HIPAA sounds like “hippo”

“Medical students of those decades had other hard things to learn about…duties required experience to be done well…needed a mixture of intense curiosity about people in general and an inborn capacity for affection, hard to come by but indispensable for a good doctor.”

Lewis Thomas got a lot of things right. I am currently reading my grandfather’s copy of Thomas’s book The Youngest Science and I am struck – chapter after chapter – by his insight. Whatever role Thomas most closely identified with (according to the perfectly-accurate Wikipedia, he was a physician, poet, etymologist, essayist, administrator, educator, policy advisor, and researcher), he was a brilliant man. Plus, in his time, you were expected to simply figure certain things out on your own — things like, say, respecting a patient and genuinely caring for them. I don’t officially start school until next week, but I have heard rumors that there will be a fair bit of memorization. Fair enough, given how much medical science has already been discovered by people other than me…but still. I like what Thomas had to say:

“What I remember now, from this distance, is the influence of my classmates. We taught each other; we may have even set careers for each other without realizing at the time that so fundamental an educational process was even going on. I am not so troubled as I used to be by the need to reform the medical school curriculum. What worries me these days is that the curriculum, whatever its sequential arrangement, has become so crowded with lectures and seminars, with such masses of data to be learned, that the students may not be having enough time to instruct each other in what may lie ahead.”

This is loosely related to my thoughts on the recent online HIPAA training that entering medical students had to complete. (I still often spell HIPAA with two p’s instead of two a’s, since the only word like it is “hippo.” Anyhow, few people even know that it stands for Health Insurance Portability and Accountability Act.) In 1996, when it was first passed, the idea was to protect a patient’s access to insurance even if they lost their job or had a pre-existing condition. Today, HIPAA is an elephantine (or, you know, hippopotamutine?) set of laws governing documents such as electronic medical records and other confusing new things.

What I really want to talk about, though, is whether some of this law-making and law-memorizing is actually a selfish desire of doctors to protect themselves from malpractice suits. Do policies sometimes get in the way of efficiency and good care? I start to wonder if we have lost faith in people’s abilities to make good judgment calls. These are things I learned in HIPAA training:

“A doctor cannot give a diaper company the names of pregnant patients without an authorization.”

“A patient can see another patient’s name on a sign-in sheet if no medical information is on the sheet or may hear a patient’s name as it is called in the waiting room.”

“Speak in soft tones when discussing protected health information.”

“Use (but do not share) computer passwords.”

Really? REALLY?!?!? People who got into medical school couldn’t have figured those things out on their own? This worries me.

Of course, I recognize that some good things have come out of privacy protection laws. Perhaps doctors think twice before leaving a voicemail with test results (it could be a landline with a message machine the whole family listens to!). Perhaps they reconsider which assistants have access to what data. Perhaps they specifically ask patients who they want in the room when they talk about prognosis. Perhaps they double check fax numbers before sending records (or perhaps no one uses fax machines anymore?).

Then again, this should have been common sense, right? I have mixed feelings about all of this, and could easily point to more examples that highlight either the pros or cons of the heightened awareness. Mostly, though, I want us to think more about it. You all (the whopping three of you who read this blog) have good imaginations and analytical skills. Go at it.