Airport Confidential: You Have the Right to Remain Silent

Back in medical school, we were all taught not to discuss in public potentially sensitive details about the patients under our care. For whatever reason, adherence to this rule was particularly difficult for us whenever we rode on elevators, despite the fact that the tight quarters meant it was virtually certain other passengers would overhear what was said. I swear, at medical school, there were “elevator police” who would tune in to make sure we were not having conversations that would have been better suited for less confined spaces. Back in those days, confidentiality was a professional responsibility; now it is required by HIPAA.

Physicians have always had to watch what they say not only while riding in elevators, but whenever and wherever they talk shop out in public. Until recently, we could only spill the beans while we were on the go if we had a companion right alongside us. Nowadays, thanks to our cell phones, we can carry on conversations with patients, colleagues, and friends at any time and in any place. Although this is undeniably convenient, it also means that unless we’re careful, we have many more opportunities to inadvertently divulge confidential information. So now we have to extend the privacy debate beyond elevators to include other confined public spaces, such as airplanes (safety issues aside, should we allow in-flight use of cell phones?) and ground transportation (do we need more “quiet cars” on commuter and business trains?).

Disruptive technologies by their very nature often move us along faster than our mores and customs can adjust, which explains why people on cell phones still talk too loudly about private matters in restaurants, theaters, and places of worship. Our opportunity to communicate these days extends far beyond the immediate party intended for our conversation. Nowhere else is this more apparent than in airports. Stroll through any airport and you’ll have ample opportunity to hear more than you really want to know; it is becoming increasingly more difficult not to eavesdrop.

My informal research has revealed that no place is worse in this regard than the airport in Newark, NJ, where it often seems as if everybody in the terminal has Bluetooth technology glued to their head. The flashing LEDs (light-emitting diodes) are so common that there should be warning signs included for those subject to light-induced seizures. The technology is so pervasive that on more than one occasion I have nearly succumbed to temptation and stopped at one of the airport shops to get hooked up. An unabashed Star Trek fan with my second-generation flip phone, fear of becoming Borg was the only thing that kept me from losing myself in this sea of near humanity.

In truth, I overhear far more detailed medical histories in airports than I can sometimes elicit from patients in my office. The conversations can run for any length of time and are often halted only by the closing of an airplane door. I am always amazed at how people describe their state of health so differently to their family and friends than they do to their physicians. If you do choose to tune in, you will quickly find out that some of the major complaints are with the doctor—patient interchange; we just don’t listen, except when we’re not supposed to!

My research into these matters has even extended to the true final frontier: the confined space of public bathrooms. Not as a perpetrator of cell phone usage in this venue, but as a victim once again, I ask you: Do I flush or do I politely hold off until my fellow traveler finishes his conversation? What is proper etiquette here? These are the great questions confronting our society. In fact, I posed them to my companions at a business dinner just a few days ago, and everybody had an experience to relate and an opinion (or two or three) to offer.

As if worrying that we might be overheard revealing private information, we must also remember that what we say in public may be recorded and used against us. I’m thinking here of Alec Baldwin’s recent rant, which in part inspired me to write this column. One must pause to consider that what we say, much like what we write, may have an afterlife.

Talking on the phone in public is seldom, if ever, confidential, and talking on a cell phone seems to bring out a generally louder voice. I think it is actually the feedback we get in trying to listen that forces us to speak louder. Despite the technological advances, amplification on a hard-wired phone remains superior to what a cell phone can deliver. We must choose our words wisely, and I would suggest that we choose where we say them even more cautiously.