What a Lot of Wimps
Over a quarter-century ago, the corrupt morons in the federal government that now control most of health care (go hug the retirees for allowing that) instituted the Health Insurance Portability and Accountability Act. This act as we have since learned, seemed designed to further control physicians and nurses by restricting their access to patient information, while simultaneously making it more accessible to helpful government agents, their buddies in Big Insurance and Big Pharma, and anyone else who had no legitimate reason to know your personal biz. I have a family member who explicitly told his primary physician NOT to share or divulge some particular info – which was promptly recorded and shared with Blue Cross. Literally overnight, I went from stumbling on to the hospital ward at 6:00 AM, bleary-eyed, going to my patients’ rooms with ease because their freaking names were on the door, to stumbling to the nurses’ station to fumble through a row of anonymous charts to find the correct ones. All because, y’know, “privacy.” It was obviously absurd in its infancy – the room door only said “Mrs. Smith”, not “Mrs. Smith with raging thundering herpes.” One moron shortly thereafter scolded our receptionist because the names on the sign-in clip board were not immediately covered up, which was funny, since anyone in our tiny lobby was always visible to anyone else in our tiny lobby. Regulations are an invitation to stupidity, which in this grossly over-regulated industry makes health care a great big ‘ol idiot convention forever, as the recent masking fetish proves.
And of course, regular doctors, not the highfalutin, big money admin types, but the ones who do the damn work have also been infected. Yesterday I had a patient in the ER (ED is something you take a blue pill for) who was a terrible historian, with a pretty pronounced blistering, peeling, circumferential burn around his entire forearm. Though he was neurovascularly intact distal to the burn, I was worried this might turn into a compartment syndrome sort of situation, and wanted to consult a burn center. The hospital where this occurred was several hours by ground from any burn center, and though I cheerfully run up the bill every shift on patients every one of whom is a potential plaintiff, I really didn’t want to ship this guy up the road if we could appropriately handle it ourselves. I talked to a very pleasant, very good-by-reputation surgeon at the regional burn center and offered to text him some photos of the burn, without any identifying info such as face, name, social security number, DOB, bar code, vaccine card, or anything else that would have identified the individual. I just wanted to show him the burn. He immediately slammed the door, whining that the photos weren’t encrypted and therefore he could not receive or look at them. I repeated, there would be NO WAY to identify or violate an individual’s privacy based on these up-close pics. Nope, no way, just send the patient and we’ll be glad to see him. A simple look at an anonymous photo could have saved over six hours of ambulance transit, but noooooo…
Three years ago, I had a nearly identical experience with a regional burn center, another burn I was on the fence about, and just wanted to pick the brain of an expert … same conversation (different consultant), same result. It is infuriating that our profession welcomes so damn many wimps into its failing ranks. These cowards didn’t have to save the photos or enter them into any sort of record, they just had to LOOK at them, then delete them for all I cared. Were they fearful that I would enter their, the consultants, names into the chart? I would either way, that’s the game. Were they fearful that some bean counter with a GED would note that they had seen the contraband images, and report them to their superiors?
Frequently enough, I am very grateful when an orthopedist will ask me to text them pics of the x-rays on the computer screen, and I scrupulously keep any identifying info out of the photo. Two years ago, I was very, very, very grateful that a pediatric intensivist over an hour by air (as it turned out) was willing to facetime with me so that he could real-time eyeball an infant in critical shape, resulting in an expedited transfer and happy outcome.
My point is that we will never in this perverted, warped health “care” industry escape the stupidity, but we need not give into it, and should try to circumvent it when possible, to take care of patients, and because it’s the rational thing to do. And any guerilla actions against this godawful system are good for the soul.
Oh, I can comment. Am so glad to be retired. I could call any specialist’s office and if the consult letter was in the mail, the staff would read it to me over the phone after I properly, verbally identified myself as the patient’s primary care doc. (This was before faxes!)
I trained in the institution where these specialists worked so that might have something to do with it. A lot of them knew me personally and I dare say it, held me in high regard. I did have the habit of dictating long introductory letters on my patients to the specialty docs and I lost count of the numbers of specialists who came up to me at medical meetings to thank me for doing that with my referrals. Said it really helped them even if there were some holes in the history. Were able to get on the right track to the problem anyways. Cripes the “holes” were the reason why I referred them in the first place!
I’d sometimes ask a referral doc at a medical meeting if “I’m giving them enough information on referrals.” Every freaking time the reply was, “Yes you did.” I humorously followed up
to some of the specialty docs I knew well, “Now you’re not just kissing my ass are you!”
Every time the specialty doc be it cardiologist, neurologist, endocrinologist would start riffing on all the consults they got with NO information from the referring primary care doc and that I did great on my referring letters. Helped them to hone down on the problem I couldn’t put a finger on. Oh, patients really respected me if I told them, “I don’t know.” but I’m going to send you to someone who might help us with this problem.
It was also shared to me that sometimes the specialty doc would kinda of shy off or “get out of” seeing referrals from certain docs due to lack of database information. That was a long time ago and I believe nowadays a fair number of specialties (sans dermatology/plastics) will see anybody no matter what.
That was way back then in the 80’s and 90’s. Had a big effect on sharing patient information. Now F.P.’s if they want to stay sane, go for regular office hours, no hospital or call work and bang away at the stupid EHR computer. Poor sots. Can’t do real medicine anymore thanks to EHR. The poor residents coming up now in F.P. don’t know how good it was back then before the cursed EHR. Kurt
“My point is that we will never in this perverted, warped health “care” industry escape the stupidity, but we need not give into it, and should try to circumvent it when possible, to take care of patients, and because it’s the rational thing to do.”
Great one Pat! Could not agree more.
Had a teenager with mental health problems attending a community health center. My practice is primary care. Kid gets put on a new psychiatric medicine a day or two before. After one or two doses, he had a seizure. Maybe a dystonic reaction, I didn’t see it. Mother witnessed it. The mother brought her kid to my office. Why not the Emergency Department, good question, she was a few brix short if you know what I mean. So, sort of supporting/dragging the kid into my office, in sort of an obtunded state, I had to assume post-ictal. No appointment of course. OK fine, put in a room, get vitals, I’ve got an older Operating Room/ICU pulse oximeter with a waveform. Vitals stable and oximetry OK. Kid is just sleepy. Then I do what mother should have done and called 911. So, what was the new medicine the kid was put on, you ask. Mother did not know, kid was in no shape to tell me even if he did know, and she didn’t bring medicine. OK fine, call the psych facility about a mile away.
They would not tell me the name of the medicine. HIPAA (and CFR in the case of a psych facility), which was interpreted by psych facility, including medical personnel, to prohibit communication between doctors. OK, I could be some sort of scam artist I suppose. So here’s my office number, call me back after verifying that I really exist at that telephone number. Nope. The psych facility absolutely dug in their heels. They had just put a patient of theirs on a medicine, he had a seizure, or dystonic reaction, whatever, right after starting the medicine, and they would not tell a treating physician the name of the medicine.
I’m sorry, I’m not allowed to comment on the comment which you may or may not have made, as it a) clearly identifies my country’s government, and b) discusses what the f* is wrong with it. I’ve asked my country to sign a Release of Information regarding this comment, which they will fax to Where Faxes Go To Die, Washington DC 20045. Remember, Patients May Die, But The Chart Lives Forever.™