RECORDS AT RISK: 'PRIVACY' LAWS WOULD END HIPPOCRATIC MEDICINE

Hippocratic medicine is technically illegal, and will be so in reality,
assuming the current "privacy" laws are implemented as scheduled (stepwise,
April, 2003 and 2004). Before managed care, the Hippocratic Oath was the
gold standard for integrity in Western medicine. It stood the test of time
for more than 2,000 years. Noble ideals from the oath, such as "prescribe
regimen for the good of my patients, according to my ability and judgment,
and never do harm" and "all that may come to my knowledge . . . I will keep
secret and never reveal" are now under fire.

Many describe these lofty goals as impractical, wasteful, and unfair - for
society, at least. Revised guidelines already have been written
(www.professionalism.org) by the Medical Professionalism Project (MPP), a
collaboration of three established organized medicine groups. The MPP
charter puts care rationing right into the patient-physician relationship.
Compromised patient advocacy, leaving patients to fend for themselves, is
not my idea of compassionate care. In contrast, the Hippocratic Oath can be
found at www.aapsonline.org under medical ethics.

Once the so-called privacy rules are enforced, Hippocratic medicine is
gone. The regulations exempt the Deparment of Health and Human Services
(HHS) from age-old patient consent standards - and leave the door open for
potential updates to further undermine confidentiality.

Come next April, most physicians (all physicians in 2004) will be required
to give individualized patient information - without the patient's consent
or knowledge - to HHS. Additionally, records may be distributed for the
following broadly defined purposes, though details and safeguards are
vague: Oversight of the health care system, FDA monitoring, public health
surveillance and activities, foreign governments (collaborating with U.S.
public health officials), research (with limitations), law enforcement,
judicial and administrative proceedings, and licensure and disciplinary
actions. Honest. For more, check out www.For- HealthFreedom.org.

ONCE THESE groups have the data, they can use or share it according to
their own standards, not necessarily medical standards (foreign states
avoid all U.S. legal protections). The approved regulations include paper
records, not just electronic ones. From April, 2003, forward, your entire
medical record, not just numerical billing data, is at risk. Believe me, it
makes a huge difference for mental health patients.

These regulations do not require law enforcement or the courts to get a
subpoena for personal medical rec-ords. Detailed psychiatric and genetic
information can be shared with the federal government without a patient's
consent. There is nothing in the law to prevent Child Protective Services
from reviewing medical charts, including sensitive family matters shared
with their used-to-be-trusted family doc. Reams of data could become
available - conveniently in computerized form - on those seeking help for a
drug problem.

HHS, which recently proposed a national medical database for Medicare
patients, will soon be able to expand its horizons. Once these laws take
effect, HHS gets patient-consent-bypassed access to privately insured and
self-pay patient data, too. Gone will be the restrictions that limit
tracking to Medicare patients, or just taxpayer-subsidized patients.

THERE ARE a few bright spots. Congress has not approved funding for the
unique health identifier for patients that would make tracking easier - yet
it refused to cancel the 1996 Health Insurance Portability and
Accountability Act (HIPPA) requiring its development. A few determined
patients have managed to keep their Social Security numbers off their
medical records. Someone got the banks off the original proposed list, at
least for now.

Medical privacy may not be convenient, but there are good reasons for it.
Employer discrimination is real - at least one EEOC case involves a woman
who was fired after testing positive for a genetic predisposition. Janiori
Goldman, director of Georgetown University's Health Privacy Project, noted
that almost 20 percent of Americans either pay out of pocket or lie to
their doctors, when they get treatment for mental health, sexually
transmitted diseases, reproductive health, or genetic counseling.

Expect the genetics revolution, with its vast potential, to suffer. Genetic
information is specifically excluded from even the limited protection
offered by the regulations. Researchers may have to find another country
that respects privacy.

DOCTORS ARE caught in the middle. The first time a (pediatric) patient's
mother told me she needed to tell me something, but only if I would promise
not to put it in the chart, I was at a complete loss. This issue is not
going away.

Proposed "solutions" sound like the unrealized utopia promised by managed
care. Dr. Arthur Derse, a senior AMA consultant, describes the new pledge
as "a vision of the physician as a balancer of resources." Supporters claim
that socially responsible physicians can both advocate for patients and
focus on resource distribution. When HMOs tried to do both, unsuccessfully,
those pesky doctors and patients just wouldn't give up.

Unfortunately, the federal government isn't giving up either. HHS is
accepting public comments about changes in the regulations until April 26
(see www.ForHealthFreedom.org, or you can write your Congressman).
Patients, not HHS or Congress, should decide who has access to their
personal medical records.