WITNESS PROTECTION IN THE DOCTOR’S OFFICE
By Mark Salamon, February 1, 2020
If you’re like most Americans, you remember exactly what you were doing on April 14, 2003, especially if you had a doctor’s appointment that day, because that is when the Health Insurance Portability and Accountability Act – or HIPAA – went into effect. This groundbreaking piece of legislation provided long awaited legal protection for patient privacy, and revolutionized modern medicine by completely overhauling the logistical process of going to the doctor.
If you ever went to the doctor way back in the dark ages before HIPAA, you may recall arriving at your appointment time, checking in, and still having plenty of time left over to read every People magazine issue dating back to the renaissance before being called back to the exam room.
But in the enlightened, post-HIPAA world, you now get to use that time to perform much more productive and fulfilling activities, such as reading a lengthy dissertation on what HIPAA means. This requires an interpreter because it is written in Swahili. You then get to fill out the HIPAA forms, which use concise legal terminology to ensure that no one understands anything that is written on them. Signing these forms ensures that anyone who says anything out loud that gives away who you are or why you came to the doctor will receive the death penalty.
At this point, many patients elect to go home because their injury has completely resolved on its own and they can’t even remember why they came to the doctor. For those lucky enough to still have an injury, the next hour is spent developing code-names and secret signs so that the medical staff can smuggle you back to the exam room at the appropriate time without anyone else in the waiting room realizing what is going on.
The HIPAA privacy law also opened up a whole new set of challenges for my end of the office: the physical therapy clinic. Like most physical therapy clinics, ours features an “open” concept. It is basically a large gym scattered with exercise equipment and treatment tables where therapists take their patients through the paces of rehabilitation. A few basic laws of nature make the HIPAA privacy laws especially tough to enforce in this setting. First of all, physical therapists have a bizarre superpower that causes patients to vomit reams of personal information that no one in the room really wants to hear. I try to control this problem by interviewing new patients in private exam rooms so they can get this out of their systems, but this doesn’t always work. The crowded gym somehow inspires many of them to expound with even more detail on topics such as the history of their bowel function.
Now technically, since these patients are spewing their own medical information, this is not a HIPAA violation. But in my opinion, it should be. A major flaw in HIPAA is that there is no protection for patients who would like to be able to attend a normal physical therapy session without hearing about someone else’s bowel function. Unfortunately, these patients are rare. Most want to know every detail about every other person in the clinic, so much so that even after the avalanche of HIPAA paperwork they just filled out, they still think it is entirely appropriate to come up and ask me about everyone else’s personal information.
Sometimes they throw questions my way that make me look like a complete asshole for refusing to answer. For example, a patient may ask me if another patient – lying on a table three feet away with twelve inches of surgical staples holding their knee together – is there for a knee problem. Legally, I have to actually say, “If I disclose that information I could be put to death.” This creates an awkward situation for everyone, especially the patient lying there with the knee problem, who usually ends up saying something like, “yes, I’m here for a knee problem, genius.”
Another problem with open clinics is that people often see people they know. So we take great pains to hide all schedules and computer screens that might show identifying information, and then someone shouts across the gym, “Hey, I know you! Aren’t you Michael Jones from 386 Norris Street in Allentown, social security number 237-98-4592?”
So the HIPAA law is not perfect, but it did usher us into a new era, from a world where nothing is private to a world where nothing is private and we have more paperwork. I propose that we take this success to the next level with a more high-tech approach: paper bags with little eye-holes.