The Writer

Frank J. Yacenda, a life-long writer, has been a journalist, editor, publisher, a science writer, a diplomat, and a public relations practitioner. See more about him here.

Let Me Be Your Editor

Frank J. Yacenda is a broadly experienced writer and editor who will help you conceive, perfect, produce, and promote your fiction or non-fiction writing project. See more here.

Check Out My New Book

Buying America the Right Way tells overseas real estate investors -- and U.S. ones, too -- what they need to know to get it right when buying in America. See it here.
Physician, Heal Thyself!

Physician, Heal Thyself!

No, this isn’t about drugs or addiction or ODing, or any of those things. It is about frustration, though. Frustration with the medical profession. Frustration in trying to create sense where sense seems not to exist. Frustration that can lead to scenes such as in the image. Fall down on the floor, tear out your hair, rend your garments sort of frustration.

To be perfectly clear, this posting is based on a personal incident – drama is more like it – playing out now with certain elements of the medical profession. To protect both the innocent and the guilty, I’m not going to name any names. Now. But if I continue to be stymied, that decision might change. Watch this space.

If you’ve read my piece on The Biggest Shell Game in the World, which you should before reading on here, you know how I feel about the so-called “healthcare system” we have in this country. You’ll also see I elaborated on some specific actions that might help ease the growth in the cost of healthcare. That posting focuses on the macro dynamic of the system. This posting focuses on the micro dynamic, the one on the doctor level.

It’s no longer a laughing matter – it never was a joke – to say that much of the medical profession is still anchored, not just in the last century, but maybe even the one before it.

When I lived in Montana some dozen years ago, my physician – an author of the reputed Helena Heart Study, so no slouch – presented himself as advanced because he took his notes on a laptop. Why that should have been considered advanced when small computers had been in fairly wide business use for a quarter century already is a good question to ask, if you’re inclined to ask questions. Now, all the doctors I go to use laptops for their notetaking and recordkeeping. Of course, it is, at last count, 2017.

The one thing my Montana doctor did that really stood out was to communicate by email. Quick, easy, asynchronous. Email. One would think this also would be pretty standard now. That’s what I thought. I mean, I run a global business and communicate with clients all over the world at close to 100% by email. So picture my surprise to be out of Montana and in a southeastern state that also shall remain nameless (besides, I often reverse the “d” and the “i” in the name, which is embarrassing) and to find that email does not play a role in typical doctor-patient communication.

Does one even have to wonder why calling a doctor’s office often leads to more frustration, lengthy stays on hold listening to dreadful “hold” music and self-serving promotions, being asked, finally when you get past the official hold, “Can you hold, please?” (Okay, at that I’m tempted to fire back, what are my options here?)

Again, how can almost any organization in 2017 function without email? It’s not only a fast and easy means of communication, but it also can be used as a system of sending health information to patients and even, if one is allowed a bit of crassness, as a marketing device. But, no, this seems to be beyond the understanding of most doctors.

Then there are those doctors’ portals. Potentially great idea, completely mutilated, misused, and just plain not used, in execution and practice. First, they’re all clunky in that clunky way that special-purpose software (like used in lawyer and, yes, doctor offices) always is. I don’t know, maybe it’s me, but I’ve had a litany of problems with the portals of several doctors and healthcare groups. Sometimes I’d have to enter a new password each time I signed in. Sometimes things I’d want to see, like reports, are there. Sometimes not. One portal doesn’t even tell me my next appointment, which would seem pretty basic. I’ve yet to be able to get a prescription refill put through based on a request posted on a portal site. And, perhaps the biggest issue I’ve encountered, often doctors’ front offices don’t mind the sites, so sending a message to the office through the portal is like throwing a quarter down a deep well. “Pathetic” is too kind a word.

Okay, despite all that, that’s not my biggest problem nor the most immediate. Oh, no. I have a far bigger gripe, which we’ll get to now. The one that concerns the Health Insurance Portabliity and Accountabillity Act – HIPAA – and how doctors not only seem not to know much about its requirements but, worse, seem to think it exists to protect them and not the patient. Which is wrong.

I had one doctor earnestly tell me that there is a $50,000 fine attached to a single HIPAA violation. Well, he was part right. Fines can range from $100 to $50,000, or $1.5 million maximum per year for ongoing violations. What puzzled me then, and which irks me now, is that the implication was that the doctor had to protect himself against violations and resultant hefty fines. The point that was completely missed, even inverted, is that denying a patient access to his or her records in whatever way the patient deems suitable seems like a more sure route to a violation than just providing what it is the patient requests, in the form or via the means requested by the patient.

Now that doctor’s office will fax me things like test results. Some will even (horror!) email them. And then there are others, like another one of my doctors, who refuses to provide records or results in any form other than by mail, or picking it up in person. Never mind the inconvenience of the latter choice, I would defy anyone to show me how snail mail is any less prone to pilferage or misdelivery than a fax or email. I even maintain an encrypted email account for highly sensitive information. But all that is irrelevant. The Department of Health and Human Services (HHS), which oversees application of HIPAA, is clear on the subject: A provider should email, fax, or accommodate alternative delivery means as requested by the patient. Look it up. It’s right there, explicitly spelled out by HHS, in the department’s HIPAA FAQs.

That’s really the key issue: Patients have a right to see and receive their own records and results, and HIPAA exists to protect them, not the doctor or other provider. So if a patient wants his or her bloody records emailed or faxed to them, HHS says the provider should accommodate that request. But you’d never know that from the patchwork of restrictions, most of which make little to no sense anyway, that one encounters when requesting one’s records.

Of course, all this assumes that a patient has signed a statement authorizing release of information to the patient and whatever third-party designees, if any, that the patient might include in the release. Now here is a suggestion – a strong one: Why not include a check-off box with a line where the patient authorizes positively (by checking the box) transmittal of records via email or fax? Easy-peasy, and takes care of any misunderstanding. And while you’re at it, how about another line with a check-off box authorizing the same thing for any third-party designees? Two lines, and you can sleep better at night knowing the patient has asked for this and HHS says you should give it to them. And it’s in writing, no less.

All this leads to the source of my current distemperous mood toward doctors and things medical. It’s been four weeks – not hours, not days, not business days, but weeks – that I have been requesting the results of an MRI from a certain specialist. I requested that the doctor or his nurse-practitioner call me before I left on an extended trip so I could at least have a sense of what the MRI revealed. I was told, well, he probably won’t call you. He likes to do things in person.

Well, I like to do things in person, too, when that works. But in this case, it wasn’t even possible to get an appointment in less than a month or more. And I was clear that I was leaving the state and needed the information before I went.

Ha. Fat chance. Four weeks have gone by, I’ve lost count of the number of times I’ve called this doctor’s office, had my primary care physician’s office call him, even the insurance company called the office when I filed a grievance with them over this. And still I can’t get either the doctor or the nurse-practitioner (which would be fine) to speak with me and discuss the test results, much less actually get those results. Now if ever there is a HIPAA violation, it would seem this is it. It will take a formal complaint to HHS, but that is imminent. I now even have my attorney on the case.

The doctor might have his procedures, but there are two parties to the transaction, the other being the patient, and in this case this patient has different procedures. And HIPAA is on his side.

It’s bad enough having to deal with doctors and tests and health issues without having to be put under further stress and duress by providers and offices that just throw more roadblocks and obstacles in the patient’s path.

All this seems very 19th Century to me. Doctors hold themselves up as miniature deities and patients are just supposed to accept whatever inconveniences, incompetence, or affronts that the doctor and doctor’s minions subject them to. And there are others besides those discussed here. Let’s just save my rant on the prescription system for some other time, ‘kay?

If you’ve encountered any of these issues in dealing with doctors, I invite you to tell everyone about it in the comments. And if you have a different and more positive story to tell, by all means post that, too, in the comments. And if you question the premises on which this piece is based, well, fire away with that, too.

Meanwhile, I’m going to fax this piece off to a few doctors I know (I have to fax them since I don’t have their email addresses) and maybe shake a few trees. Or else things will just go on as they always do. And watch this space if I decide it’s necessary to start naming names.

Physician, heal thyself!

2 Replies to “Physician, Heal Thyself!”

  1. As far as I know, most French doctors don’t communicate with their patients via email, even if most of them use computers these days. The doctors installed in shared medical centers use a reception that centralises the appointment requests and some even have an online appointment website. And the other doctors on their own still take appointments by phone.
    I think that the reason why they don’t communicate their email is because they want to avoid receiving too many messages for just about anything and people asking for diagnostics by email (wanting to avoid paying the doctor appointment fee – even if this is reimbursed by social security). I can only imagine that after a long day receiving patients, then filling in the medical reports, putting orders through for supplies, keeping themselves up to date with the latest treatments, then going out for home visits, they are probably exhausted and the last thing they’d fancy doing is having a litany of emails to respond to from some of their more hypochondriac patients.

    The French system uses a system called Carte Vitale, sim cards that everyone has the moment they get a social security number and this card is used to hold all the medical history of each person, the doctor will plug it in when you visit and will update the information about the symptoms, diagnostic and proposed treatment. This card is also used by the pharmacist when you go and get your treatment, so there is a real trace of all the treatments you get. But only the doctor can see the medical history of the patient, what other doctors he has consulted and past treatments or operations.
    But before the Carte Vitale, the moment a child was born, it was given a « Carnet de Santé » that would be filled in by each doctor the child, teenager or adult would visit throughout its life; this was mostly used to follow the various vaccinations and health issues it might have. This was more practical for patients to review their medical history as we don’t have the possibility to read the information on our Carte Vitale at home. And even today, when company employees are required to do a medical check up every 2 years, they are asked to bring their Carnet de Santé (because the company doctors are not able or maybe allowed to access the contents of the Carte Vitale).

    As I wasn’t born in France, I never had a Carnet de Santé, so the only way my mother used to keep track of my vaccinations was just by writing down the information in a small notebook and keeping every single medical prescription note written out by the doctors or keeping X-Rays and Scanner results. We never had any problem getting these from the medical centers or doctors.

    Of course, I have heard of stories where people had great difficulty getting their full medical file – and this mostly occurs in the situation of medical malpractices, operation errors or hospital caused deaths that oblige the families to sue. These are the cases when the hospitals and doctors tend to delay or refuse to hand over medical files, maybe because these would clearly show their errors.

    But I do find it absolutely scandalous that your doctor is postponing sending you your file or obliging you to come and pick it up personally. The only explanation I can think of about why he would not want to send it to you via secured email might because he might not use a secured email system and that maybe he might have had a problem in the past that obliged his attorney to tell him to no longer send out any information to someone through email. However, this can also be a problem if, for example, you were not physically able to visit him. But in this case, he could always Fedex it to you in exchange for the presentation of ID and with a signature.

  2. Gem, I’m not sure if it’s encouraging or discouraging that doctors in France also don’t communicate with patients by email. Of course I considered the reasons you give for why they might not want to do so, but here at least most doctors have a support staff that includes receptionists, office and business managers, nurses and nurse-practitioners, technicians, and possibly others. This is why a full quarter of what we spend on medical care goes to administrative costs. So I don’t have much sympathy or understanding why doctors don’t want to use a system that makes it easier to communicate with patients, whether it is by the doctor or one of his or her support minions.

    I don’t think it’s unfair to say, even given the reasons you cite, that the doctor considers his or her time worth more than the time of the patient. And sorry, I just don’t accept that. I mean, I can’t think of any organization or business, no matter how large or how small, that does not make it reasonably easy for its customers and stakeholders to communicate with it. I mean, even attorneys in this country communicate with clients by email, and certainly they are as vulnerable to requests, whether bona fide or whack-o, as are doctors.

    As for why this particular doctor won’t communicate with me, your guess at this point is as good as mine. I think it’s become a point of honor for him to not provide what I’m asking. But, in this country at least, it is a point of law, and the law — HIPAA — exists to give the patient certain rights and to protect the patient’s interests. And HHS, which oversees enforcement of the law, says clearly that if the patient requests that things like test results and medical records be conveyed by email or fax, or even by phone, that the doctor or other provider should comply with that. If I am willing to risk the extremely remote possibility that the communication could somehow be compromised, that is my decision, not the doctor’s, to make.

    Now it’s possible the doctor just wants to bill for a second visit, and if that is the case, I consider that outrageous. My health supersedes his profit margin. And besides, I wouldn’t keep him or his NP on the phone for half an hour. Five minutes would probably do it, if that. And he would likely get the follow-up visit anyway which, after the ordeal he has put me through, is pretty unlikely he’ll get now.

    Finally, that Carte Vitale you mention sounds like it could be a good thing. But certainly the patient should have access to what it contains and not just the so-called “professionals.” I don’t know what the law is in France, but here I’m pretty certain it would be covered by HIPAA and, in any case, it seems like it should be a basic human right to have access to one’s own health information.

Leave a Reply

Your email address will not be published. Required fields are marked *