6 ms·

Doctor-patient confidentiality is important so that the doctor can act in your best interest (yes, yes, very funny) with full information. Very many things doct

Doctor-patient confidentiality is important so that the doctor can act in your best interest (yes, yes, very funny) with full information. Very many things doctors need to be aware of to diagnose conditions have significant social stigma. Examples include alcoholism, mental disorders, substance abuse, genital status, sexual status, pregnancy status, the list goes on. The average person is reluctant to share this information to begin with, with good reason, as it goes into a permanent record. If such a record were public… No, even for longitudinal studies, even with “anonymized” data, the risk is too great for any individual, and to society in general. Ideopathic and non-causal diseases should have some buy-in from patients; a standard waiver might be useful for research use of data. (I’ve signed one.) But in general, no, the restrictions are worth it.

ClumsyPilot 3y ago
> many things doctors need to be aware of to diagnose conditions have significant social stigma some are illegal - think threating drug overdose
- michaelmior 3y ago
  In some jurisdictions, this not always the case. One example is the "Good Samaritan" law in California[0] which provides some protection patients seeking medical treatment for an overdose. https://www.wingerdenlaw.com/blog/2020/02/can-you-be-charged-with-drug-possession-if-you-overdose/ https://www.wingerdenlaw.com/blog/2020/02/can-you-be-charged...
- ChrisMarshallNY 3y ago
  Nowadays, seeking abortion/family planning could -literally- result in being jailed, and forced to give birth. Mental health is a big deal. For better or for worse, if your employer/licensing org is aware of any mental health issues, then they could adjust how they treat you. Crappy bosses could use your history as a way to discredit or manipulate you. That's exactly what the CIA does, whenever someone blows a whistle on them. Some medical conditions can be interpreted by different people, in intensely negative ways. For example, at one time, being left-handed, meant that you were possessed by the devil. Often sexual orientation/behavior is a part of your medical history. But I'm suuuuure that no one would ever use this information in a questionable way. Look at the "mug shot protection racket" sites. These sites leverage personal information that has been made public, as a way to force you to pay them to remove it (and then immediately republish it in another venue). I guarantee that a number of folks on this very site, run those sites, and sincerely believe there's nothing wrong with it. No. Just because "I have nothing to hide," does not mean that I get to force others to divulge intensely personal stuff.
iandanforth 3y ago
[flagged]
- scarby2 3y ago
  the amount of people who think that social stigma cant be changed is beyond me. This is one of those cases where when we open things up we realize that just about everyone has or does things that are stigmatized and we have no choice but to stop stigmatizing them, the secrecy and shame are self-reinforcing.
  - JohnFen 3y ago
    > we realize that just about everyone has or does things that are stigmatized and we have no choice but to stop stigmatizing them Yeah, it almost never actually works out that way, though.
  - Nullabillity 3y ago
    Eventually perhaps, but is it fair to demand that everyone subjects themselves to that in the years or decades that that process takes?
- engcoach 3y ago
  Your desire to "help" others at the cost of social stigma for me is something I find disgusting.
- yomlica8 3y ago
  People will die as a result of their medical privacy being stripped away, when they forgo care in fear of the effect that stigma has or fear of losing their job due to their medical needs being to expensive or being prosecuted from having a miscarriage or drug use, etc.
  - nmca 3y ago
    sure but to engage in the relevant consequentialist reasoning correct you need to argue that this is more people, not just some people (I'm undecided on the whole thing but this argument as stated is bad)
cloverich 3y ago
> Very many things doctors need to be aware of to diagnose conditions have significant social stigma... the risk is too great for any individual Very many things doctors need to be aware of, because the patients life depends on it, are left out when patients move between specialists and physicians, which happens all of the time. Outbreaks of viral and bacterial illnesses result in thousands of people independently chasing diagnoses and treatment, because the system doesn't share information that could be used to piece together and get ahead of it. Every time my kid gets sick at school, I get to play a game of "What is it? Do we see a Doctor? How much money should we spend?". Lets pretend we know nothing about this and go see a Doctor who hasn't seen anyone else in school, who may provide antibiotics they may or may not need or worse. Effective prevention methods and early detection of bad treatment are discarded because its so difficult to investigate and connect the dots between interventions and outcomes. Patient privacy is important, but the system we have today is nothing less than a tragedy. Real damage in emotional, physical, and economic is happening on a grand scale every day in this country. We shouldn't pretend HIPPA is a good thing, or the current system is doing a good job. Its not. We need to radically transform how we operate, and much more open and connected medical records is certainly a part of that transformation.
- JohnFen 3y ago
  > We shouldn't pretend HIPPA is a good thing, or the current system is doing a good job. Honestly, my problem with HIPAA is that it's not really adequate. There are too many loopholes in it. I'd like to see it strengthened quite a lot. > much more open and connected medical records is certainly a part of that transformation. As long as the patients those records are about are in full control over their disclosure and use.
- EatingWithForks 3y ago
  HIPPAA doesn't just cover, say, the spread of tuberculosis. It also bars things like collecting a panel of homosexuals, transgenders, women who are on birth control or have abortions, people seeking treatment for schizophrenia or a personality disorder or addiction, or just fat poor smucks that don't adequately treat their diabetes. Any number of highly stigmatized things or things that Palantir would love to own to sell to a private company. I would start freaking the fuck out if my primary care physician gets to sell my diagnosis for money to Facebook, and I don't give a rat's ass if some 3 year old could've been cured of epilepsy if my doctor was able to do so. HIPPAA prevents my doctor from doing so and I'm glad for it.
dheera 3y ago
Yet they leak my medical records to debt collectors every single time, for debts that aren't even mine (when insurance refuses to pay for what they should).
- JohnFen 3y ago
  I hear you, but those debts are actually yours. When you get treatment, you're assuming responsibility for the bill. The insurance company is technically reimbursing you, not assuming your debt.
  - mindslight 3y ago
    That's certainly the bullshit narrative the billing department vampires want to push on you (the whole medical system revolves around punting responsibility on to someone else). But very rarely when you receive medical services is an actual contract being formed. Contracts require defined consideration, and some arbitrary numbers pulled out of a hat after the fact doesn't meet that bar.
    - JohnFen 3y ago
      That's the sort of case that needs to be made to a judge in the course of a lawsuit against the provider, then. Listen, I'm not saying that this is ethically or morally right. I'm just saying that's the way things actually are (in the US).
      - mindslight 3y ago
        Why would you proactively sue a provider over a billing issue? You mean a lawsuit from the provider, trying to substantiate the debt they claim you owe? I've no doubt that there is some assortment of corrupt laws bought by the medical industry that have enabled these blatantly abusive billing practices. But until shakedown victims actually force the issue and publicize it, then those corrupt laws continue to avoid scrutiny.
  - dheera 3y ago
NoZebra120vClip 3y ago
Doctors almost never act with full information. Doctors don't even want full information. It wastes their time. If you come to a new doctor they will make you fill out a stack of forms where you inaccurately self-report your medical history and then they will toss that in the rubbish bin. If you so much as dare to suggest that a doctor should transfer your old medical records from one place to another, they will vehemently object and question why you would want to do such a thing. In fact it is far easier to sign a release of medical records and authorize their release, than it is to cajole any given Records Department into accepting the transfer of records in any format, much less a machine-readable format that would be useful. I believe it is a liability for doctors to know a true medical history, and anything not already being treated can be ignored and re-diagnosed later, which of course is an ideal situation for the insurance and the new provider, because you can charge all over again for those diagnostics. Case in point, I had two EKGs performed on me, one in urgent care and one in the hospital. It was not too long before I was going in for surgery, and a prerequisite was a "12-lead EKG" readout, so naturally the hospital tried to force me to undergo a new one at enormous cost and inconvenience, and I balked, because I already had two perfectly good readouts in hand. They eventually relented, but it was incredibly difficult for them to admit that the test results were valid and acceptable, and this is all part of the scam, to charge as many times as possible for anything that wasn't performed here and now by us. Likewise with psychiatry and therapists; I've been through multiple clinics and dozens of counselors, and of course each one produces a mountain of case notes. So I always offer and suggest that I sign a release and have all the prior case notes transferred over so that they get to know me better. The answer is always "no". They want to know nothing beyond what is in the intake forms, that they will spend 5 minutes reading. Then we will start my therapy over from Square One with a stranger and I get to recount all my feelings and life experiences over and over and over again, on my dime. Nevertheless, it is still of the utmost importance that you continually sign authorizations for release and that you requisition all available records from all your providers. Authorize all providers to release information to your friends and family. They will hang up the phone if there is no release on file. Renew those authorizations on time, every time; your provider will not remind you. Release all records to yourself on a regular basis, especially after a hospitalization or major incident. You will want good records, just for your own examination, and also if there is ever a dispute or litigation about something, your attorney will appreciate those records too.

ClumsyPilot 3y ago

> many things doctors need to be aware of to diagnose conditions have significant social stigma some are illegal - think threating drug overdose

michaelmior 3y ago
In some jurisdictions, this not always the case. One example is the "Good Samaritan" law in California[0] which provides some protection patients seeking medical treatment for an overdose. https://www.wingerdenlaw.com/blog/2020/02/can-you-be-charged-with-drug-possession-if-you-overdose/ https://www.wingerdenlaw.com/blog/2020/02/can-you-be-charged...
ChrisMarshallNY 3y ago
Nowadays, seeking abortion/family planning could -literally- result in being jailed, and forced to give birth. Mental health is a big deal. For better or for worse, if your employer/licensing org is aware of any mental health issues, then they could adjust how they treat you. Crappy bosses could use your history as a way to discredit or manipulate you. That's exactly what the CIA does, whenever someone blows a whistle on them. Some medical conditions can be interpreted by different people, in intensely negative ways. For example, at one time, being left-handed, meant that you were possessed by the devil. Often sexual orientation/behavior is a part of your medical history. But I'm suuuuure that no one would ever use this information in a questionable way. Look at the "mug shot protection racket" sites. These sites leverage personal information that has been made public, as a way to force you to pay them to remove it (and then immediately republish it in another venue). I guarantee that a number of folks on this very site, run those sites, and sincerely believe there's nothing wrong with it. No. Just because "I have nothing to hide," does not mean that I get to force others to divulge intensely personal stuff.

iandanforth 3y ago

[flagged]

scarby2 3y ago
the amount of people who think that social stigma cant be changed is beyond me. This is one of those cases where when we open things up we realize that just about everyone has or does things that are stigmatized and we have no choice but to stop stigmatizing them, the secrecy and shame are self-reinforcing.
- JohnFen 3y ago
  > we realize that just about everyone has or does things that are stigmatized and we have no choice but to stop stigmatizing them Yeah, it almost never actually works out that way, though.
- Nullabillity 3y ago
  Eventually perhaps, but is it fair to demand that everyone subjects themselves to that in the years or decades that that process takes?
engcoach 3y ago
Your desire to "help" others at the cost of social stigma for me is something I find disgusting.
yomlica8 3y ago
People will die as a result of their medical privacy being stripped away, when they forgo care in fear of the effect that stigma has or fear of losing their job due to their medical needs being to expensive or being prosecuted from having a miscarriage or drug use, etc.
- nmca 3y ago
  sure but to engage in the relevant consequentialist reasoning correct you need to argue that this is more people, not just some people (I'm undecided on the whole thing but this argument as stated is bad)

cloverich 3y ago

> Very many things doctors need to be aware of to diagnose conditions have significant social stigma... the risk is too great for any individual Very many things doctors need to be aware of, because the patients life depends on it, are left out when patients move between specialists and physicians, which happens all of the time. Outbreaks of viral and bacterial illnesses result in thousands of people independently chasing diagnoses and treatment, because the system doesn't share information that could be used to piece together and get ahead of it. Every time my kid gets sick at school, I get to play a game of "What is it? Do we see a Doctor? How much money should we spend?". Lets pretend we know nothing about this and go see a Doctor who hasn't seen anyone else in school, who may provide antibiotics they may or may not need or worse. Effective prevention methods and early detection of bad treatment are discarded because its so difficult to investigate and connect the dots between interventions and outcomes. Patient privacy is important, but the system we have today is nothing less than a tragedy. Real damage in emotional, physical, and economic is happening on a grand scale every day in this country. We shouldn't pretend HIPPA is a good thing, or the current system is doing a good job. Its not. We need to radically transform how we operate, and much more open and connected medical records is certainly a part of that transformation.

JohnFen 3y ago
> We shouldn't pretend HIPPA is a good thing, or the current system is doing a good job. Honestly, my problem with HIPAA is that it's not really adequate. There are too many loopholes in it. I'd like to see it strengthened quite a lot. > much more open and connected medical records is certainly a part of that transformation. As long as the patients those records are about are in full control over their disclosure and use.
EatingWithForks 3y ago
HIPPAA doesn't just cover, say, the spread of tuberculosis. It also bars things like collecting a panel of homosexuals, transgenders, women who are on birth control or have abortions, people seeking treatment for schizophrenia or a personality disorder or addiction, or just fat poor smucks that don't adequately treat their diabetes. Any number of highly stigmatized things or things that Palantir would love to own to sell to a private company. I would start freaking the fuck out if my primary care physician gets to sell my diagnosis for money to Facebook, and I don't give a rat's ass if some 3 year old could've been cured of epilepsy if my doctor was able to do so. HIPPAA prevents my doctor from doing so and I'm glad for it.

dheera 3y ago

Yet they leak my medical records to debt collectors every single time, for debts that aren't even mine (when insurance refuses to pay for what they should).

JohnFen 3y ago
I hear you, but those debts are actually yours. When you get treatment, you're assuming responsibility for the bill. The insurance company is technically reimbursing you, not assuming your debt.
- mindslight 3y ago
  That's certainly the bullshit narrative the billing department vampires want to push on you (the whole medical system revolves around punting responsibility on to someone else). But very rarely when you receive medical services is an actual contract being formed. Contracts require defined consideration, and some arbitrary numbers pulled out of a hat after the fact doesn't meet that bar.
  - JohnFen 3y ago
    That's the sort of case that needs to be made to a judge in the course of a lawsuit against the provider, then. Listen, I'm not saying that this is ethically or morally right. I'm just saying that's the way things actually are (in the US).
    - mindslight 3y ago
      Why would you proactively sue a provider over a billing issue? You mean a lawsuit from the provider, trying to substantiate the debt they claim you owe? I've no doubt that there is some assortment of corrupt laws bought by the medical industry that have enabled these blatantly abusive billing practices. But until shakedown victims actually force the issue and publicize it, then those corrupt laws continue to avoid scrutiny.
- dheera 3y ago

NoZebra120vClip 3y ago

Doctors almost never act with full information. Doctors don't even want full information. It wastes their time. If you come to a new doctor they will make you fill out a stack of forms where you inaccurately self-report your medical history and then they will toss that in the rubbish bin. If you so much as dare to suggest that a doctor should transfer your old medical records from one place to another, they will vehemently object and question why you would want to do such a thing. In fact it is far easier to sign a release of medical records and authorize their release, than it is to cajole any given Records Department into accepting the transfer of records in any format, much less a machine-readable format that would be useful. I believe it is a liability for doctors to know a true medical history, and anything not already being treated can be ignored and re-diagnosed later, which of course is an ideal situation for the insurance and the new provider, because you can charge all over again for those diagnostics. Case in point, I had two EKGs performed on me, one in urgent care and one in the hospital. It was not too long before I was going in for surgery, and a prerequisite was a "12-lead EKG" readout, so naturally the hospital tried to force me to undergo a new one at enormous cost and inconvenience, and I balked, because I already had two perfectly good readouts in hand. They eventually relented, but it was incredibly difficult for them to admit that the test results were valid and acceptable, and this is all part of the scam, to charge as many times as possible for anything that wasn't performed here and now by us. Likewise with psychiatry and therapists; I've been through multiple clinics and dozens of counselors, and of course each one produces a mountain of case notes. So I always offer and suggest that I sign a release and have all the prior case notes transferred over so that they get to know me better. The answer is always "no". They want to know nothing beyond what is in the intake forms, that they will spend 5 minutes reading. Then we will start my therapy over from Square One with a stranger and I get to recount all my feelings and life experiences over and over and over again, on my dime. Nevertheless, it is still of the utmost importance that you continually sign authorizations for release and that you requisition all available records from all your providers. Authorize all providers to release information to your friends and family. They will hang up the phone if there is no release on file. Renew those authorizations on time, every time; your provider will not remind you. Release all records to yourself on a regular basis, especially after a hospitalization or major incident. You will want good records, just for your own examination, and also if there is ever a dispute or litigation about something, your attorney will appreciate those records too.