“There’s such an issue of privacy in health care, and yet they let all the patients walk around with their derrières sticking out.”
This quote within an article by the National Post got me thinking about HIPAA.
The Health Insurance Portability and Accountability Act of 1996 is a big flat hammer with excellent intentions. Like EMTALA, however, it too has its side effects. Along with many other ER docs after the 2010 Haiti earthquake, I flew there to lend a hand. And after just a couple weeks, I really started to wonder how much we in the U.S. actually benefit from our quest for absolute privacy.
Exposing preexisting conditions to employers or insurers was a bigger concern before the ACA. Less so now. For infectious disease containment, privacy (or rather separation) is a sure winner. However, for many other medical problems I’m not so certain, as the extreme end of privacy is isolation and sometimes despair. I wish HIPAA had privacy settings like Facebook, Linkedin, Google+, etc.
Q: Do you mind if the patient on the other side of the curtain hears our conversation?
A: Depends. No problem for most things, except probably bowel or genital stuff. I’d love it if they would refill my ice water, or call for help if I roll off the bed.
Q: Do you mind sharing a room with Typhoid Mary?
A: Heck no! Also, whose grandmother or baby did she sit next to in the waiting room, and why doesn’t HIPAA offer better shielding out there too?!
Q: Do you care if we take your photo?
A: Well, if it’s one of me hanging off the gurney in a drunken stupor, I’d prefer no. But if you want to text a photo of my lacerated tendon to an orthopedist, please do!
Q: Is it OK if we send your birthday, license, social security number, Facebook username/password, telephone number, and mother’s maiden name to another hospital to get your records?
A: Absolutely not OK! … Unless I’m toes up, head injured, tied to a backboard in Iceland. Here are all my credit cards too if you think that’ll help.
In my short time working in Haiti, I watched patients in femur fracture and amputee wards become families. As I rounded, friends and family members helped other patients with their dressing changes and rehab. Strangely, there seemed to be more harmony and laughter than I’ve experienced among patients in any American hospital. Unless we’re talking infectious disease, give me a laughing, crying, singing, praying ward in Haiti over a private, beeping, hermetically sealed hospital room with cable news streaming any day. (Admittedly, I’d choose personal shower and toilet in my privacy settings.)
I realize it’s absurd for me to hope for American hospitals to swing in this direction. And for those of you literal readers, I am kidding … a little. I won’t be headed to Haiti for my appendectomy. More plainly stated, I’m just not certain HIPAA helps as much as we may hope. The back bends we do to obtain records from clinics and hospitals make us frequently abandon our efforts in the ER. It’s often far easier to repeat an x-ray than to hunt for one elsewhere.
HIPAA, plus data-overloaded EMRs that don’t talk with each other, has made the goal of rapid record sharing feel like a distant dream. Patients often languish alone in private rooms with beeping monitors making them crazy, all for the sake of their privacy. Plus countless teaching moments are lost, because the days of eager high school or college seniors “shadowing” doctors in ERs, ORs and clinics are essentially gone. A decade ago, pre-meds used to join me for every shift, but no longer.
American hospitals are unlikely to adopt the Haitian model anytime soon, and it’s hard to imagine any legislative changes on the way. But maybe we could at least hope for a new triage track for infectious disease one day. Actually, why not a swing back to old school house calls specifically for ID issues? Perhaps the recent growth in telemedicine and “on-demand” medicine will nudge us in that direction.
Maybe we’ll one day have a universal user-friendly EMR. Maybe we’ll get smarter with infectious disease containment. Maybe we’ll develop a 1 to 10 point scale for loneliness and isolation. And maybe we’ll find some value in ward medicine and community for healing again.
However, one thing for me is certain: If I’m ever a patient I will do whatever I can to receive as much of my care at home, where I can dial my privacy settings with precision.
Sam Slishman is an emergency physician.
Image credit: Shutterstock.com