Sitting on the front porch the other night after supper, one of our guests started talking about how he liked his doctor, but he was increasingly angry at having to answer his questions. On his last visit, the doc had asked the man about firearms in the home. A longtime gun enthusiast, the man responded that it was none of the doctor’s damn business. The doc told him that the computer told him to ask, and that it was one of the little boxes he had to check for the insurance company. That led a lady in the group to relate how, while establishing as a new patient, she had given the physician information that she specifically asked her not to record or relate to any other entity. The physician promptly entered said info into the EHR, and it was repeated in the lady’s documentation from her insurance company. She refused to return to that office. All of which got me to thinking.
I thought about this article that “Two-thirds of Americans OK if doctors ask about guns.” We’ve covered this before on this site, and took fire from all sides. But now we have at least the potential that clinicians inquiring into home habits might be related to payment. As for the lady incensed over her private info being entered into that great database in the cloud, I paraphrase Warren Oates as Sgt. Hulka in “Stripes”: Son, there ain’t no medical privacy no more.”
Yeah, I also have empathy for the doc who is trying to keep an accurate record in order to provide the most comprehensive care. That physician, like most of us, is caught between the professional obligations of thoroughness, and the bleeding ethical wounds caused by sharing technology, wielded by the health industry. But of course there is no longer any medical privacy outside of an independent practice with no – and I mean none!- electronic links to the outside world. As we have all now come to learn, HIPAA was only really intended to keep patient info protected from the physician.
My advice to the crowd: Lie. We know from training, and from watching “Scrubs”, that all patients lie, and that’s the truth. I used to get angry when patients lied to me; now I see that lying is a rational response in a world where Big Insurance and Big Government are trying to give everyone a continual, lifelong colonoscopy. When medical databases and insurance premiums treat the occasional fine cigar the same as a 2-pack per day habit, who can afford honesty? If the federal government successfully convinces the insurance industry that it will back any premium increases for private gun owners, skydiving, or entering hotdog eating contests, then those candid discussions with your doc could lead to real money. The elements of employer-based health care, government-provided health care, crony corporatism combining the two, and a whole lighter fluid can full of EHR has accelerated this bonfire of the privacies. We doctors are now the enemies of patient privacy.
Since my physician is now a quasi-government agent, the less he knows about me, the better. Sure, that may sound paranoid. But then again, I don’t own any firearms, have never touched tobacco, had unprotected sex, drink only in moderation, and have not driven over the speed limit since my last ticket. And that’s the truth.