Commentary

Half-a-HIPAA


 

One of my goals has always been to keep both feet firmly planted on this side of the provider-patient divide. But every now and then, stuff happens.

A couple months ago, one of my usual colonic polyps appeared in a location that made it unapproachable by any kind of scope. I was told that I should ready myself for some good old-fashioned knife-and-forceps surgery. I preferred to have this assault take place at a major teaching hospital in the big city. So, I packed myself off to Boston.

Dr. William G. Wilkoff

As part of the registration process I was handed a glossy two-color brochure describing my rights and their protection on the federal HIPAA (Health Insurance Portability and Accountability Act) regulations. I signed the form acknowledging my understanding, not sure what would happen should one decline.

Not being a sheik from an oil-rich state, I knew I wouldn’t be staying in one of the sumptuous suites not listed on the button panel in the elevator. Nor was it anticipated that I would be sick enough to warrant a private room. And so I entered the self-contradictory realm of semi-privacy.

My first roommate was a young guy in his 30s who had been stabbed multiple times in his abdomen by his "girlfriend." As he said with a wink on one of his shirtless trips to the bathroom, "She got me pretty good."

Obviously, this knifing was not his first social misadventure, and his family seemed to have evaporated. Listening to the nurses and social workers struggle to find someone to retrieve him was sadly humorous.

My second roommate came at a bad time, the night of my ileus, a complication I had struggled, but failed, to avoid. He was a guy probably in his mid-60s. I was never clear what brought him into the hospital. I wasn’t alone. The unfortunate staff physician assigned to do his work-up seemed confused as well. The guy had a totally positive but vaguely recalled past history and review of systems. "Mr. Fergus, have you ever had purple bowel movements?" "Well, I’m pretty sure I have. Maybe it was around the time I had that whaddya-call-it autoimmune thing? Have I told you about that?"

This interview went on for what seemed like hours as my gut continued to fill with air and fluid. Mercifully, the doctor decided that he had better decide on a working diagnosis and chose, randomly it seemed, to ship my roommate to the coronary care unit. Just in time for me to be rescued by a nasogastric tube the size of a garden hose.

After a day of partial solitude, my third roommate arrived. Another guy in his mid-60s, he also suffered from what was probably a chronic case of vagueness. I suspect he was a college professor from a family that had come over on the Mayflower. Somewhere, they had lost their ability for self-help and, again, the discharge team spent hours attempting to get him to focus on the notion that he couldn’t stay in the hospital until it might be a good day for his wife at home to find the time to call a car service.

The medical information that my roommates and I shared didn’t stop with dialogue. We all had our own beeping monitors that would alarm when leads fell off or IV bags ran dry. Even when ours were silent, alarms from adjacent rooms on the hall penetrated the walls. As they seemed to convey little critical information, the staff seldom responded to the cacophony in a timely fashion.

But I’m home now and mending in silence. I’ve always had my doubts about the value of many of the HIPAA regulations. However, my recent experience on the dark side has made me wonder whether we should expand HIPAA. In addition to protecting my health information, how about some rules that protect me from everyone else’s medical facts? As it stands now, HIPAA in a semi-private world is bad joke.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.

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