Patient Privacy Needs A Closer Examination

Posted: February 14, 2000

The need for privacy in medical care has been recognized since Hippocrates. But large for-profit corporate medical enterprises are throwing aside 21/2 millennia of good sense and tradition by drastically diminishing doctor-patient confidentiality.

Many people delay getting medical care because they feel ashamed, embarrassed, even guilty. Knowing the doctor will keep matters confidential helps people obtain care, despite their misgivings. In psychotherapy, with patients revealing their innermost feelings and fantasies, the need for strict confidentiality is even more crucial, the Supreme Court recognized in a 1996 decision.

Computers enable transfer of vast amounts of information in ways never before imagined, put to very creative and lucrative use. For example, some pharmacy chains electronically collect data about what prescriptions have been filled by whom and sell it to other companies, which then sell this data to pharmaceutical companies, which use it to target advertising, sometimes to the individual.

HMOs and other insurers, which require information in order to approve (or disapprove) payment for medical, surgical or psychological services, have bought and sold medical data to each other. Health data has been shared with employers.

Personal information used to remain in doctors' offices. Release of this information required patients' consent. Now many insurers require a "consent" statement, giving the insurer broad discretion for use of the information. This is a sham, as most people cannot afford to waive insurance payments in order to safeguard their privacy; many don't know what they are signing.

The law provides much better protection for conversations with lawyers and clergy than with doctors or psychotherapists.

In the Health Insurance Portability and Accountability Act of 1996, Congress required itself to pass medical privacy legislation by last August, and failing that, required the secretary of health and human services to promulgate medical privacy regulations by this month. The period of public commentary expires Thursday.

But Congress did not give HHS authority to regulate electronic medical data, nor did it provide for individuals whose privacy rights are violated to have any legal remedy. HHS rules would permit, with some regulation, circumstances in which personal health information could be disclosed without the patient's authorization. This release of medical information without consent represents an important change in the practice of medicine. Doctors should be wary of this, and so should you.

Dr. Lawrence D. Blum, a psychiatrist, is director of the Psychodynamic Psychotherapy Training Program, sponsored by the Philadelphia Psychoanalytic Society and the Philadelphia Association for Psychoanalysis.

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