Tuesday, June 11, 2013

HIP HIP HIPAA HOORAY! Where's My Medical Privacy?



And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. 
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Today, I"m ranting about medical privacy (now gone) and electronic medical records over on KevinMD.  The link is HERE.  Did you know that hospitals now send your medical information to the state (at least in our state), whether you want that or not? 

And while you're reading about privacy, there's a terrific article in the Wall Street Journal called Families of Violent Patients: We're Locked out of Care.

Okay, I'm going to make a confession here.  I have no idea what HIPAA is.  I don't know, I don't care.  My practice is small enough that I don't have to give out privacy notices, and I confine my "HIPAA" comments to "I don't release information without your permission."  I also note that I do release information in case of an emergency and that the state has requirements about the reporting of child abuse.  But from my take on it, HIPAA is not about who doesn't get your information, it's a long list of who DOES get your information, like it or not.  When I go to the doctor, I often cross out some of the listed entities, and tell them I don't want my information released.  But no one reads these things so it's just about making me feel like I have some control.  We all like those delusions.

Before HIPAA, doctors were not allowed to release your medical information without your permission.   There was this guy, way back when, named Hippocrates who had something to say on the matter.  Psychiatrists never did talk about your care without your permission, I remember this from before HIPAA.  

Regarding the Wall Street Journal article -- the implication here is that suddenly HIPAA prevents families from getting information about patients against their will.  I sometimes wonder if there is a reason the hospital/doctor/etc aren't plugging harder to talk with the family.  In the case of a violent patient, no doctor wants to see their patient hurt someone or die, and it's hard to imagine that if it were crucial to to share this information, a psychiatrist wouldn't say, "Listen, I can't treat you if you won't let me include your family."  The slant of the article assumes that the patient is always the sick one and that the family is well and harboring nothing but good intentions.  Perhaps the family has been intrusive, or the patient is really adamant.  Do we really want to tell a psychiatrist our private thoughts knowing they will repeat them to our family members whom we don't want to know them?  There are times when a really psychotic person won't allow communication because in the past, the family has insisted he take medication or go to treatment he didn't like, but which helped him anyway, and perhaps that was the right course of action.  But there are also times when families make the situation worse.  I don't think the issue is HIPAA, but I do imagine that part of it is that hospital staff don't have the time to work with patients and their families to help everyone come to a place where families know how to be helpful without being intrusive, and patients can feel more comfortable and respected.  These things take time (sometimes a lot of time) and if you're fighting with insurance companies for an extra day, and spending your time entering data into the computer, when a patient says "No, don't talk to my family,"  the doctor may just say "HIPAA, I can't," without exploring whether that makes sense or if there is a way the patient might allow communication about some aspects of care.  And finally, there is nothing about HIPAA that prevents family members from giving crucial information to a doctor.    

Okay, I've ranted for today.