Heather Kelly, MSN, RN, BCPA, CPC
As I stood in the produce aisle contemplating the delicate timing of my weekly avocado purchases, I felt a tap on my shoulder. I turned, smiled instinctively, and immediately felt a surge of panic.
It was a patient I had been seeing weekly in the oncology clinic.
Before I could speak, he quickly leaned in and said, “I’m here with my wife and children, and they don’t know I have cancer or that I’m in treatment… so please—you don’t know me.”
Time seemed to stand still as I processed what he was asking of me. In that brief moment, I understood the weight of his request, not just as a nurse, but as a case manager entrusted with his care, his story, and his trust.
I paused, met his eyes, and replied calmly, “I’m sorry, I don’t believe we’ve ever met.”
The tension in his face softened almost instantly. He smiled with visible relief, thanked me, and hurried back to his family. I remained in the aisle, still holding my avocados, reflecting on what had just occurred.
The Invisible Role of the Case Manager
Case managers operate in a unique and privileged space in healthcare. We are not only coordinators of care, but we are also stewards of deep personal information, advocates for our patients’ needs, and trusted partners in some of the most vulnerable moments of their lives.
What makes this role so complex is that it often extends beyond clinical settings. Unlike many other professions, our ethical responsibilities do not end when we leave the office, the hospital, or the clinic. They follow us into everyday life, into grocery stores, community events, and shared public spaces.
In this moment, the decision I made was not outlined in a policy manual or workflow. It was grounded in professional ethics, patient-centered care principles, and the fundamental commitment to confidentiality that defines our role (Case Management Society of America [CMSA], 2022; American Nurses Association [ANA], 2015).
Confidentiality Beyond the Clinical Setting
Confidentiality is often discussed in terms of documentation, HIPAA compliance, and secure communication. However, real-world scenarios like this highlight a less discussed, but equally critical dimension: situational awareness and discretion in public environments.
A simple greeting, something as well-intentioned as “Hi, it’s great to see you,” could have unintentionally disclosed this patient’s diagnosis, undermined his autonomy, and caused emotional harm to his family. It could have immediately fractured trust in our therapeutic relationship, trust that is foundational to effective case management.
As case managers, we must constantly balance human connection with professional boundaries. In some situations, caring deeply for a patient means choosing not to acknowledge them at all.
Adapting Our Communication with Patients
Experiences like this have shaped how I communicate with my patients. Early in my career, I would often say, “We don’t discuss religion, politics, or other sensitive topics unless they relate directly to your care.”
Over time, I realized that this guidance was incomplete.
Now, I proactively set expectations with patients by saying:
“If you see me out in the community and I don’t acknowledge you, please don’t interpret that as a lack of care. It’s actually the opposite; I care enough to respect your privacy and allow you to choose how and when to engage.”
This small shift empowers patients, reinforces trust, and ensures they remain in control of their personal narrative.
The Ethical Foundation of Case Management
At its core, this experience reflects the ethical principles that guide case management practice:
- Autonomy: Respecting a patient’s right to control their personal information and disclosure
- Beneficence: Acting in the patient’s best interest, even in non-clinical settings
- Nonmaleficence: Avoiding harm, especially unintended emotional or relational harm
- Fidelity: Maintaining trust and honoring the patient-provider relationship
These are not abstract concepts; they are lived realities that influence our decisions every day (CMSA, 2022; ANA, 2015).
In case management, some of our most important interventions are the ones that go unseen. They are the quiet decisions, the restrained responses, and the deliberate choices to protect rather than engage.
That day in the grocery store, I didn’t provide education, coordinate care, or document an intervention. Yet, I upheld one of the most critical aspects of my role: protecting my patient’s dignity, privacy, and trust.
Sometimes, the most powerful way we show up for our patients… is by choosing not to be seen at all.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA.
Case Management Society of America. (2022). Standards of practice for case management. CMSA.
This week, we RECONNECT. Reconnect with colleagues. Reconnect with new ideas. Reconnect with the case management community. And reconnect with the purpose behind the work you do every day. It's the first week of CMSA’s month-long celebration of case managers. RECONNECT. RECOGNIZE. REIGNITE. RISE. See what is happening this week: https://bit.ly/3PR89WG
Bio: Heather Kelly, MSN, RN, BCPA, CPC, is a registered nurse with more than 30 years of healthcare experience, including oncology, hospice and palliative care, and healthcare administration. She brings a strong background in care coordination, medical policy, and clinical program strategy, with a focus on improving access, quality, and patient‑centered outcomes. Heather currently serves as a Senior Clinical Strategist, collaborating with multidisciplinary teams to support effective care management and program development. She is a frequent community speaker on cancer survivorship and end‑of‑life planning and is deeply committed to patient advocacy and professional mentorship.