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Uncle Sam has swiped your medical 'privacy'

Posted By Lee Hieb, M.D. On 12/17/2012 @ 8:10 pm In Diversions,Front Page,Health,U.S. | No Comments

Government mandates “truth in advertising” but certainly does not practice it: Hence the “Employee Free Choice Act,” which eliminates closed balloting for unionization; the “Financial Reform” bill that anointed the existing banking elite; or the “Food Safety” bill, which threatens small, organic, healthy farming.

But the leader of the pack is HIPAA – technically the Health Insurance Portability and Accountability Act, but more often referred to as “The Privacy Act” for its supposed protection of a patient’s personal health information.

In truth, there is no more medical privacy.

As a doctor who operates within the Medicare/Medicaid system, under the so called “Privacy Act,” I can be fined $50,000 and/or given a year jail sentence for blabbing your medical information to my neighbor, but I am “allowed” and under the rubric of physician quality improvement mandated to give the government your most personal data – your body mass index, drug use, whether you smoke, diabetic glucose levels and anything else they may want.

And this information does not even go to a health care professional. It generally goes to an unelected government bureaucrat who has not taken the Hippocratic Oath to put the patient first, who does not know or value your sensitivities, who puts the needs of the government above the needs of you as an individual.

And it goes to their computers and laptops, which have a propensity to be “misplaced.” Remember the 4.9 million Tri-Care patients who received letters last year that all their private data had been compromised when a laptop was stolen? As it turns out, that was just the tip of a very big iceberg. Since 2009, according to the Office for Civil Rights, nearly 21 million patients (20,970,222 to be precise) have had their medical data lost or stolen from electronic records. Much of this is outright theft, such as when the AvMed Health Plan of Florida lost 1.22 million patient records due to the theft of a laptop computer. In some cases the theft may have been for the laptop, but as in the case of Wellpoint’s 31,700 patient confidentiality breach, the system was hacked specifically to get the data. Others have lost backup tapes and external hard drives, which themselves have little value but contain everything from credit card payment numbers to the addresses of the patients involved.

According to Health and Human Services, there are 12 reasons for doctors to divulge data “without an individual’s authorization.” These fall under the heading of “Public Interest and Benefit.”

First and foremost, you have to cough up the goods if it is “required by law.” So that means anything is potentially fair game. The State of Oklahoma wants to know who among its diabetics are not adhering to their medications? No problem, mandate reporting. New York wants to know who has had a sex change? Not a problem, mandate reporting. In short, there is nothing that is private if some law-generating agency wants the info.

Other reasons for others to disclose your information include “Public Health Activities,” “Research,” “Essential Government Functions” and – my personal favorite – “Law Enforcement Activities.”

The TV portrayal of a doctor steadfastly refusing to divulge a patient’s medical information to policemen is pure fiction, existing only in the minds of TV producers. Doctors can’t protect your information, because they are no longer the keepers of that information. Medicare-participating physicians are required by law to use electronic medical records, so they type your private health history into a computer. A policeman wanting to get your information would be silly to ask a doctor. The police agency can just go to the Health Information Management administrator and have them release your chart. Slam dunk. No doctor’s principles getting in the way of good police work. The health record administrators are the ones who, according to HIPAA, now exercise “professional ethics” and “best judgments” in whether your HIV test result and level of obesity is sent out for someone far away to peruse.

Comforted?

Privacy is the foundation of the ethical doctor-patient relationship. Just like your priest or your lawyer, doctors traditionally kept your secrets so you would be free to confide your deepest secrets to them. But privacy, and so too the ethical doctor-patient relationship, have been sacrificed on the altar of the “public good” – the notion that the good of society outweighs the needs of any individual.

How can you protect your privacy? There is only one way. You can seek out one of the growing number of physicians who practices outside the government Medicare/Medicaid/Tricare system. Such a physician can keep paper records on his locked shelf – just like in the old days. Or, he can use a computer that he alone controls. In either case he will take personal responsibility and can truly guard your secrets. He or she charges you for your visit, and you pay the doctor directly – not through a third party. That way, you can be assured that no third party can request your data. Though you pay cash up front, these physicians can actually be cost effective, because they are unhampered by ponderous government regulation. In the final analysis, what is your privacy worth?


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