Demystifying Medicine One Month at a Time

Category: personal health information (Page 1 of 2)

Wallet X-Ray

Have you ever heard the term ‘wallet biopsy?’

A wallet biopsy is what occurs in U.S. health care when you or a loved one show up with a medical complaint to seek treatment.

From the emergency department to the inpatient hospital, to the doctor’s office or the procedure suite—at any location where an American might receive health care, you’re subject to a wallet biopsy.

Health care is a business. An expensive one. And the beast has to be fed—not only to keep the lights on, but also to buy the latest equipment and pay the folks that provide the care.

In a recent piece for Kaiser Health News, journalist Phil Galewitz updates us on how the U.S. practice of wallet biopsy has morphed into wallet x-ray.

The idea is longstanding: grateful patients (with financial means) have always looked for ways to share their good fortune with the medical establishments (and professionals) that have treated them.

Galewitz’ piece suggests that the practice of seeking out potential donors has ramped up in intensity: large health care enterprises (often university-based or affiliated) are performing financial background checks on patients they deem to be potential donors—and then aggressively wooing them.

There’s nothing necessarily wrong with this—it just smells a bit fishy. And it implies that if you’re not a grateful patient, or in financial position to be one, that you may wind up getting a bit less…er, attention? Fewer amenities? Less TLC?

Check out the article, which also ran in the NY Times, and let us know what you think of the specialty of wallet radiology.

Medical Privacy

You may have heard about a data breach at Anthem Blue Cross.Russia-hack-624x351

It’s estimated that the hackers who were able to break into the company’s computers had access to 80 million files. That’s one out of every four Americans.

Just like prior breaches at Target, Home Depot, Sony (did you see that awful movie, ‘The Interview?’), etc., hackers are eager to demonstrate that they can break into ‘secure’ corporate networks. We all need to be ready for computer hacks, identity theft, etc. It’s part of living in a connected world where much of our personal data lives in ‘the cloud.’

The Anthem breach has an additional wrinkle to consider: Not only was personal information (demographic, SSN, income information, etc.) hacked, but private medical information was potentially vulnerable.

The federal law known as HIPAA is an added privacy protection for consumers (patients) about our medical data. Unfortunately, I now believe that it has outlived its usefulness.

HIPAA creates ‘above and beyond’ penalties as a form of deterrence for being careless with private health information. While well-intentioned, the law is an unfunded mandate that has added billions of dollars in unrecoverable costs to the health care system.

Ironically, it’s another federal law, the PPACA (‘Obamacare’) that in my view has rendered HIPAA less relevant. Obamacare forbids insurers from denying patients eligibility on the basis of ‘pre-existing conditions.’ It was exclusions for those conditions that made HIPAA so necessary — under such a system, people needed the right to keep their medical info private.

I think medical data should be private, but only inasmuch as financial and demographic information. Creating an added layer of bureaucracy and penalties has only clouded issues for all of us.

There are at least two possible goods that could come from revising (or repealing) HIPAA:

  1. Increasing transparency in general. This might help increase price transparency in health care, something sorely needed. Obstacles to us sharing our health information keep prices shrouded.
  2. We’d have many more opportunities to anonymously collect data in huge data bases and perform analyses that would lead to more knowledge generation. We still do many things in medicine based on tradition without knowledge of whether it’s helpful [see, as examples, this wiki-startup or this Harvard scientist-librarian with a really great idea].

We’ll all have our data stolen at some point. Making at least one aspect of that data less ‘valuable’ to crooks would diminish the appeal of stealing it and perhaps allay some of our anxieties over our medical privacy.

DIY Medicine Gets a Step Closer

As with other industries, the Do-It-Yourself movement has come to health care—and it’s getting stronger.

Unlike engine repair, craft brewing, or laying sheetrock, the barriers to entry for DIY-ers in health care are higher. The main barrier, medical knowledge, is lowering fast as autodidacts have more tools and information than ever before—as but two good examples, see Khan Academy or what’s known in the Twittersphere as #FOAMed–“Free Open Access Medical Education.”

Another big barrier has long been established by those that pay for health care–in the U.S., primarily insurers. They’ve had rules mandating that diagnostic testing be ordered by physicians, who then ‘control’ the results.c767d9a6

Last week, in a victory for self-motivated patients, the U.S. Department of Health and Human Services issued a ruling giving patients the right to obtain lab results on their own from freestanding diagnostic labs–without needing the interpretation or control of information from a medical provider.

This is not likely to have a huge impact, as many if not most medical practices have adopted electronic health records and it’s now common practice to share test results directly with patients.

But for laggards that have not implemented secure data-sharing policies, a major incentive is now there as patients will be able to collect data back from the lab on their own. Much better from the provider perspective to get out in front of an ‘abnormal’ result.

How about you? Do you get your results from your doctor automatically, or do you wind up having to hunt them down? Does this new ruling make you more excited to take control of your own health information?

Quantified Selves

Are you a data junkie?

Do you feel compelled to record your vitals, throughout the day, during workouts, or while you sleep?

the-quantified-selfHave you ever tried a calorie counting app to see what you really eat in a day?

If you own a smart phone, you are now able to do all of these things as never before.

A growing movement known as Quantified Self is putting people more in charge of their data and their health. NPR ran a great story on QS (embedded below). Some of the more popular apps were featured and some devoted QS’ers were interviewed.

As a doctor, I welcome people’s engagement with their health. As the illustration shows, anything that gives people a sense of control over their lives (and their ‘well being’) can’t be bad.

Yet I do want people to keep these tools in perspective–you may find, like I do, that some of the subjects of the story are a bit, er, obsessive. And if you look at the comments, you’ll see there are many skeptics, who express doubts that these modern tools will help Americans change their unhealthy habits–arguing that those motivated enough to quantify themselves are likely to be healthy types in the first place.

Know any good tracking apps? Share them with us.

Help Wanted: DIY Medicine

Taking medical care to the self level.

First there were contractors. Then came Home Depot.

Once we had accountants. Along came TurboTax.

Stockbrokers? E-trade.

Printers? Soon we had Kinkos, er, FedEx.

Even venerable old lawyers are being outsourced and replaced by do-it-yourself manuals and online services.

Which brings me to my profession. Medicine.

I’m researching a new frontier in health care: do-it-yourself medicine. As more information is available online, patients are empowered like never before.

The rise of the e-patient movement is one such example. But now, with direct-to-consumer lab testing and radiology, people are able to access medical services and consume them like any other commodity.

I’m interested in learning about people that obtain these services without the consultation of a medical professional.

Caveat: a lot has been written about cyberchondria, google-itis, and patients advocating for themselves and their loved ones with their doctors.

I’m looking for people out there that self-diagnose and treat but make every effort to steer clear of the medical establishment.

Are you such a person? Do you know one?

All information and stories will be held in strictest confidence. We’re trying to gauge the prevalence of this phenomenon in the world.

Comment on the blog or send tips/inquiries to GlassHospital [at] gmail [dot] com.

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