that is a helpful thing.

thing to remember, a helpful kind of frame for understanding HIPAA, like the patient who tells you they're okay with something, that's fine. You are not, as a reporter and the patient, are not covered entities. The covered entities for HIPAA are health plans, health facilities, and providers. So if they're giving out information that's easy to identify the patient without that patient's permission, that is not okay.

But, you know, being in a waiting room that you've gotten permission to be in and talking to patients and giving them a chance to say yes or no, that is okay under HIPAA.

Another way that this plays in is, so say you talk to a doctor about a condition and you want to talk to a patient who they've treated. They can't give you a bunch of information of patients and you just reach out to them. But what they can do is they can reach out to the patients themselves and give those patients your contact information. So then the patient is in charge. And if they want to speak to a reporter, they can.

Getting back to Selena's reporting on Seven Hills Family Medicine, here's how it all went down. She saw they were open about providing abortions, so she called the clinic, spoke to Dr. Arnold, the family physician. She recorded an interview and then asked permission to record on location. Dr. Arnold felt like she needed to run the idea by colleagues, and eventually she said yes. Arnold told Selena what day would work.

And then what they did was this. The clinic reached out to all of the patients scheduled on that day. They asked, how would you feel about a radio reporter recording your visit? Then the day of, Selina waited in the clinic with her colleague, Alyssa Nadworny. Alyssa came along to take pictures. More on that later. When patients arrived, the reporters wouldn't have any contact with them at first.

The patients did the usual. They checked into the front, and then someone on staff would take them to an exam room. The medical staff would go and do the stuff that you get done at the beginning of appointments, like your blood pressure check and the weighing and the whatever, whatever. And they would say, okay, yeah, but there are reporters here. Do you remember we had that conversation? How are you feeling? What do you think?

When they consented a second time, that's when Selena and Alyssa went in with Dr. Arnold. And the doctor, I think, would do her own little spiel, like, they're reporting on me and this clinic and what we're trying to do here. And it's not, you know, we're not reporting on you and your appointment and what is the substance of your appointment. Let's hear those recordings again.

The day gets rolling, and it really is a little bit of everything. A patient walks in and scoots onto the exam table with a suspected yeast infection. Alright, I'm going to do a quick little swab so I can look at it under the microscope. In the doctor's office, there's a follow-up for a patient with GI issues. So your labs came back and honestly are looking pretty good. There was no evidence of celiac. Later in that same appointment... Alright.

Let's talk about your chronic back and hip pain. Another patient comes in for gender-affirming care and sits at the edge of their chair with excitement to start on testosterone. There's like kind of two extremes on the dosing approach. Fast track or the scenic route. We're going in the middle. Yeah. All right.

Because of how far away the voices are in the recording, I thought maybe Selena set up the recorder, pressed record, and then left the room. I could see how that could have some advantages, but I feel like in some ways it makes it easier for the patient to know that this is happening if there's like a person attached to the room. But yeah, no, I was in the room.

Two of the appointments she recorded were consults in the doctor's office. One was in the exam room, the patient with the suspected yeast infection. And she was like kind of crammed into the schedule because she was about to go on vacation and she had tried an over-the-counter treatment and it didn't work. And so her attitude to us coming into the room was just like, ah, sure. So

When the doctor actually did the exam and she laid back, we kind of scooted all the way back to the door. And I recorded from very far away the conversation that they were having during the exam itself. And then we all kind of scooted out. I give her credit. She was a sport. There's a fourth patient in the story that you refer to.

someone who was there seeking an abortion. Out in the waiting room, a patient who took the bus from Tennessee sits and wait for her abortion appointment. She gets an ultrasound and counseling while Dr. Arnold switches into scrubs for the aspiration abortion procedure. I'm going to go do an aspiration. Just in the mix. How did you report on that patient? Well, I didn't realize that this was the patient. I was in the waiting room, like, waiting for a while.

Then I, you know, heard from the staff that they were going to be doing an abortion. And that patient was clear that she didn't want any reporters around, which was totally fair. So, you know, the clinic telling us that this is a patient from Tennessee here for an abortion does not exist.

divulge any identifiable information. Like that patient would not be findable by anyone. But we wanted to be able to be there to have the tape of the doctor going in to do the abortion. So we hung around for that. How many were there that day that you were there?

I think there were three and those patients were not having us, which is completely fair. But you asked. Well, we didn't ask the patients directly. The staff asked on our behalf. I see. I see. Yeah. I think there's probably a lot of access that people don't get because they don't try or ask.

I have experienced this a lot reporting on abortion. I remember a colleague of mine, Carrie Feibel, had done a lot of abortion reporting as a reporter in Texas. She said, don't assume that patients don't want to talk and that they want anonymity.

And that was like a really powerful reminder that patients feel like they have stories to tell sometimes. In my time on this beat, I've recorded...

in a doctor's office while a pediatric patient was getting vaccines. And that did involve waiting a lot in a clinic for a patient who felt comfortable and willing to share that moment with a reporter. I've also recorded an appointment with an HIV patient and an HIV doctor, and that was a patient-doctor relationship that had existed for like 40 years.

And I think that they both felt like it was important for access to be given to that appointment because of stigma and because of the fact that those kinds of appointments happen and matter. And so, yeah, I do think that

When it is important to the story that you hear those conversations and you don't just talk about the kinds of conversations that are happening in the exam room,

It's important to ask and it's important to try and just know that there is a chance you're going to end up with nothing. You know, Alyssa and I could have gone down there and every single patient in the day could have said, uh-uh. And we would have, you know, written the story differently and managed and made lemonade. But, you know, we did have a couple of patients who were like, sure, you know, I don't care. Yeah.

And that made for, yeah, it made it feel like you were in there. You were like you were in the clinic and seeing actually what was happening there. As I mentioned earlier, Selena reported the story with Alyssa Nadwerny. She's also a radio reporter at NPR. And they both were in the room with the patients and the doctor. But Alyssa was there to take pictures.

Selena firmly believes the online version of the story won't reach people unless it has strong visuals. The hill I will die on is not using stock images of doctors and patients. Like, I just, it makes my skin crawl. It's the worst. They're so bad. But how does that work? How do an audio reporter and a photographer work together in the same, usually private, space?

And how did they respect the patient's wishes for privacy and anonymity? Selena has a couple of thoughts. You can find them at the post for this episode at transom.org. Sound School is produced by me for PRX and Transom. Genevieve Sponsler and Jay Allison give me an edit. Jennifer Jarrett is the managing editor of Transom. And I record at WCAI in Woods Hole, Massachusetts. I'm Rob Rosenthal. Thanks for listening.