Pity the poor bureaucrat, my friend Bob says. Bob used to be a director in health care administration.
For the person whose life is owned by the bureaucracy, the system is more powerful and more important to please than the customer. When one's children are paid for by a salary, not making mistakes becomes almost a life or death issue. And there are plenty of Monday morning quarterbacks looking for ways you might have overlooked a rule. Creativity and reasonableness are not the highest values.
And yet we need bureaucracies -- there are so many people that complex organizations are needed to provide them with services.
Given all this, it is predictable that we should have overreaction to the new federal medical privacy law.
You should know that it's dangerous.
The Health Insurance Portability and Accountability Act (HIPAA), which took effect in 2003, originally was designed to reduce disclosure of "protected health information" through the electronic world. The law says that it doesn't apply to information needed to provide medical care; it's not supposed to affect health care quality.
But if you give obsessive-compulsive bureaucrats an opportunity, they tend to run with it a little too far.
Here's a quick example. Over the Labor Day weekend, a physician was trying to get a prescription filled for an anticoagulation medication for a patient. The insurance company told the physician that they wouldn't pay for this expensive stuff without the hospital's taxpayer ID number, because it was "a HIPAA violation."
This is madness. The situation had nothing to do with HIPAA. HIPAA is just used as a cover for all sorts of nasty, passive-aggressive acting out.
I have had trouble getting X-ray reports from hospitals who say that because of HIPAA, I have no right to the information unless I get a signed release from the patient. Again, this is madness -- especially so because the patient was demented.
It's other stuff, too: people are having trouble finding relatives in hospitals because they won't give out the room number. EMS personnel in some places are reluctant to transmit critical information over the radio. Researchers have trouble collecting information. Even public health officials are having trouble doing things like tracking SARS.
From your point of view, the immediate effect is that physicians and other providers are having increasing difficulty getting information they need to take care of you. Sure, extra attention and fastidiousness to collecting information should compensate for this, but any time you put up this kind of roadblock, information flow will slow, and in some places stop altogether.
You can't be sure that one doctor knows what another one is doing, or that a doctor has all the testing you have had in different places. Given the constraints that everybody is gleefully putting on providers, you should probably collect all the information you can and carry it around with you to appointments.
I know this isn't fair, but I don't know what else there is to do. We have an information-constipated health care system and it's not changing any time soon.
In some cities, like Indianapolis, there are city-wide health information databases, with access carefully controlled. If you go to an emergency room in one part of town, they can get essential information on you from everywhere else very quickly.
It's not like health information is just some cosmetic thing that it's nice to have. People live and die based on medical records. Intelligent people I meet somehow have the idea that if you just get a CT scan or something you shouldn't need to ask any questions about the medical history.
My mother, an epidemiologist, always said that if you want to save a great many lives, go into public health. With all respect to good health care administrators, the profession has the power to do significant harm.
Dr. Mike Merrill is an internist practicing in Buffalo. His column appears once a month on this page. E-mail your comments to him at firstname.lastname@example.org.