Greg Roach's Berkshires Blog
Sunday, January 28, 2007
  Clerical Errors - A Cautionary Tale
You know those slightly annoying privacy notices that you have to sign off on every time you visit a new doctor? - the little pamphlet that basically tells you that your information cannot be shared with anybody except the insurance gods without your consent?

These little Xeroxed forms are the result of HIPAA (Health Insurance Portability and Accountability Act Of 1996). I have heard many people refer to this type legislation as "nanny-state" and "big brother" because it forces doctors, hospitals and other who keep and read our medical information to handle it uniformly with the privacy that it deserves.

More importantly (but oddly less known) is that this law also gives consumers the right to demand to see their records and have them corrected and amended if there are errors.

That's a very good thing. Let me give you a real life example:

A few weeks back I was visiting an Ear Nose and Throat specialist (ENT) about a chronically stuffy nose. While leafing through my chart, he began to speak of some very serious medical conditions from which I was supposedly suffering and more than a few heavy duty pharmaceuticals that I was reportedly taking. The problem was, none of that information was in any way accurate or correct.

I asked the ENT for a copy of this erroneous report that had come from another doctor after some tests last year. Upon reading it, it was clear that my personal information had been pasted at the top of medical data that had actually been generated by 61 year-old male with severe chronic health problems who apparently had seen the same doctor on the same day in 2006 as I.

In a worst case scenario, this screw up could have had a tragic result.

Imagine if I had been an emergency medical situation and the docs were forced to make quick decisions based upon a 30 second summary of my incorrect medical charts. The medications and procedures available to me may have been limited by the chronic conditions that my chart mistakenly claimed I ailed from. It is not unlikely that the course of treatment could have been severely compromised.

Forget worst case and consider the fact that I am getting ready to purchase Long Term Disability Insurance. The insurance company's underwriters would have based their decision and their rates upon information that made it look like I was a medical ticking time-bomb. That would not be good.

Had HIPPA not been in effect, I would have been at the mercy of the doctor's office to correct the mistakes out of their own free will. For that matter, they could have denied me the right to see my own charts, thereby preventing me from even knowing the extent of the problem.

By invoking HIPPA in my letter requesting a correction, the office from which the mistake originated corrected it almost immediately (well within the 30 days mandated by law) and apologized profusely. And they sent corrected copies to everyone who has seen my records.

Conclusions: 1) Sometimes nanny-state laws are there for a reason and they work. 2) Modern medical record keeping allows mistakes, as well as the correct information, to be shared around the medical community in record time. 3) Check your records every few years. You might be surprised what you find.
Good advice.

I recently started with a new MD in the area, the same general practicioner my dad -- with whom I share a name -- sees. This has led to a couple of minor mixups as the practice gets used to dealing with a doubling of the Toms Bernard on their roster.

It's really been nothing much more serious than a crossed phone call and a few extra minutes in the waiting room because the assistant saw the name on the appointment sheet, and came out looking for my dad, but it's easy to imagine how something relatively mundane like that could lead to complications if we're not all careful.
I don't know of anyone who has decried legal protections of privacy as "Nanny-statism" or "big brother" -- but even if some did, what does this have to do with actual meddling "nanny-state" legislation in the health area, such as making it illegal to sell a health insurance policy that does not cover hair transplants or in vitro fertilization?

Also, do you really think your doctor would be so arbitrary or evil as to refuse to remove such material, despite your showing it to be false?
David - this is all anecdotal, but...

In 1993 I asked to see my personal records after a claim denial by my insurer. My physician at the time refused to let me see the file. He claimed that it was his property and showing it to me would somehow violate my own privacy. Seriously. The doc offered to "expalain" to me what was in the file, but he would not let me actually read it myself.

When I mentioned this to my attorney, he pointed out that MDs are paranoid about liability and therefore do not want patients combing records for mistakes. HIPAA remedied this by providing a mechanism for both Dr and patient to resolve simple issues with protections for both parties involved.

Secondly, when the HIPAA standards went into effect just a few years back, almost every physician's office I visited rolled their eyes and complained about "the gov't telling us how to do our job." I even had a pharmacist spout off because he had to collect signatures when dispensing drugs.

Milton Friedman (RIP) surely would have considered HIPAA a nanny state intrusion into the free market.
OK, you apparently have a point that HIPAA was needed on this matter, to grant us all the right to see our own medical records. But I repeat that the government requiring open records is not nanny-statism, unless you define it far more broadly than the people who use the term and decry such actions.

As it happens, Milton Friedman was around and still writing, but I can find no such position of his on HIPAA. His ideological soulmates at the Heartland Institute, however, did write thoroughly on HIPAA; their objection to its effects on records concerned privacy issues from the records going to the government, not a fear that patients would see their own records:

"The Act requires all health professionals to disclose to the government the details of every patient encounter, including diagnosis, test results, therapy, charges, and 32 pieces of demographic data on every patient.<32> These provisions could mean the end of patient privacy and confidentiality of the physician-patient relationship."
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