Patient Privacy - my eye!

                The Electronic Medical Record, of which I was an unequivocal supporter for many years is causing me increasing concern.  The very concept of patient privacy, regarding which we pretend to be fervently committed, is now not much more than pretense.   I would go so far as to say there is no longer any.    When the innermost secrets of the Department of Defense, the Government and Target can be easily hacked into, getting into medical records is child's play.  Every physician knows that and so does every administridiot in the Department of Health.   Although the rationale behind EMR was improvement of health care, there seems to be little evidence to support that thesis, in fact suggestions have been made that the doctor - patient relationship has deteriorated  as a result of the effort and concentration to  input and  retrieve data to and from the machine.  Much of that data is not directly related to the health care of the patient.   All of that data will be available forever and because of the omnipresent data-gathering applications it will be linked to applications such as facebook, linked in, inquiries that you make to medical and other health  related sites on the internet, as well as sites not directly related to health, such as the increasingly ubiquitous observation cameras.
                 Data Brokers have a goldmine in the sale of sensitive material, regardless of the use to which it may be put.   Experian is a global information services group with operations in 40 countries.  Initially a credit rating company, it has now morphed into something quite different.  The company collects information on people, businesses, motor vehicles and insurance. It also collects 'lifestyle' data from on and off line surveys.  The company sells personal information and it is very likely that it sometimes includes medical data too.
                The Government also likes to have as much information available on its citizens as possible, partly so that it can be aware of individuals or groups likely to cause it problems.   As George Orwell said in '1984', "We know that no one ever seizes power with the idea of relinquishing it."    Government will use whatever means it can to remain in  power.  The greatest source of power is information. Organizations like Experian are likely to proliferate greatly.   Your health care history will be one of the more easily accessed sources of information.
               So don't be surprised when people keep their health issues secret when they perceive that revealing them may have a deleterious effect on their job, or life in general.  That reluctance to seek treatment because of fear of failure of medical  confidentiality may be one of the main reasons deterring some patients from seeking  help.

Ebola - The Bleeding Edge. Part 3.

             The Dallas Hospital Staff that discharged a patient who had recently been in West Africa, with a fever, headache  and abdominal  pain was guilty of an egregious mistake.  The initial excuse was that the electronic entry into the medical record made by the nurse did not appear on the doctor's screen and was therefore missed and the patient inappropriately discharged.  This, in fact, was no excuse at all and was later retracted.  The doctor patient relationship depends on the doctor talking to the patient and taking a medical history, the first and vital stage in any medical  encounter. If that was done he could hardly avoid arriving at a conclusion that would be apparent to any first year resident.   Of course I don't know  the  details of this particular case, but I  would strongly suspect that this patient was not seen by a physician at all. 
              I  am surprised at how quickly  this issue seems to have dropped from the radar, because a mistake such as this could result in wide dissemination of the  infection.  That makes me wonder about the lack of any effective travel controls from  the danger areas into the United States and the rather glib assurances given by some physicians that it is impossible to get the disease from from a person who is not febrile.  While this  is  unlikely, anyone who has practiced medicine for a number of years knows full well that no such absolute assurances can be given. 
              So, while there is no need for panic, there is need careful surveillance and appropriate precautions and care.  One of those precautions should certainty be travel restrictions from infected areas.