Voting With My Feet

Dr. SJ made an appointment for me with a dermatologist.  I hesitate to use his name, as I can’t say for sure that he deserves to be maligned by the likes of me.  I didn’t want the appointment, and I avoid such appointments to the extent possible because nothing good ever comes of them. Dr. SJ sees things differently, and insisted I go.

When I arrived ten minutes early to the appointment, I did so begrudgingly.  But I was there, despite my belief that anywhere else would have been a better place to be.  I went to the receptionist, but before I could give her my name, she instructed me to put my name, reason for coming, insurance information and some others stuff that eludes me, on a piece of paper sitting atop the receptionist’s desk.

I said no.

She said I must.  I said that “must” may not be the word she intended, given that she was unarmed.  She said, “it’s our policy.”

There is probably no phrase that pisses me off more than “it’s our policy.”  You see, of the many, many things that concern me, the “policy” of people whose services I use (and who charge me for the pleasure) is invariably not on the list. My policy is to not use anyone with their policy. See how that works?

In this instance, I have a particular reason why their policy is offensive.  Neither my name nor my reason for seeing a physician, even a dermatologist, is anyone’s business. HIPAA much?  I do not care to have them appearing on a list sitting on a receptionist’s desk.  I have this personal medical privacy thing, and it trumps their policy. So does the law, but that’s a separate issue.

I told the receptionist that I would not put my name on her list, and if that meant the doctor would not see me, then I will be happy to leave.  She reiterated something about policy, but I said good-bye before she could finish. I left.

Now the doctor is allowed to have whatever policy he wants, provided it’s not unlawful (as this is).  In a sense, I don’t blame the receptionist, who is likely only following unlawful directions, but doesn’t realize it’s unlawful.  Sure, she might be capable of grasping the privacy problem without regard to the legality issue, but then, I am reluctant to attribute malevolence when ignorance will do.

And I am allowed to walk out if I don’t care to have my privacy violated. And I did.

Dr. SJ is going to be pissed with me.  The problem is that I had skin cancer, which was removed,* and now I have something where the cancer was that she thinks needs to be seen to make sure it’s not back. She’s got this thing about me not having cancer. Go figure.  I am confident that I’m fine. I have no good reason for my confidence, but then, we all have to believe in something, and I pick this.

Still, she will have some cross words for me when she learns of my intransigence. She knows my feelings on this subject, as we’ve discussed it at length. She doesn’t care. I do. Plus, I don’t want to see the doctor anyway, and was only doing it to get her off my case.

But if anyone doubts my adherence to principle, I would rather court cancer than allow my privacy to be violated.  And I really hate going to doctors anyway.

* Edit: Because my buddy Turk assumes I must be a blithering idiot, I add that this was not the first time I had been to this doc. He previously excised the offending cancer, and we had gone through this “sign in” issue before.  That time, Dr. SJ accompanied me, and forced me through threat of bobbitization to sign in despite my refusal.  What I would not do for the receptionist, I did for Dr. SJ. I’m weak.

However, having gone through this before, I was already aware that there was no persuasion, negotiation or discussion involved. This was what was required before the doctor would see me.  I left this part out of the original post as I thought this degree of background unnecessary to make my point.

Clearly, it was insufficient to fill the assumption gap. I thus fill it with information, even though I still don’t see it as necessary, unless one prefers to assume I am a blithering idiot, as apparently some do, rather than accept what I wrote at face value.

89 thoughts on “Voting With My Feet

  1. michael

    Blogging the reason for the appointment: three cheers for keeping your medical issues private! You showed them…

    1. SHG Post author

      The point is that privacy is my choice, not theirs. I can disclose what I choose to disclose. I don’t disclose it because a receptionist demands that I do so.

      1. ExCop-LawStudent

        I would hope that you were aware that Dr SJ would force you to return, despite your privacy issues.

        I know that Mrs. ECLS would have been severely pissed if I returned without having been seen. And the punishment for contempt of wife is much worse than for contempt of cop.

  2. Erich

    I find it slightly amusing that you’d share the nature of your visit to the dermatologist on your public blog but not on a sign in sheet at the Dr’s Office. This doesn’t invalidate your privacy concern, but perhaps suggests that you are just a cantankerous person.

    1. SHG Post author

      While your first “amusement” is addressed in my reply to Michael, and I am a cantankerous person, neither seems to reflect much a grasp of principle.

      Principles often give way to convenience, because it’s so much easier just to let is slide than not. That’s why people, like this dermatologist, have policies that put their purposes ahead of those they serve. It’s the same acquiescence that makes “you’ll let me search if you have nothing to hide” work. If slip sliding away works for you, don’t complain when you finally hit a line you don’t want to cross. It’s your own fault.

      1. Karl Erich Martell

        I just want to note that this “Erich” isn’t me, and that I find the entire ECLS/Mark conversation hilarious.

        SHG, I’ve got an appointment coming up with a specialist (my primary care doc wants to make sure there’s no issue with a small irregularity), and the reams of paperwork that specialist wants me to complete prior to arriving is pretty astonishing. I’d been contemplating how to deal with the situation, and have taken some solace in your experience (as I’m usually the only person of my acquaintance with my “It’s our policy!” issues). I very much appreciate this post and the comments it generated.

        Thanks and have a great one!

        1. SHG Post author

          You can be “The original Erich,” even though you’re usually Karl. Or I can make him “the other Erich,” or George or Susan. Your choice.

  3. Turk

    It seems like fair game to ask who you are and whether you can pay.
    The reason for the visit? Dermatology.

    If it was truly privacy you were concerned with (as opposed to other reasons), I bet you could have worked your way around that just fine. (Here is my name and insurance. Please make sure it does not sit in full view for other patients to see.)

    I am confident that I’m fine.

    You are in excellent company; Your hero, Steve Jobs, said the same thing.

    1. Dan

      I’m pretty sure that nothing would happen if you said please make sure that my name and info doesn’t sit in full view for other patients to see. They’re in the policy business, not the common sense business. The clipboard is there in full view, as per policy. That’s suddenly going to change?

      For some reason (low pay?) medical office staff has become a disgrace.

      1. SHG Post author

        Not only is it a certainty, but it was an express certainty. I don’t know what compels Turk to make baseless assumptions, but it’s something he really needs to work on.

        1. Turk

          My baseless assumption was based on this:

          She reiterated something about policy, but I said good-bye before she could finish. I left.

          Are you not trained in the art of persuasion?

          This assumes, of course, that you actually wanted to see the doctor, as opposed to looking for an excuse to leave.

          1. SHG Post author

            This wasn’t my first rodeo. Must I give you every excruciating detail of my life before you don’t leap to the assumption that I’m a moron rather than I know what I’m talking about?

            If you find a piece of information lacking, there are three things you can do:

            1. Ask, so that you don’t feel compelled to assume
            2. Assume the best
            3. Assume the worst

            You chose number 3. You might think you chose the most likely rather than best or worst, but you wouldn’t be capable of assessing likelihood without either having the information you lack the forces you to assume in the first place, or projecting your experiences onto mine, which also renders your assessment of probability flawed. Of course, if best/worst are of similar probability, then the assumption is purely a reflection of your choice.

            1. SHG Post author

              Well, I was a dick to him the other day, so maybe he’s paying me back? Or he thinks I’m being stupid because I should see the doctor, despite my privacy issues, because I shouldn’t neglect my health. I dunno.

            2. Turk

              I thought you and Turk were friends. Why is he being such a dick?

              Because we are friends.

              Or he thinks I’m being stupid because I should see the doctor, despite my privacy issues, because I shouldn’t neglect my health.

              Cutting off your nose to spite your face is rarely a winning strategy. And with regard to the privacy issues, if there’s a will there’s a way.

            3. SHG Post author

              There are other dermatologists, you know. Or I can just go pro se. There must be website about this somewhere on the interwebs.

            4. Sgt. Schultz

              So, since I’m pretty clear that you’re not Dr. SJ, that means you’re exercising your right as a New Yorker to substitute your judgement as to SHG’s health care for his, because he doesn’t achieve your desired level of paranoia?

              I’m sure you do so out of concern and friendship, but sheesh, you don’t see at all how little regard you have for a guy making his own decisions for himself when they don’t sync with yours.

  4. Alex Bunin

    “And I really hate going to doctors anyway.”
    That pretty much sums it up. Just so I get it straight, you wanted to see the doctor with no preconditions, tell him/her about your skin, and leave with no record of your visit? You can probably do that for your own clients, but they don’t pay with insurance.

    1. SHG Post author

      Not at all. They already had all my insurance information, and my chart. The only thing they don’t have is the authority to demand I put my info on a clip board that sits on the reception desk for all to see.

          1. Alex Bunin

            I do. I am much more concerned that others see my opinions in cyberspace than my name on a clipboard. If I am under surveillance, the clipboard is the least of my problems.

            1. SHG Post author

              My name in cyberspace is my choice, not because a receptionist ordered me to put my name on a clipboard. If I choose to protect my privacy, I can so whether it’s the least or most of my problems. I bet you could too.

              Of course, if your privacy doesn’t matter to you, that’s fine, but that doesn’t change the fact that it matters to me. Some people just like being given orders by receptionists more than others.

      1. skitch

        Lets peel a few layers off of the ‘legal Privacy Issue Onion’ and dig deeper. You apparently didn’t want to allow the ‘voluntary’ donation of your DNA for a ‘exceptional/special needs or suspicionless/warrantless search and also provide the identification for the sample which would allow the ability of the dermatologist to identify and investigate for any ‘unknown/unsolved’ skin problems, certainly, after its entered into the collection of samples, national DNA database – (CODIS).
        Theres always a possibility that all medical personnel have received a ‘directive’ ordering them to skip the fingerprinting, and the warrant, directing them to ask the client/individual for a ‘voluntary’ submittal/confirmation of identification/data/label, disguised as a ‘policy’ and proceed with the more intrusive undertaking of gathering ‘samples of DNA’ and to log/label them into ‘CODIS’, w/o any warranted/false arrest. What a time saver, money wise and manpower wise, Pretty Slick…!
        You forgot to mention a crucial fact about this possible/probable DNA collection attempt; after he (R.H.) finished reading his book, “Misleading DNA Evidence”, he loaned it to you and you briefly briefed it prior to your appointment, thus justifying your ‘guard/walls to be put up”, another hypo.
        Also, you’ve apparently forgotten to cancel – 24 hours in advance to prevent any possibility for the client to be charged for a technical ‘no show’, don’t forget the ‘fine print’. I am sure glad that there’s other people ‘on watch’ like myself…!
        I may not be as, “Wise as the Court sees to make the leviathan all seeing, so that he may protect us all the better” quote Justice Scalia’s assertion from his dissent in ‘Maryland v. King’ and again quoting our S.C. Justice Scalia, this is all “To much in the end even for todays majority…!”

        1. SHG Post author

          It’s too late for my DNA, but other than that, it’s like you were there standing next to me.

    2. Dan

      This is very simple. The person explaining the policy can instead take down the person’s name and put it on a record that he or she keeps out of public view.

      1. SHG Post author

        It really is that simple. Whatever purpose is served by the list can just as well served by a list that is kept out of public view. Problem solved. Confidentialit maintained. HIPAA not violated. It’s like magic.

  5. Bruce Coulson

    Despite the existence of HIPAA, many people involved with the medical profession (including, but not limited to, medical practicioners, office staff, insurance agents, and third-party administrators) try to come up with creative ways to get around the regulations, in order to speed the processing of claims (and transfer of money).

  6. spencer neal

    HIPAA makes is clear that health information must be kept confidential. I took a three day legal seminar on this act’s requirements when it was first being implemented. Keeping health information on a front desk where anyone can see it is a clear violation of the law.

  7. ExEMT

    I am not one to ever argue with you (you do a much better job than me at debating the finer points on things), but I would like to get a tiny clarification and offer some input. I apologize for the length.

    You state that the receptionist “instructed me to put my name, reason for coming, insurance information and some others stuff that eludes me, on a piece of paper sitting atop the receptionist’s desk”. My question and request for clarification is whether this paper was the office patient registration form (which I am thinking is likely) or the usual “sign in sheet” that are pretty much standard at medical clinics.

    For someone not involved in healthcare administration, the two might seem interchangeable, but after 30 years in healthcare I can assure you 100% that they are not. What you describe has two completely different aspects of healthcare laws and rules behind them.

    “Neither my name nor my reason for seeing a physician, even a dermatologist, is anyone’s business”, and I agree and support you on that completely. Under the HIPAA Privacy Rule (and I have been Privacy Officer for a clinic for a number of years since HIPAA was rolled out) , physician’s offices may use patient sign-in sheets or call out patient names in waiting rooms, so long as the information disclosed is appropriately limited. The HIPAA Privacy Rule explicitly permits the incidental disclosures that may result from this practice, for example, when other patients in a waiting room hear the identity of the person whose name is called, or see other patient names on a sign-in sheet. However, these incidental disclosures are permitted only when the covered entity has implemented reasonable safeguards and the minimum necessary standard, where appropriate. For example, the sign-in sheet may NOT display medical information that is not necessary for the purpose of signing in (e.g., the medical problem for which the patient is seeing the physician). See 45 CFR 164.502(a)(1)(iii)

    Bottom Line on that one: A “sign in sheet” can ask for your name and maybe the time your appointment was scheduled for, but that is just about all. I think you can see above how the HIPAA Privacy Rule outlines that.

    OK, back to the “form” that they dropped on you. Most clinics have a variety of form that are used for both clinical and clerical purposes, and all are covered and protected under the HIPAA Privacy Rule. A physician and the clinic are held responsible under a variety of Federal statutes to provide and secure all healthcare related information that is given them by the patient. A doctor cannot treat the patient unless the doctor is given some basic information: reason for visit, chief complaint, medical history, current symptoms, current medications, and the list is endless. Since a majority of doctors are using electronic medical records, there has to be a process to collect that information, and that is usually done on paper and transferred into the electronic symptom. Other pieces of information (such as your insurance information) are there for medical and legal purposes. You would be shocked at how many patients go to clinics and use stolen or fake insurance information. This is something that costs the healthcare world billions every year. So when they have you complete your insurance and demographic information, they are in essence binding you to have provided true and accurate information, especially for the insurance coverage you may have used. You opine “I do not care to have them appearing on a list sitting on a receptionist’s desk”, and my reply is that under a variety of laws (including HIPAA) clinics are required to safely secure all patient-related information from parties who do not need access to it.

    Think of it this way: In the “old days” doctors offices kept all patient information inside your “medical record”, usually known as your “chart”. This was a physical folder that everything was in. The bad side of that is that (technically) anybody in that office could “grab” your chart and look thru it at any time, and who would be the wiser? The advent of electronic medical records means that there is a computer trail of every single person who might “look” at your chart. The process of completing the “form” that they asked was probably a precursor to them taking that form and scanning it into your electronic medical record, after which the paper form is shredded and destroyed.

    Final thought: I am VERY supportive of your stance about the “it’s our policy” issue. My staff knows that for me it is a different phrase that is verboten in our clinic, which was “well, we’ve always done it that way”. Nobody dares utter that phrase in the office these days

    1. SHG Post author

      The more you know, the more detailed the information required to distinguish things. What I am talking about is a separate sign-in sheet on a clipboard that sits on the receptionist’s desk where all patients are supposed to put down their name, their reason for coming, their insurance carrier name, and, if I remember correctly, the time of their appointment.

      This is a general sign in sheet for everyone, with one line per patient. They maintain a separate chart for the patients, which includes insurance info (no clue why they ask for insurance company on the sign in sheet) that has been verified, as well as a copy of the patient’s driver’s license to prove that the patient is the insured.

      So yes, they have all the expected and required information necessary to get paid and treat patients, plus this sign in sheet for all to see.

      1. ExEMT

        Based on what you just outlined, you are absolutely and positively correct on them stepping over the line and violating numerous aspects of HIPAA. I know you did not need to hear that from me, but I figured I would respond to you that although it was an annoying waste of your time to go to the appointment, you did the right thing!

        The agency over HIPAA (which is the Office of Civil Rights along with The Secretary of the Department of Health and Human Services (HHS) ) would hammer this office for this type of violation, which I personally would think falls into a category they they “knowingly” violated HIPAA by collecting the private info you describe in a manner where it could be disclosed to anyone. While it may be a stretch, you could probably make the case after all these years of knowing HIPAA that this office has committed a “HIPAA violation due to willful neglect”

        In June 2005, the U.S. Department of Justice (DOJ) clarified who can be held criminally liable under HIPAA. Covered entities and specified individuals, whom “knowingly” disclose individually identifiable health information in violation of the Administrative Simplification Regulations face a fine of up to $50,000, as well as imprisonment up to one year.

        Ding! Ding! Ding! We have a winner!

        1. SHG Post author

          While the remedies exist, I’m disinclined to be a rat, and I won’t go that route. But I will not stand for it, and if others stopped acquiescing in it, the docs would go hungry. But as you can see from the comments here, people are inevitably inclined to take the path of least resistance, even if its unlawful and compels them to give up their privacy.

          This is why we can’t have nice things.

          1. UltravioletAdmin

            Or next time you just write on the form, collecting names for a big fat HIPPA lawsuit…

            1. SHG Post author

              One time, I wrote I was Richard Nixon and there for hemorrhoids. Dr. SJ punched me and made me change it. I doubt they would have noticed.

  8. Hull

    HIPAA is part of the problem. But lots of it is the somewhat grandiose MD attitude. And so maybe “getting off our knees” is a good thing here, too.

    I am “rude” to MDs and especially their staffs several times a year–on phone and in person–in various situations–and I intend to keep that up. Some of these offices seem to really dislike patients. Twice this year I’ve gone to new doctors, in both instances for specialty work: an oral surgeon and new dermatologist (on latter, we light skin sun wimps from northern Euroepan tribes see a dermatologist every couple of days.) In both cases, I was asked to acknowledge that I had received “office privacy policies” (mainly HIPAA rules) which I was not given and, much worse, was I was given looks of disdain and disbelief when I had the temerity to ask for copies of them.

    Most but not all MDs treat patients like troublesome peasants. Which is strange in that doctors as a group are loopier, more culturally illiterate and more clueless about how the world works than even lawyers are. (I’m in a good mood today, huh?) As if MDs–along with lawyers–have a professional “status” give them license to treat customers as props or equipment. MDs–more than lawyers–routinely surround themselves with adoring assistants who have not figured out that the boss is a well-meaning but very mediocre human in lots of respects. Patients buy into the myth of MD “smartness” and “knowing the answer” more than anyone and it’s the biggest part of the “pedestal” problem.

    I meet doctors all the time that I think are nice people. But it’s been a long time since I’ve met a doctor that seemed remarkably smart. Or even fully “involved in their environment.” Even a little. And the average patient still looks up to the doctor? Hey. Gotta go. Excuse any typos. Just got a voice message. I have to call an insistent MD scheduler because the doc can’t make that July 23 appointment and she needs to make a new one for late October.

    1. SHG Post author

      Arrogant docs are nothing new. But that the receptionists think they get to bask in that arrogance is astounding.

      The “get off your knees” point just continues to have legs.

    2. ExEMT

      Just a note to declare that I am NOT trying to be the “expert” on this topic and monopolize the conversation today. Just a regular reader who loves the blog, and for once I have some direct and inside knowledge on a topic (I usually just get to sit on the sidelines and marvel at the lawyer stuff), and I apologize for the length of my answers. I am just trying to be thorough.

      Yes, you are right, and there are an increasing number of physician offices that have staff (clinical and clerical) and nurses and doctors that have what can easily be interpreted as a “superior” or “holier than thou” attitude. Doctors have no right to be “placed on a pedestal” and declared right or correct by default. I agree with your thoughts that they need to be more “down to Earth” and willing to appear human

      I would offer a minor “behind the scenes” view that clinical people (from doctors down to people like me, an ex-EMT who served 17 years on an ambulance) are trained to make decisions and “run with them” in many instances in a split second. It is drummed into our heads that we are making a “medical decision”, and that based on our training, knowledge, and experience, we are “right” and will not allow second guessing. Don’t get me wrong, I am never going to say that is the “right” way to do things, since we are all human and can make a mistake. But doctors that I personally know state that one of their primary fears in admitting they were wrong is about potential litigation, even though the link between litigation risk and the practice of disclosure and apology is tenuous. But the other two primary barriers are the “culture of medicine” that trains clinical people, and the inherent psychological difficulties in just facing your mistakes and apologizing for them. That last one is for more than just doctors and people in healthcare that is an apt description for how everyone in the world will handle their mistakes. The adage of “just own up to your errors, suck it up, apologize and move on” is appropriate.

      I’m not making an excuse here, just letting you in on some background of how doctors and clinical people are trained. While not always the case, in certain ways of approaching the medical decision making process, doctors and caregivers (and this is especially true of EMT’s and Paramedics) are expected to make a rapid (some would say instant or “snap”) decision on the diagnosis and how they should treat the diagnosis. In the proverbial “blink of an eye” the doctor must not only get enough background information of the diagnosis to decide how to act, they must decide the diagnosis and how to treat it, and at the same time must make that decision based on current “guidelines” that are in many instances designed and dictated by the demonic assholes in the insurance industry. In the normal course of patient care a doctors must take into account an almost incalculable number of facts regarding each and every patient they are treating based on the signs and symptoms of the patient, and all that information is supposed to be used to make a decision that will work best for the patient with the most positive outcome.

      Another aspect of the current healthcare environment means that the supply of doctors and their staff seem to be getting to be “younger” (or I am just getting older and more crotchety), and the sense of entitlement is a growing issue in more than just healthcare. How many of you have ranted about “customer service” from the younger generation at almost every place you visit and shop? Physicians (and the younger the doctor the more this fact is displayed) and their younger staff are especially prone to feeling entitled and smug. These doctors will whine that they worked hard and accumulated massive student debt to earn the degree of being a physician. They will assert that they are spending their lives in the service of society caring for the sick and infirm, all the while watching as their compensation fails to keep pace with their expenses. As someone who does insurance contract negotiation for medical clinics, I can assure you that doctors are being paid far less today while it is demanded that they see more and more patients, and all the while being expected to know every single detail that each insurance company requires. Entitled physicians will assert that that society owes them something.

      It is an unpleasant fact of life that there are physicians who treat patients more for the adulation and money that they feel is their due, than for the benefit they can offer to society. These physicians behavior is characterized by an excessive sense of entitlement, anger and hostility in response to any criticism, selfishness, the indefinite holding of grudges against those who, often innocently, offend them, and an inflated opinion of their own ability and importance to the organization. They often maintain their “importance” by demeaning or ridiculing colleagues, staff and (the worst sin) patients. A recent study showed around 75% of all physician/patient conflicts was associated with significant narcissistic personality traits in the physician. So the argument is compelling that the narcissistic physician is more likely to be a disruptive physician, and that disruptive physicians are a threat to patient safety due to their negative impact on team function, communication and the confidence and well-being of other doctors and staff.

      Scott, I especially appreciate your last comment of “This is why we can’t have nice things” and what I think you are driving at. It is not just behavior at the doctor’s office, it is how we are treated in everyday life from the innumerable number of interactions we have with others. There well and truly does come a time when we have to stop acquiescing to things that we know are not just wrong, not just inadvisable, and not even just the possibility of being illegal, they are just plain wrong. The rapid changes in the medical field have strained the age-old good relations between the patient and the treating physician. The aspects of what you described happening to you is just one more experience that points out the wrongness of delivering health care as primarily a “for-profit” business model, a model that increases the exposure to illegal acts. The current “for-profit” healthcare delivery system fosters adversity between patients and doctors, which fosters the feelings of discourtesy from your doctors you describe. It discourages patients from disclosing important issues that might be costly to address, and that could become even more costly later, and, frankly, it is a system that makes engaging in fraud more attractive to doctors. Whether your personal story is one that would have led to a violation of privacy laws is not as important as the description of the story and how all patients need to take an approach that demands that their privacy concerns must be addressed and understood by their physician and the physician staff.

      I am very confident that a majority of the privacy issues are not the direct fault of the doctor themselves, who in many ways is absolutely clueless about data theft and data security and privacy, the majority of violations of privacy and patient identity theft are the fault of the “McDonald’s Drop Outs” that are hired to staff physician clinics. Most clerical staff in a medical clinic have no more than a high school diploma or a GED, and the sketchy clinics do not even require that. Clinics in impoverished areas have high turnover rates, and the revolving door means that the cliche of “any warm body to fill the office chair” comes into play. The lower ranks of clerical staff in a medical clinic get minimal training, and your story outlines how they follow “policy” blindly and without a clear understanding of what the hell they are doing. They get just enough training to learn the system, and they have the proverbial “keys to the kingdom” in front of them. If we do not do as you suggest and “question authority”, we will get what we deserve.

      Just because something is “policy” at a doctor’s office (or any office), that does not mean we should become sheep and accept it. We all know that even the lowest of physicians are paid a multitude of times more than their clerical staff. Inside each and every patient medical record is pretty much everything that an identity thief would ever need to commit fraud: Name (Current and Maiden), Address (Current and Former), Date of Birth, Social Security Number, Banking Information (Account and Routing Number), Credit Card Information, and the list goes on and on. The ease of doing this is compounded by the fact the for over a decade doctors and clinics have spent billions of dollars in investing in the conversion of paper to electronic, so all a perspective thief needs is access to the “system”. Once in they can easily do identity theft on an almost unlimited number of people since everything they need is on-screen at their fingertips. Hell, they can do it from the privacy of their home computer, and most physicians are not bright enough to know it is being done.

      As long as our current health care system operates by selling services to consumers the same way as an auto repair garage, a plumber or a building contractor, consumers have every right to question their doctor on every aspect of their care, and this includes the protection of their privacy in this day and age of identity theft. I do not believe that physician clinics expose us to identity theft more than any other aspect of the business world, but who can take that chance? To truly function in the best interests of doctors and patients alike, our health care system needs to be reshaped to try and put the focus of doctors on health, not money. If we do that I hope the issues regarding the “attitude” of doctors and others in the healthcare arena will fall properly into place.

      Sorry if any of this is scary, but I figure sharing it might be valuable. Most people have no idea how much of their personal identity is exposed and able to be accessed from within a medical clinic, and we need people like you (and others on today’s topic) to stand up and demand accountability to protect our personal information. Yeah, HIPAA is a great policy that the government has designed, and HIPAA has good intentions, but I know from 30 years of working in it that the most terrifying statement in the world is “I’m from the government, and I’m here to help”

      1. SHG Post author

        This is a very long comment. Very long indeed.

        Protip: Brief comments get read. Long comments, particular one that discuss a broad array of subjects, get TL;dr’d. You raise a great many issues, some of which are rather far afield of this post (and as you may have noted, my wife is referred to as “Dr. SJ,” meaning that I have a bit of knowledge about some of these things.

        I focus in very narrowly here at SJ, so that a specific issue can be addressed with some degree of depth. I’ve found it to be a very useful way to address issues in a meaningful way.

        1. ExEMT


          Thanks for giving me my one chance to not be brief. I will PROMISE to place a word-cutter on my copy of Word from now on!

    1. SHG Post author

      I love medical forms, and the fact that people will dutifully fill out every question, complete every line, without any thought whatsoever of how it relates to medical treatment. And then there are the debt collection questions, because every doc needs to know your social security number. Just in case.

        1. SHG Post author

          I think he’s expressed himself pretty thoroughly already. If you want to invite comments, you could always start a blog of your own for that purpose, you know.

    2. william doriss

      Thanx for the link, Kathleen. This is truly funny. When I encounter forms like this, I check: “no, no, no, and no” again, irregardless,
      w/out reading the questions. Puhleeze! I just want to get on with it. This one is over the top: “Encounter gas pains after eating meat”? Say what? This is truly bizarre.
      Do you smoke, or have you ever smoked? (Illegal drugs?) Are you allergic to any medications? Do you have high blood pressure? Do you have trouble eating, eliminating, urinating? Did you ever read Playboy Magazine, or….? Do you have nitemares, nite terrors, or nite tremors? Do you sleep-walk? Do you sleep-walk in the nude? Do you sleep-walk, or have you ever slept-walked, nude in pewblic?
      And don’t call me Shirley!

  9. Mark Draughn

    Of course, had you written “To see if the skin cancer has come back” on the form as your reason for the visit, there’s about a pretty good chance that when the nurse took you to the exam room, she would have asked “So what brings you in today?”

    And then after she leaves and the doctor comes in, I wouldn’t bet against his first question being “So what brings you in today?”

    1. Onlooker

      Yes, and if you were to have the temerity to point out that you had provided that info on THEIR form, you would be considered to be a jerk, or cranky, or something similar. Grrrr

  10. anonymouse

    I was thinking that somewhere in your whimsy you would throw in some snark, but like some doctors, maybe you didn’t have enough patience.

  11. david

    I’m a private surgeon in Oz, doing bone cancer, trauma, joint replacements and consult withe the Australian Defence Force (to set the scene).
    If you come to see me as a new pt, we get you to fill out a form with your personal details, referring doctor, and insurance details. This is partly so we know who are, and partly so we can give you an invoice/receipt that is correctly formatted so you can access your various rebates. The receptionist does not ask why you are there.
    The form is given to the receptionist, who enters it in the computer; the paper is then shredded by a commercial document destruction service (admittedly stored on site until we have enough, but its in a locked bin similar to a sharps bin).
    As a review pt, you simply tell the receptionist your name. I then get a ping from ol’sparky, and call you in by your 1st name.
    We are fully computerised. There are no printed lists sitting in public view. Oz has fairly strict laws regarding ownership and storage of pt days, both electronic and hard copy, which has had several recent successful prosecutions.

    How does this compare with your doc’s set-up? Was your main issue this clipboard was sitting in public view with (some) medical details that could be visible? Or was it disclosing medical details to the receptionist? If either of these, you are justified.
    If it was just checking in at all, Turk is right and you are a dick 🙂

    1. SHG Post author

      I have no issue with the usual med history and insurance forms. I frankly don’t have a big issue with telling the receptionist why I’m there. She may not be a doc, but I will take the leap of faith that she understands confidentiality. My problem is with the clipboard sitting in public view with name and med info. That’s where I draw the line.

      Confidentiality belongs to the patient, just as it does to the client. If the patient or client decide to reveal it, that’s their business entirely. But under no circumstances will I be told by the receptionist that I have to put my information on display because that’s their policy.

      And I am a dick, whether or not Turk’s right (and he’s a dick too).

  12. Ken Bellone

    Despite spending my adult life in healthcare, and fully comprehending that changes in regulation that occur over time, the stupidity of some facilities still amaze me.

    On my last interview, I was actually asked to take a brief HIPAA examination prior to being showed around the practice that would be my new home for the foreseeable future., proving that I understood the applicable privacy regulations, then signing a document guaranteeing that I would not divulge “protected patient information”. That’s the way it should be done.

    Still, it’s common practice to have folks sign in on a clipboard for all to see in most of the doctors I visit. They just don’t get it……until they get slapped with some serious fines, perhaps. For the record, I’m no fan of EMR (Electronic Medical Records). Sure, they “may” help a physician in case of emergency , but I value my privacy and see the potential breach of it as a greater threat than any benefit divulging my personal information may provide.

    1. david

      I don’t know if this is a ‘Murica! thing, but I’m not aware of a single medical practice in Oz or the UK, public or private, GP or specialist, that has a pt sign on sheet . . .

  13. PaulaMarie Susi

    Fortunately, my doc only “requires” your name on the sign in, not why you are there, but I do want to be on the list to be seen. Yes, on my knees.
    I agree with your stance on the privacy issue, 100%. But, you’re being a dick, my friend. 1) happy wife, happy life: so you’re fucked, for the moment. 2) most of us here (most…) would like you to remain cancer free. So, please, go the fuck back and see the doc, even if it’s as a Dick (Nixon).

    1. SHG Post author

      My wife will get over it. She’s pissed at me at least twice a day because I just won’t do what she says. It’s part of my charm.

      I’ll find another doc who has some greater concern for his patients. And I’m not going any time soon (only the good die young). But thanks.

  14. John Barleycorn

    Pro Tip: Clipboards made of all aluminum sink in a graceful gliding fashion to the bottom of a fish tank and don’t freak the fish out nearly as much as a wooden clipboard which will resurface after the dunk.

    P.S. Amatures should never attempt to break a hard plastic clipboard in half. It is very doable but the broken edges are nasty sharp.

    1. SHG Post author

      Good tip. Most of my clipboard experience is with particle board, and I’ve never shown adequate concern for the fish.

  15. KP

    “”One time, I wrote I was Richard Nixon and there for hemorrhoids. “”

    Love it! The sort of thing I always do. As far as I’m concerned I rock up to a Doctor’s, sit in line, see the man and explain what I want, then hand over a pile of cash as I leave.

    They have no need to know who I am, where I live, or anything except what the Doc asks when he is investigating my problem. Hence I hardly ever go to a medic!

    I’ve walked out of a couple and had one dentist refuse to serve me, but that’s what life is all about. If you give everyone else what they want all the time you will live on your knees.

    I hope the cancer is cleared right out SHG, we need you here!

    1. SHG Post author

      I regular walk out of my dentist’s office when I go for a cleaning. I have a 15 minute rule; if I’m still in the waiting room at 15 minutes after my appointment time, I walk. Their time is valuable. So is mine.

  16. st

    Good for you! Voting with one’s feet and wallet is the only effective way to change such disrespectful behavior. I’ve fired a dozen fools this way, and as a result the ones I do see are professional and respectful, as is their staff. Double whammy – less money spent on jerks, and more money spent on their competitors.

    When facing the choice of principle vs Bobbitization, I’ve resorted to writing “Clark Kent” or whatever other name comes to mind, and “getting the receptionist fired” as my reason for visiting. Only rarely does that get their attention, and then only after they’ve called the name, when it is too late – the boss, who is responsible for the mistreatment, is waiting, and now s/he wants some ‘splainin.

    The 15-minute rule always applies. Once it goes past 10 minutes, if I’m not being at least mildly entertained by excuses or stories, I prepare to leave. That’s never been a problem anywhere other than a doctor’s office.

    I find it telling that lawyers and all other professional service providers have reception areas, typically with pleasant and helpful receptionists. Doctor’s offices have “waiting rooms.”

    1. SHG Post author

      I hope that the doc asks the receptionist why I didn’t appear for my appointment so he could get paid. My assumption, however, is that the receptionist will reply that I was an asshole who walked out, and she saved the doc from having to deal with “another difficult patient.” I’m confident she will not convey my message as it was intended.

      1. Wheeze the People™

        Yeah, I’m sure if it were your proctologist instead of your dermatologist, he would have literally said to the receptionist, “I’m ready for the next asshole. Send him in” . . .

      2. st

        But that’s the beauty of voting with your wallet. It doesn’t matter what excuses the receptionist offers. The message is delivered directly to the bank account of the person responsible for the practice. Even the most clueless doc will be more likely to notice the increasing number of “difficult patients” when he is short for his next boat payment.

        If you follow through and find a better practice to serve you, they get the same message – in positive terms – to their bank account.

        The communications of the market aren’t subtle and nuanced, but they are effective. Walking out of a single appointment doesn’t change much. Ten million people acting similarly will change things faster than you can believe possible – and ten million is a tiny fraction of the number of office visits in a year. Economics happens on the margin, and by acting as you did, you shifted that edge a tiny bit in a good direction. Good for you.

        FWIW, in my experience the same defensiveness and entitlement that leads too many docs to treat their customers like dirt also makes them very touchy about receptionists practicing medicine. I’ve heard more than one receptionist get a blast from their boss when they offer opinions about patients – including diagnoses of “difficulty.”

        1. SHG Post author

          You may not have noticed, but a lot of comments here reflect the view that most people can’t be bothered and would just bend over and do as told. And that’s here, where people tend to be a bit more principled than other places. Loss of one patient won’t do it, and it doesn’t look like I’ve started a movement.

          1. st

            But I don’t care what other people will tolerate – I care about me. I’m selfish that way.

            Those same people gripe to me about 7-minute meetings with a doc who is half listening. All of my (too many) doctors spend a minimum of 30 minutes face-to-face, full attention. I don’t argue or proselytize the legions who are willing to bend over. I just find the good docs and reward them with my business.

            Guess what? A few people have changed their attitude and responses as a result of my efforts. Some docs, some patients. Welcome to the margin.

            1. SHG Post author

              You’ve kinda missed the point here. This is what I did, and how others reacted to it. You’re riding my coattails here, not the other way around.

          2. Alex Stalker

            You won’t start a movement unless you sing a few bars of Alice’s Restaurant before you walk out next time.

          3. Bill

            ” it doesn’t look like I’ve started a movement.”
            That’s why you have a proctologist. See above.

  17. st

    If you really want to put a point on it, write a short letter to the offending office, and another to the new practice (if you chose a new one.) I make myself write at least one positive note for every complaint.

    Letters addressed to doctors better not be ignored! They may get opened and read, but not conveying the message would put someone at risk of termination. Even if they shred it, they will get the message. If you ever come back, they will realize you might mention it to the doc, and will suffer the pangs of their conscience the entire time you are present.

    A brief, polite, factual expression of dissatisfaction with hotel service has earned me a great deal of complimentary food, beverages, and room upgrades. The one doc I wrote answered my letter, requested a second chance, and has treated me very well since then. Fire the jerks, there are too many decent ones out there. Just like preventing the spread of stupid, we can all make the world a better place by not tolerating abuse by those we hire to serve us.

      1. Michael Andrew Lockard

        OMG! I just spat Diet Dew all over the damn keyboard on the “Seriously? You’re telling me how to write a letter?” comment. Funny reply, funnier concept proposal.

        Bravo! Well played, Sir!

        PS to st: Your “theory” looks good on screen, but as an employee of doctors (16 years and counting on current clinic), unless you know something I have not seen you really have no hope in hell in the real world of the actual doctor seeing the letter, and even less of getting a response. Trust me, the doctor is shielded (sometimes by design, sometimes not) from the “angry patient letter” in probably 95% of clinics by staff and management. This is like the theory of sending a letter to the CEO of Walmart of the President of the United States and actually sitting by the mail slot waiting for a reply. Not gonna happen.

  18. Jeff Hall

    A few years ago I had an appointment at a specialist’s office. Right before I saw the doctor they wanted to take a photocopy of my driver’s license. I refused, but unlike you I was “lucky” enough to get them to make an exception. I say “lucky” because the procedure I was paying for took three sessions — and they wouldn’t make an exception on the third session. I refused again to let them copy my driver’s license and they refused to finish treating me.

  19. MJBees

    @Jeff Hall That will become more common because Patriot Act (requires picture ID) and Obama care/electronic records and AUDITS!! Doctor offices/ clinics are getting much more scrutiny. I spent forty+
    years in acute care hospitals and a few in a doctor’s office before I retired.

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