An erosion of privacy in health care settings

Our privacy is eroding. Some of this erosion is our own fault — we post to Facebook, Twitter, and other social media with reckless abandon. Some is the nature of modern communication — electronic trails are just as easy to find as paper trails (if not easier). Some of the privacy erosion really doesn’t bother me so much — if Target knows that I buy a lot of Cheerios, I’m happy to accept their General Mills coupon for $1.50 off my next breakfast cereal purchase. But there are some places where I expect and demand privacy.

Like in a doctor’s office. Or hospital. Or pharmacy.

But business has so inserted itself into so many aspects of life, including medicine, that my expectation of health-related privacy is being slammed into the wall. Although I really couldn’t care less if Target knows my cereal-buying habits, I certainly do care if they share the information when I purchase a pregnancy test. Or athlete’s foot spray, for that matter. Of course the store has no idea if I’m purchasing health-related items for my own family or for someone else, so it’s unlikely that this information will be used for anything other than targeted coupon offers, but it still really bugs me that people look at this information. And yes, I am aware that I can simply use cash when purchasing over-the-counter wart remover if I want complete privacy on that issue. But the fact that I have to consider it really bothers me.

What price convenience? And what price financial savings? I have a Target REDcard. It gives me 5% off the price of everything I buy at Target. It allows me to return items even if I’ve lost a receipt. It gives me coupons for things I buy. But I read an article a couple years ago that talked about a man finding out that his teenage daughter was pregnant because she started receiving store coupons in the mail for diapers and infant formula after she had purchased a pregnancy test and vitamins. This is a breach of privacy. And it could also cause harm aside from breach-of-privacy with its presumptions.

For example, while some couples who purchased a pregnancy kit and then started purchasing vitamins may in fact be delightedly experiencing a pregnancy and happy to receive a coupon for a stroller, a couple experiencing fertility difficulty (or who experienced a miscarriage) might not appreciate receiving constant flyers for baby item sales. It’s one thing if someone actively opts-in or signs up to receive notification of promotions of certain types of items, but quite a different thing to have the automaticity and presumptuousness, and it’s a problem.

There are other financial “incentives” that erode our medical privacy. One that bothers me quite a bit is the extra charge for health insurance that many companies currently impose unless you have a yearly health screening and fill out an online, detailed, personal questionnaire about health-and-safety-related issues. Strange that this bothers me, considering what I do for a living. And considering that I am all about people taking responsibility for their health. And considering that I am all about educating people on health-and-safety-related issues and healthy lifestyles. And that I like when there are resources to help people. And that I understand deeply how addressing certain issues can significantly improve a person’s overall health and well-being (and in so doing, how it can have a positive financial impact as well).

But I figured out what it is that bugs me so much. I actually would have no problem with it if there were the same requirement for a yearly checkup with one’s own physician and if the questionnaire were between each individual and that person’s physician. My problem is with the online, one-size-fits-all survey/questionnaire with detailed, personal questions (many of which have nothing to do with modifiable risk factors) that goes to some random computer algorithm and perhaps some random person (who is not a doctor). Seriously, the lifestyle health coaching company does not need to know when someone’s first menstrual period was — they can simply ask if a woman has discussed breast exams and mammograms with her physician My issue with the current system of monetarily penalizing those who don’t comply with this invasive questioning is the presumptuousness and the intrusion of someone else into my doctor-patient relationship. There are too many people in the exam room.

By all means, the companies should feel free to offer their support services as an option to those who decide they would like to use them, or to those whose doctors feel they would benefit. But if you are not my patient and you were not invited in by my patient, then get out of my office. And if I did not invite you, then get out of my doctor’s office.

Abigail Schildcrout is founder, Practical Medical Insights, and blogs at DocThoughts.

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  • JPedersenB

    Amen!

  • Abigail Schildcrout

    That was indeed my point! We pay for convenience and safety with our privacy, and it sometimes goes too far. We should not have to choose between carrying large wads of cash and losing our privacy. Anything health- or medical-related should be off limits to the info gatherers.

    • Judgeforyourself37

      Perhaps there should be a box to check if you do not wish to receive coupons, or to have your information tracked or sent to any other source. I guess that would be too much to ask, as one takes the discount, and pays with the loss of privacy.

  • Lisa

    I refuse to use any discount card when making purchases. If I don’t have cash, stores still take checks.

  • Lisa

    That could be. If that is the case, tthey are getting incomplete/inaccurate data as I usually use cash.

  • Shawn Huecker

    Dr. Schildcrout,

    A very thoughtful post and I am absolutely in agreement. Have you thought about taking your concern a bit further? For example, what is the AMA’s position on privacy in these situations? Is it in alignment with your thoughts? If not, as a member of the profession have you escalated your concerns via that avenue? Have they even weighed in on these particular privacy concerns? The AMA is a very rich and powerful lobby. It would be great to have them in your corner, and if not to at least know they oppose you as you move forward.

    Have you approached Target? Given their recent black eye over data leaks, this would seem to be the ideal time to do so. I’m under no illusion that they would update their privacy policy because it is the right thing to do; however, it would be a great issue for them to take the lead on as a PR move in the wake of their data disaster.

    Have you approached your congressional representatives? Tom Clayton’s response notwithstanding, government intervention is likely to be the most effective avenue of change as self-policing of industry has a mixed track record at best. There would be lobbyists to fight, but at least your congressional representatives have some independence from the industry.

    Have you thought about posting an online petition via change.org? The awareness you have created with your post is good; the action you could motivate via such a petition is even better.

    The awareness you are creating is a good starting point. Looking forward to seeing your next step.

    Shawn