Patient Privacy Part 1

Below are some extracts of a contract a physician signs with some of the payers he contracts with. It is generally understood that you have “client privilege”, which is confidentiality with a lawyer. You also have confidentiality with your Rabbi, Priest, or Minister, but you may not have as much privacy with your doctor as you may think.

Patient confidentiality is an important principle that most physicians still respect. Patients trust physicians not to reveal their private, medical information to others. They expect that physicians will adhere to the Hippocratic ethic followed for thousands of years that states, What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men I will keep to myself.

Patients might be surprised to learn that physicians sign contracts with insurance companies with provisions similar to the following that was included in a contract once sent to me:

Provider shall readily make available to [Insurer], the Department, HCFA and any other government agency with regulatory authority, medical and health records of Beneficiaries receiving Contracted Services and all related administrative records.

This information is then readily available to insurance companies, future employers, and others who can decide a patients future. A front page article from the Wall Street Journal last December 26th entitled Spread of Records Stirs Patients Fear of Privacy Erosion described the public availability of supposedly protected information and its consequences. This was my unpublished response.

Privacy erosion, it seems, is not merely an unintended consequence of our tax preferred, employer-based third party payment system. It is actually mandated by the payers themselves

Breaching patient confidentiality cost Ms. Galvin and others mentioned in your article a lot personally in terms of withheld disability payments, future employment, reputation, and chronic dysphoria from feeling violated. After reading articles like this, patients are likely to think twice before deciding what part of their person they are willing to entrust to medical professionals.

Third party payment for non-catastrophic medical care destroys the sanctity of the doctor-patient relationship. At direct pay primary care practices like mine, physicians have no obligations to third party payers only to patients, who feel secure that no information is released to third parties except with their expressed consent.

Therefore, physicians who sign such contracts breach patient confidentiality. Most dont make a big deal about these contracts, and I didnt for several years after finishing my residency. After all, how else can a physician make a living except by taking insurance? Every other doctor signs them; therefore, it must be all right.

However, now that I have actually read and studied some of these contracts and have had more time to reflect on what it means to do so, I have come to a different conclusion. You see, in order to accept third party payment, I have to sign these contracts and abide by their terms. This, I believe, is where many of the problems within our healthcare system start and could potentially stop if more primary care physicians refused to sign them.

Signing a contract is a big deal because you have in essence affixed your person to the contract. Doing so says to the world and to yourself, This is who I am. Not only does it demonstrate the type of person you are at the time you sign it, but it also determines the type of person you will eventually become over the long period of time the contract is in force.

The 1960s movie A Man for All Seasons put this well when Sir Thomas More said:

When a man takes an oath [or signs a contract], hes holding his own self in his hands. Like water. And if he opens his fingers then he needn’t hope to find himself again.

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