Wednesday, April 17, 2013
Say it ain't so, HIPAA!
I'm sure you get a lot of hate mail, especially from folks in my profession, so when you got this letter from me you probably assumed it was more of the same. Let me reassure you: I am not one of those docs. I do think patient privacy is important, and actually found you quite useful when facing unwanted probing questions from family members. I believe the only way for patients to really open up to docs like me is to have a culture of respect for privacy, and you are a large part of that trust I can enjoy. Yeah, there was trust before you were around, but that was before the internet, and before people used words like "social media," and "data mining."
But there have been things done in your name that I've recently come in contact with that make me conclude that either A: you are very much misunderstood, or B: you have a really dark side.
The first situation has to do with my newfound infatuation with communication in health care. I believe that the tools afforded by the internet tubes could really change care for the better; in fact, I think they could allow systems of care that could totally disrupt our malignant sick-care, cash-care system. I've found ways to communicate that you would approve of and have shared them with my patients. They love it. They love to connect with me while they have problems instead of paying for a visit and waiting in the office for a few hours for my help. It's been really fun to see their enthusiasm.
So what's the problem? It's the doctors. Even though this communication system would allow them to give better care, allow us to collaborate without hassle, and bring back some of that "doctor's dining room" collegiality we've lost, these doctors are afraid to use it. No, they are terrified.
Asking them for their e-mail address is taken to be as brash as asking for their credit card number or their wife's cell phone number. I can see it on their faces: they picture headlines about doctors being sued millions for stolen laptops with patient files on them. They hear the ravings at conference warning against the use of email for patient communication and the perils of using social media. They see me as a temptress trying to lure them into the dangerous online neighborhood, full of federal agents waiting to pounce, lawyers eager to sue, and journalists anxious to put their photo on the front page of the paper. OK, well, maybe the electronic version of the paper, but I was using a figure of speech. Nobody reads the paper version any more.
The point is, my patients are getting worse care because of this fear. I can't send a message to consultants explaining why I am sending them the patient, so they make a guess and order extra tests. I can't put my thoughts together with a colleague on a mutual patient with a difficult problem. All I get are forms to be filled out and faxed (although who knows where that fax has been?) and faxed notes with bits of information hidden under layer upon layer of E/M coding bubble-wrap. It's worthless. It's not communication at all, and it hurts my patients.
The second circumstance is more personal. When I got the boot ... left my practice last fall, I left behind 18 years' worth of patient records. Those are records documenting my decisions, my though processes, and my care of my patients. Sure, they weren't the prettiest notes around, but they represented a lot of thought and care. As I was heading out on my last day at the practice I was notified that, upon leaving, I would not have access to these records. It seems that, despite the fact that these are records I personally wrote about my own interaction with my patients, I would be violating you if I looked at them. This information is the property of the practice, and allowing someone who was no longer a member of that practice to view them would bring down swat teams of federal agents within seconds. This, at least, was the opinion of the practice's legal counsel.
Having just gone through a divorce, I had no desire to argue with my ex's lawyer, so I took it like a soldier. I figured I'd just get information sent to me when I needed it. In fact, I came upon another very secure solution to make this process easy and efficient. But alas, the ex wanted nothing to do with my newfangled way of doing things, instead resorting to the high-risk behavior of faxing records (who knows where those fax machines have been?). As fate would have it, our faxes didn't get along well, causing them to inundate me with duplicate faxes, a veritable torrent of TIFs, a plethora of PDFs. This has made it next to impossible to get records on my patients, making care of them much, much harder. These are not just any records, they are my records of my care for my patients!
Say it ain't so, HIPAA!
Do you really keep doctors from their records? Do you really keep patients from good care? Or is this simply a culture of paranoia that has propagated on ignorant doctors by fear-mongering lawyers, lecturers, and office administrators happy for the chance to intimidate the consummate intimidators? Yes, flaunting medical records to anyone who throws you beads is a bad practice that will lead to regret in the morning, but preventing communication kills. I thought better of you. I thought you were there to protect people from careless talk, from snooping employers, and from front-office gossips.
So, I ask, is it you or is it those who wish to slander your name? Are you a tool to protect, or are you a gag in the mouth of good care?
I anxiously await your reply.
After taking a year-long hiatus from blogging, Rob Lamberts, MD, ACP Member, returned with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind), where this post originally appeared.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
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