Willam E. Jones, MD

     There's been a lot of talk in Congress and the media these days about the privacy of patients records.    The politicians and talking heads on TV yammer about this issue ad nauseum, and most of them are either misguided or just flat wrong because privacy of medical records has ceased to exist; and it's never coming back.
     All information in a patient's medical record was once a sacred trust for doctors, and we all swore in our Hippocratic Oath to guard faithfully our patients' privacy.    Until managed healthcare, patients were confident that their doctor adhered to such high ethical standards that they never had to worry that he (or she) would reveal some private aspect of their health to anyone other than to another professional involved directly in their care.
     That sort of privacy is a thing of the past.    We doctors, now more then ever, are required to document everything thoroughly in our records.   If we don't document everything thoroughly:

     Sadly, when it comes to demanding privacy, none of us patients (me included) have a leg to stand on because every one of us who has ever signed an application for any kind of life or health insurance also signed away our right to privacy.   In the very fine print at the bottom of every insurance application it states in effect that the patient gives the insurance company the right to obtain any medical information it wants from any source.
     That means you gave them the right to demand all information about you from any doctor, any hospital, and also from the Medical Information Bureau (MIB).    The MIB (sounds like Men in Black, doesn't it?) is an immense centralized computer database of mutually shared medical information supported by the entire insurance industry.    The MIB contains, preserved forever in their database, just about every item of vital medical information that any insurance company has ever learned about you; and any insurance company can access your information any time they wish.    That's one of the ways they can catch you if you fail to report a pre-existing medical condition when you're applying for new insurance.
     The hard fact of the matter is that the minute a patient allows any entity besides himself to take over responsibility for paying his medical bills, he also automatically gives up essentially all his rights to medical privacy.    There is simply no way to put this information genie back into the bottle.

The new HIPAA (Health Insurance Portability and Accountability Act) attempts to do this; but like most government regulations, it ends up just creating more bureaucratic jobs while accomplishing little else. Doctors must now jump through a whole new set of federal bureaucratic hoops (such as promising our patients in writing) that we will not misuse their medical information. DUH! Isn't that what we already swore to in our Hippocratic Oaths? Forcing all this extra HIPAA red tape and paperwork on doctors who are already severely overburdened with government and managed care red tape means that doctors will have just that much less time to spend on good patient care.

SO DOES THIS MEAN THERE IS NO LONGER
ANY MEDICAL PRIVACY AT ALL?
Most of you have probably noticed how lengthy and neatly typed the medical records are in my office. In order to take the best possible care of my patients, I feel it is essential that I document thoroughly every finding, diagnosis, and treatment, not only for myself but also for other doctors who might later become involved in your care. It would be unethical and even illegal for me to fail to record accurately any pertinent medical information or diagnosis. Like it or not, any insurance company with whom you choose to sign a contract then has every right to see those records before they agree to pay for your care which means that you've given even the lowliest insurance clerk permission to read everything in your medical file whether you like it or not. The only way out of this trap would be for patients to drop their health insurance and go back to paying for all of their own care themselves; and we all know that's simply not possible because most of us could not afford to pay the cost of surgery or hospitalization ourselves.

Fortunately the confidentiality of your
really sensitive information is still safe with me
After years of building mutual trust, my patients often confide in me information about themselves that is highly personal, details which the patient intends only for me to know, but no one else. I generally do not record information such as sexual preference, extramarital sexual encounters, occasional marijuana use, etc. into my patients' charts for all and sundry to read. To protect my patients' privacy, I usually keep this sort of information only in my head; or I will sometimes "lay it between the lines" in my dictation in such a way that I know precisely what I'm saying; but no other reader could possibly understand the true meaning of the phrases I've used.
Although I cannot and will never "shade the facts" I record about your medical conditions, you can have confidence that the truly private aspects of your life will remain private with me.

. More and more government regulations are not going to enhance the privacy of your medical information. You either trust your doctor; or you don't. You should always feel totally confident that your doctor is protecting your best interests; or else you ought to be looking for a new doctor.