How to get professional consults while upholding confidentiality

In many bereavement cases, we as bereavement doulas (or any kind of support people) can benefit from a consultation with another professional. You may want to ask a neonatologist their general standard of care for a certain type of case, or an experienced bereavement doula how they might handle the family dynamic you’re presented with, or a grief therapist what modalities of therapy might be most useful to someone in your client’s situation.

Seeking out advice and wisdom from others is often a brilliant idea. But, it poses a few challenges. In this blog post, we’re going to address the potential pitfalls with calling for a consult as regard confidentiality.

Bereavement doulas and confidentiality

In the United States, bereavement doulas are generally not bound by HIPAA (the Health Insurance Portability and Accountability Act of 1996), the law that typically protects people’s protected health information from being widely shared by their care providers. The cases where bereavement doulas may be bound by HIPAA usually involve their employer (they work for a hospital, for example) or another role they play (they work as an L&D nurse in addition to a bereavement doula, and those roles may cross at times). If you do not know if HIPAA applies to you, I encourage you to find out immediately.

But even if you’re like most bereavement doulas and HIPAA or other legal standards in your jurisdiction do not dictate what health information you can share about someone else and how, the code of ethics of your work do dictate that. Haven Bereavement Doulas, for example, pledge to uphold client confidentiality in our code of ethics. This is in service of a person’s right to tell their own story, which is a key principle not only of caregiving but also particularly of grief work.

So, while you may not be legally required to uphold confidentiality, I would argue strongly that you are ethically required by your grief work (and if you are a Haven Doula, you are also professionally required by your scope of practice) to protect client health information.

Strategies for handling the tension

How do we balance these needs to uphold client confidentiality with our desire to seek wisdom from other care providers?

Here are a few strategies we can use.

  1. Work as a part of a collective or agency where clients willingly give permission for you to share protected health information (and other kinds of information) with your colleagues. This can work very well when you already have a community of bereavement doulas (or birth workers or grief workers) that you trust and associate with frequently. The downside to this strategy is that you’re likely to primarily get input from people whose role is fairly similar to yours. Sometimes, you need to reach out beyond other bereavement doulas, and those folks are less likely to be part of your collective or agency. 
  2. Ask your client to sign a permission slip for you to share identifiable information about them. It’s best in these cases to explain clearly why you want to involve another provider and why you want to be the one to tell the client’s story (rather than having the client reach out to the professional). It is also best to hire a lawyer to make sure that your permission slip meets the requirements of the area in which you live. 
  3. Word your question in a non-identifiable way (that is, one that doesn’t share information that helps people substantially narrow down who your client could be); AND, pose that question to a care provider who is highly unlikely to know your client. This is a huge benefit of having a widespread bereavement support network, like Haven’s; you can find a bereavement doula to give you a consult from five states away, or get a recommendation for a grief-informed lactation consultant to help you think through a client’s needs who will probably never lay eyes on your client — much less recognize them or attribute the details of the case to them. 

I hope these strategies help you learn from others’ wisdom without sharing client stories. 

Photo by Christina @ wocintechchat.com on Unsplash

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