Like many other people, Ms. Krinsk thought that her prescription information was private. But in fact, prescriptions, and all the information on them — including not only the name and dosage of the drug and the name and address of the doctor, but also the patient’s address and Social Security number — are a commodity bought and sold in a murky marketplace, often without the patients’ knowledge or permission.
But given the money involved, I’m afraid it isn’t.
But with the pharmaceutical industry soon to release $150M dollars of ads promoting health reform as they cozy up to Congressional leaders, the conflicts of interest for patient’s privacy are staggering. Further, the promotion of the electronic medical record, personal health records, and ultimately, cloud computing (where no one will know where health data resides), are firmly part of the health reform landscape.
Now before people think I’m totally against the EMR, let me be candid: I’m not. It does facilitate care and is an incredible means of communication between physicians and laboratories and pharmacies and the like. When used properly, they are miraculous.
But the risks of losing information remain huge. Certainly, the above referenced New York Times article notes that safeguards are supposed to be enacted to prevent this wholesale marketing of your health data.
But suddenly, we learn of a White House snitch line where they will collect e-mails of people who might be spreading “misinformation” about the health reform efforts underway. (Thanks to my previous blog post, I am happy to report I’ve been reported! ;)) But this occurs at a time when privacy issues in health care must be seen as paramount and electronic medical records protected as secure.
Ooops.
So now we have a White House eager to build a snitch line as they cozy up to pharaceutical interests that are already selling personal information from prescription data, all while trying to promote the security of electronic medical records to the masses.
Who are they kidding?
But then, shucks, just think of the marketing possibilities for the government:
And lest people think I’m too partisan (who me?), the Republicans with their travel junkets aren’t any better.
Sheesh!
-Wes
Reference: White House blog with snitch e-mail link at flag@whitehouse.gov .
*This blog post was originally published at Dr. Wes*
There is not a big difference, even if a lot of people think there is. I’ve written many posts about online image building and reputation management but here is a practical example why everyone should be more cautious about what they say online (just like they’re cautious about what they say offline).
Somebody posted a message about her job on Facebook. But the boss was also there…
*This blog post was originally published at ScienceRoll*
By 4: 30 am Saturday, the previously healthy 65-year-old female had a fever and lower extremity weakness. A family member heard her repetitive moaning. The patient got up to void, but could barely negotiate the one step up to the hallway. As she negotiated the hallway, she staggered.
By 5:00 am she was in the ER.
*****
The patient was taken to an exam room. Vital signs were taken and it was noted that the patient’s fever was “extremely high”. The doctor came into the room and the temp was re-taken. Extremely high. The patient had no insurance and was not verbal; the doctor discussed options with the family member.
The goal: find the source of the fever and begin treatment. A CBC, Chem 14, a urinalysis, an IV and hydration would be started. No lactate level would be done; the doctor stated it would be pointless to run a test that she already knew would be elevated based on clinical presentation. Blood cultures would be drawn, but not sent immediately. As the doctor explained, they are expensive and it would take days before the test results would be back.
In this facility, payment was expected at the time of treatment and a detailed estimate was provided to the family. The low end of the estimate was the deposit.
*****
By 8:30 am Saturday, the fever was still raging; the lab tests were normal. The patient was in ice packs with a fan in an attempt to lower the fever. An IV antibiotic was initiated; hydration was on-going. An internist and a neurosurgeon were consulted as the patient was experiencing lower back pain in addition to the profound weakness. The patient was admitted.
Further tests were proposed: lumbar x-ray to rule out spondylitis and, given the patient’s age, a chest x-ray to rule out occult pneumonia. The pros and cons of each test were fully explained along with rationale and the cost.
*****
The radiographic exams were normal. A loose bowel movement that morning had been blood-tinged. The patient had been medicated for pain. A second antibiotic was started. The next step would be an abdominal ultrasound, as no obvious source for the fever had been found. The rationale for the test and the cost were discussed and the family gave the go-ahead.
The spleen. Enlarged and mottled on ultrasound. A call was made to the family to discuss needle aspiration to rule out lymphoma.
*****
Monday morning the patient’s fever was down. She was eating. She was voiding. She was still weak, still moved slowly and awkwardly. She would be discharged home on oral antibiotics with the results of her spleen aspirate pending.
*****
It’s been a week now and the patient is acting 100% normally.
The patient was my dog, a 10-year-old, 70 pound Shepherd mix. We still don’t know what nearly killed her last weekend. The spleen aspirate was abnormal, but not lymphoma. The fact that the fever responded to antibiotics (as did the weakness) leaves us with the feeling that it was an infection in such an early stage that the source was not obvious.
I realize veterinary medicine is not human medicine, and a million holes can be found in my attempt to draw a parallel between them. But a few things crossed my mind during this experience:
(a) Tests were not done just for the sake of testing or because a printed standard said they should be. This was not template medicine dictated by any outside organization or government regulations.
(b) The doctor/patient relationship was unencumbered by insurance company approvals, government regulations, billing, coding or the number of patients that had to be seen in a certain time frame.
(c) there was full transparency regarding what each test would cost.
Maybe the human health care system can take a few pointers from what the veterinary world has been doing all along.
(P.S. I just realized you can read this story from the vantage point of ME being the third-party payer standing between the vet and my dog, deciding what would be “covered” – i.e. paid for. Interesting either way….)
*This blog post was originally published at Emergiblog*
I have never been one to shy away from the truths about our world. An Inconvenient Truth was a movie that affected many of us profoundly. Most of my family does not like Al Gore because they are in denial about what is happening to our planet, and our role in that. A new movie does the same about our food sources in America. It is called Food, Inc. It may upset you, but I highly recommend it. The authors explore just where our food comes from, the chicken, the beef, the grains and how our big corporate food industries operate.
I am not an anti-corporate person. I agree with Calvin Coolidge that the business of America is business. In our modern life, we have accomplished many things through industry. Our supermarkets contain a richer variety of food than ever available before in the history of mankind. But, there are important issues for us to address. What are the implications of feeding our cattle corn meal when that is not their best food source? What danger do we have of serious bacterial contamination? How do the big food corporations treat our farmers? These are all questions explored in this film. Like Anderson Cooper on CNN, this film “keeps them honest”.
Two of the main characters in the movie are authors I admire a lot: Eric Schlosser, who wrote Fast Food Nation, and Michael Pollen, author of The Omnivore’s Dilemma. These men are dedicated to keeping our food supply safe and healthy and for us to avoid the traps that make us unhealthy and obese.
Should you become a “locavore”? That is a new word to describe someone that only eats locally grown food. That may be an option for some but not for others depending on where you live. Locally grown food, like what is found in a Farmer’s Market, is more likely to be fresh and have fewer questions than other commercially developed foods. I saw an interesting bumper sticker today, “Supermarkets have branches, Farmer’s Markets have roots”.
The tagline for Food, Inc. is “You’ll never look at dinner the same way again”. I must say that is true. I continue to shop in supermarkets and eat in restaurants, but I am much more mindful about what I put in my body. We all should be.
*This blog post was originally published at eDocAmerica*
I went to Home Depot to look for some, but couldn’t find any. There was some drywall of doom, tiles of the abyss, and sheet rock of destruction, but no panels. I guess the Obama administration has bought them all.
Honestly, I am not sure what the “death panel” fuss is about. Everyone dies. There are times it is a surprise, but many times it is expected. When it is expected, shouldn’t people plan for it? Shouldn’t we encourage people to plan for it?
The focus of a physician is twofold: to prolong life and to minimize suffering. We practice preventive medicine to keep the person from avoidable pain and/or death. The younger the patient is, the more we call their death things like tragic, pointless, and distressing. We go to great lengths to save the life of someone who has many potential years ahead.
But there is a point when things change. There is a point when the focus shifts from quantity of life to quality of life. There is a time after which a death is no longer tragic, but instead the end of a story. My focus as a physician shifts from trying to find and prevent disease, to maximizing function and minimizing pain. When does this happen? It depends on the health of the patient. But eventually, ignoring one’s inevitable end becomes more tragic than the end itself.
I had a man in my practice who had advanced Alzheimer’s disease. I cared for him before he started his decline, and so had a good chance to know both him and his family. They were people of strong faith, accepting the hard things in life as being from the hand of God. The children took their father’s condition not as a horrible burden, but an opportunity to pay back the man who had given them so much. There was no fear of illness or death.
His wife died fairly soon after I started caring for them. He grieved greatly when she died, but was so surrounded with the love of their children that his grief was short. He spoke often of her in subsequent visits, talking about her as if she was not far away.
As he became increasingly short in his memory, my relationship with their children grew. You can tell a lot about people from their children, and these children were a dazzling crown of honor to these two lovely people.They always came asking good questions, patiently dealing with their father’s confusion, anxiety, and occasional outbursts. Together we worked to maximize his quality of life. When I suggested we stop cholesterol medication and cancer screening tests, they understood. Our focus would not be on the length of life, but the quality of time they could spend with their father.
I was shocked, therefore, when the report of his admission to the hospital came across my desktop. He had chest pains and some difficulty breathing. In the emergency room, a plethora of lab tests, x-rays, and other studies were done. The hospitalist physician on call felt there was a good possibility of heart attack or pulmonary embolism (blood clot to the lung). My patient was sent to the ICU, where he underwent CT angiography, serial lab tests, and even a stress test to rule out heart problems.
I was mystified as I read these reports; the family clearly understood that prolonging his life wasn’t the goal. The patient was ready to die and join his wife, and the children were very comfortable talking about his eventual death. These reports made absolutely no sense with what I knew of this man and his family.
He looked his normal self when he came in to my office for a hospital follow-up. I questioned the daughter about the details of the admission, which she recounted carefully. Then I paused and asked her, “Can I ask you one more thing?”
She smiled at me, “Of course, Dr. Rob” she said gently.
“I was honestly a little surprised when I read about your father’s admission to the hospital. It seems like they pulled out all the stops, even putting him in the ICU. Did they ask you if this is what you wanted? I thought that you wouldn’t want to be that aggressive.”
She thought about what I said and a puzzled expression slowly appeared on her face.
“Did you ask to have everything done, or did you just follow what the doctors at the hospital told you?” I asked.
“They didn’t ask us. We just did what they told us we needed to do.” she said, now scowling slightly.
I explained to her that they need to make their wishes known in advance. If they don’t say anything, the doctors will assume that you agree with what they are doing. As I told her this, she nodded and looked down sadly.
“It’s OK what you did” I reassured her. I patted her father on the shoulder and added, “he looks great now. I am glad I get to see him again. I just want you to know what to do if it happens in the future. You never know what will happen, and I’d hate for him to suffer needlessly.”
This one short hospital stay undoubtedly amassed a bill many times that of all my bills over the 12 years I saw him in my office. My years of care, long conversations, and real personal connection built with this man and his family are worth only a fraction of a few days of unnecessary care. This care was not demanded by the family. It was not done because of denial or ignorance; it was because the family wasn’t prepared for the mechanics of the hospital stay. I never had that conversation with the family until after this event.
Politicians have labeled this merciful conversation as an act of rationing. That is not only ignorant, it is shameful. Talking to people about end-of-life issues will certainly save money. But it’s a contemptible step to imply that this money is saved by killing the elderly. It’s more wrong to make money off of keeping them alive unnecessarily than it is to save money by letting them die when they choose.
This is politics at its ugliest – taking a provision that will reduce suffering and help people and pervert it to be used as a tool to scare the people it will help. The discussion about healthcare has been subverted by those who want poll numbers.
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