Welcome interns and congrats to all on completing your first week of the new academic year! On behalf of the UCSF Peds Residency Immigrant Health Task Force (IHTF), we wanted to share our first Immigration Health Tip of the Month.
Given the demographic make-up of California and the Bay Area, you will care for children in immigrant families. Some of these encounters may include an intentional or unintentional sharing of the child or caregiver's immigration status as it relates to health care access, clinical care, mental health or social needs. Here are some things to consider when handling this sensitive information.
Explicit documentation of immigration status of patients and their family members in a health record should be avoided, particularly when risks outweigh benefits. While the theoretical use of HIPPA-protected medical records being used for immigration enforcement is low, immigration status in medical records has the potential to be harmful depending on the sociopolitical context at the federal, state, and local levels. If immigration status is needed to facilitate the patient’s receipt of services or resources, conversations with clinicians and social workers should be prioritized over written communications (including text, Voalte, email, inBasket, H&Ps, problem lists, etc).
If necessary, please use indirect language in your charting and written communications to describe social context (eg, “immigration stressors”, "acculturation difficulty" or “ineligible for insurance”) rather than any direct language (eg, "legal", "illegal", "undocumented") describing the immigration status of your patient or their family members. Patients should be assured of confidentiality, informed of privacy laws, and invited to discuss their concerns. Regardless of immigration status, patients deserve to have their health care needs met without fear (Kim et al. 2019).
We will have more teaching on this and other topics coming this year. Please let your senior, attending or one of us know if you have questions. If you'd like to join the IHTF, email [email protected]. Our next meeting will be at the end of July.
Best,
UCSF Pediatric Residency Immigrant Health Task Force