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everal weeks ago, I treated a patient from Medellín, Colombia, who had escaped narco-terrorism and political violence to find a home in the US. But he was living here undocumented — and caring for him taught me what it means to do no harm.

In my first year as a resident at Cambridge Health Alliance, I often treat people new to the US who come here without documents. I’m thankful that I can provide health care to my patients in what I believe is a safe setting. But these patients change the way I practice medicine, because they change the way I document medicine. This is something I never learned about in medical school.

Normally, hospitals are safe zones, free from immigration enforcement efforts. But this is a tenuous agreement — if the government wants to, a place of healing can become a place to detain.

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To protect those living without documents, I’ve had to learn to exercise caution about how I record a patient’s social history in our files. “If you don’t document it, it’s not discoverable,” said Dr. Robert P. Marlin, the director of the Coordinated Care Program for Political Violence Survivors and the Refugee Health Assessment Program at CHA.

Looking back, I realized I’d never seen this aspect of my Colombian patient’s history documented in his charts. While knowledge of legal status often helps medical providers connect our patients with valuable resources and care, that information has often been missing. Now I know why. While HIPAA typically protects patient health information, it’s not an unconditional legal shield. For these patients, given the current immigration climate, it’s better to be safe than sorry.

Earlier this year, President Trump signed an executive order effectively empowering immigration and customs officials to detain and start deportation proceedings on undocumented people in the US who have been charged with a crime, who have been convicted of a crime, who have received public benefits, or who have misrepresented themselves. For physicians who practice social justice, this order is at odds with our vows to “protect our undocumented patients, advocate for their rights, and continue to serve them as healers.”

At a recent seminar on immigration and asylum at the hospital, Dr. Marlin and others taught attendees how much of a lifeline the cellphone can be to an undocumented patient. I now know to counsel patients to memorize important phone numbers — family, friends, and a trusted immigration lawyer, as one of the asylum speakers suggested. The sad reality is that this advice can be particularly important for children, making sure they know how to get help if their parents don’t come home.

And for all the documentation that doesn’t happen, there is one piece of paper that needs to be really accurate — emergency contacts. For example, if something were to happen, children may get stranded at day care, said Marlin. He even suggested setting up a lifeline, a system of friends and family that keep tabs on each other every day, with the idea that “if you don’t hear from me in 24 hours, I might not be safe.”

Another thing I’m learning — if a patient doesn’t show up for important medical care, I might need to reach out to them. With the threat of heightened surveillance some patients may be afraid to seek any services, even in a sanctuary city like Cambridge. Even if these patients have support from grassroots medicine all the way to Boston’s hospital leadership.

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“Leave them a message, asking if everything is OK,” Marlin said.

What I’m realizing is that maybe this is what preventive medicine looks like in 2017. Not only does my work mean I’m preventing disease, but I’m also preserving families. I’m also protecting health care as a human right. I’m trying to live the idea that America’s doctors do not equate “not American” with “not human.”

My patient from Medellín experienced unrelenting violence that I cannot begin to fathom, and he needed my help for a serious injury. My oath and my conscience dictate I care for him as a human being, and because of the risks he faces in having his undocumented status documented, I did this by sharing his relevant personal history orally. I am moved by his suffering and motivated to ensure that his health care, this one aspect of his experience, will be free of trauma and terror.

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  • Seems like no humanitarians read STAT or post comments here.
    Bet that none of these posters have ever made a donation to a charity that helps people.
    So you must all be totally against the humanitarian aims of Medicines Sans Frontieres (Doctors Without Borders).
    And all those poor, deprived, starving people in Somalia and The Congo should pay for the food and other aid they receive.
    After all, everyone should pay for the services they use, shouldn’t they?
    Hmmm.
    Sometimes we have to act in the real world to mitigate the effects of disastrous politics and policies…..
    Save your legal niceties for discussion in the halls of academia, and over your capuccino at the pavement cafes in the leafy suburbs of Arlingtonia…..
    Its terrible what the country is coming to, isn’t it?

  • I find this physician’s naïveté and brainwashed indoctrination into a far leftist mindset quite frightening! Once you modify the concept of Justice and turn it into “social justice” true justice is out the window—you are making value judgments or excuses for behavior based on an individual’s group identity, rather than holding each person responsible for their own actions and life choices.
    Providing valuable medical care to an illegal immigrant without notifying the authorities is:
    1. Stealing from Amaerican wage earners and taxpayers.
    2. Ethically reprehensible in condoning criminal activity and violation of US law.
    3. Morally indefensible and assumes unwarranted superiority of personal opinion and personal agenda
    In place of the citizens of this country.
    Finally, where on earth did this poor excuse for a physician ever get the idea that “health care is a human right”? In a capitalist society, goods or services are exchanged by citizens in the pursuit of nirmal commerce. Socialism, on the other hand, maintains that I am breathing, therefore give me stuff.
    One’s only “human rights” guaranteed by the constitution are life, liberty, and the pursuit of happiness, along with the Bill of Rights later adopted. Medical care, food, shelter, or a new car every year are not mentioned.
    The author MUST realize nothing is free, national borders are important, and no one named Jennifer the decider-in-chief to impose her hilarious flawed morality on the rest of us.

    Good God, they must be scraping the barrel for medical school applicants these days, as this fuzzy brained woman has demonstrated in this idiotic article.

  • A tragically beautiful article. How horrible that medical professionals need to help keep some of their patients safe from government intrusion in addition to helping them with their health issues.

  • Leaving blank spots in patients medical records for the purpose of his health care protection and quest to ensure further trauma and terror is an act of kindness and more so ensuring accurate life line instructions are understood and emergency records are accurate. I admire health and educational professionals unselfishness when outside their job demands deal respectfully with similarly afflicted children, young teenagers, and adults. That is a non-citizen added non disclosure benefit.

    Standard USA citizen are not entitle to privacy anymore. Not even measured in blank spots for the sake of protection from internal and/or external uncultured initiated terror and trauma caused for their own uncanny satisfaction.

    What would a citizen expect where corporate GOOGLE, FACEBOOK, social activity collection and multi-lionars, “The Koch brothers” maintained databases of all USA addresses and corredponding occupants; are mined, merge enhanced by learned and predictive algorithms?
    What would a citizen expect when above are ready for further comparative analysis with government transportation and police, ……State departments video inputs, devices, iPhones, tags, and biofeedback are merged with President Obama’s health care plan records collected, and medical specimens test results, captured, SSN’s, only missing plans to map the brain? Have an awesome day! Ha
    Inching its way with prosthetic advanced bio-feedback, and molecular cell advance, medical devices and cameras traveling our body internal system monitoring and regulating organs what’s left?

    Let’s hope – His health care, this one aspect of his experience, will be free of trauma and terror.

  • Looks like the hospitalist skipped out on history taking lectures in second year of med school. Then again, the original referring doctor was the one who did the initial comprehensive history and physical exam, including a social history, so that the in house consultant, ie. the hospitalized doesn’t have to do the heavy lifting.

  • Emergency rooms are where illegal immigrants go for medical care. They are NOT sanctuary cities. This is a perfectly logical place, if your in the TIRA (Trump Immigration Roundup Army) to go trolling for illegals-the ER’s of major city public hospitals. Docs may choose to leave out immigration status. The ICE guys are not NICE guys, and they will get the information one way or another.

  • Some of our colorful “charity” cases on public assistance own yachts in Florida and the Caribbean, come in after obvious hard work trips to the Keys and remote ports with knuckle injuries, fractures, other unexplained trauma. Hola, que pasa? “Doc, I fell off my boat”. I suspect fights and other high risk ventures w drug dealing… but all of this of course NEVER reaches the E H R. See no evil, hear no evil, speak no evil … and treat each patient as circumstances allow. Not all undocumented aliens are nice guys dreaming for enhanced economic opportunities for themselves and loved ones.

  • As a medical professional, I believe what you’re doing by leaving out documentation ( important and pertinent information) is illegal and could be called malpractice. Full documentation is the only way to legally provide information for all patients. It’s not your choice.

    • I agree, illegal and potentially important. I am reminded of the neurology resident who neglected to take a social history on a stroke patient by not asking where he went to school and how many grades he completed. After all, it is important to know when you’re doing serial sevens backwards from 100 whether the patient completed third grade or has a PhD in mathematics.

    • It’s not illegal to leave out a social history. It’s only there in the first place so you can bill more. Come on.

  • Question – if the patient has evidence of injuries predating his entrance in the US, does he not need your appropriate and complete documentation of them in order to apply for asylum?

    • Documentation of a patient’s trauma history is highly encouraged. Documentation of a patient’s CURRENT suffering as a result of unspeakable past traumas are even more encouraged. But that can still be done without specifically mentioned a patient’s immigration status.

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