Privacy:

An issue of People magazine lay open in the staff restroom, and copies of Star were scattered on the lunch table, but the office conversation that slow summer morning ignored the usual celebrities in favor of a relative unknown.

How did that patient with all the tattoos manage to pay cash for his medical care anyway?

The office assistant said she bet he had a stash of $100 bills buried in his backyard.

The receptionist thought he was probably dealing drugs.

The nurse knew for a fact that he had been in jail for something. He had told the doctor, she said, and the doctor had told her.

They all nodded sagely and went back to work.

Had the man with all the tattoos overheard this discussion of his private life, he probably would have felt the same degree of embarrassment, anger and personal violation that people experience when their medical details leak far afield.

"It's none of their business," he would have snarled.

In the old days, he would have been right. But in some forward-thinking medical circles now, he would be considered quite wrong.

For centuries, authorities from Hippocrates right up through Uncle Sam have broadcast the virtues of a closed mouth when it comes to patient care. The energy behind such efforts has escalated sharply in recent years. Hospital elevators, once notorious for loose-lipped conversations, now often have signs reminding staff members to keep quiet.

An ambitious federal privacy law, passed in 2003, restricts the traffic of information out of medical settings so stringently that sometimes even vital communication is curtailed.

Given these developments, you might conclude that your medical privacy is now more or less guaranteed. But that depends very much on what you mean by medical, and what you mean by privacy.

Back when Hippocrates cautioned his disciples to keep everything they saw at work to themselves, doctors worked more or less on their own. Now, health care takes place in the equivalent of the New York Stock Exchange, full of noise, negotiation, and cellphone yammering. Even if you don't have a serious problem, by the time you finish with a few routine appointments, a small army of receptionists, pharmacists, nurses, medical assistants and radiologists have become part of your team.

Most of them are honorable souls who would never dream of gossiping about you to friends or relatives (or a tabloid reporter, should the occasion arise). Most, in fact, know little about you save for the uninteresting facts of your prescription insurance or when you last saw a dentist.

But they do sometimes sit down to chat together, and their conversation may well turn to you.

Some of these conversations are standard lunchtime fare: the medical office is, after all, a small, closed world, an office like any other, with numbingly dull routines and a water cooler. Idle conversations grease its wheels; eccentricity and scandal attract attention as they do anywhere else, with bad behavior very close behind. Anyone who is rude at the reception desk is bound to get a moment of fame at the lunch table.

Some in-office gossip, though, takes place not at water coolers but in conference rooms, and is actually pure business. The profession of medicine is beginning formally to subsume the riotous human comedy — the stuff of lunch table conversation — into its legitimate borders.

No longer is a well patient with a sick gallbladder of medical interest for her gallbladder alone. With doctors increasingly exhorted to care for the whole patient, not just the disease, that gallbladder is often examined in its full context, and all social information — what might be considered gossip in any other context — becomes relevant.

Is the gallbladder upset because its owner is eating too much fatty food? Are those deep fried onion ring binges caused by unhappiness in the home? Is there a possibility of domestic violence? Should a social worker and a lawyer be called as well as a surgeon? The scans show only the inflamed gallbladder, but medical caretakers are now encouraged to see beyond the scans.

Sharing information from every perspective has become the way of the future. In medical school, students are now encouraged to link disparate medical and social details into a cohesive story, a veritable novel about each patient. In hospitals, doctors, nurses, social workers, psychologists, therapists, dietitians and members of the clergy regularly meet to pool information about patients in "multidisciplinary rounds."

Objective evidence argues that this trend is good. The horror stories from the days when professionals minded their own business are legion: patients given wads of prescriptions they had no way to pay for; patients set up for home care when they had no home; patients discharged with catheters that everyone forgot about; patients headed for a medical future that directly violated some ethnic tradition or deeply held religious belief.

Studies show that multidisciplinary rounds improve every facet of patient care, from length of hospital stay to infectious complications and even mortality. But it still means that medical privacy is becoming a very relative concept. No longer can you offer up your gallbladder to the system, and keep the rest of yourself tucked safely away.

The walls between medical providers and the outside world are tall and thick now, bolstered by custom and the law. Nothing much gets out.

Inside the castle keep, though, the tongues are wagging, and it's all for your own good. From marital problems to drug and alcohol dependence to that odd habit of paying for your medical care from a wad of crisp new $100 bills, there is no such thing as "none of their business" anymore.

Everything is becoming our business now.

source: http://www.nytimes.com/2005/08/30/health/30essa.html?pagewanted=print 29aug2005

Mindfully.org note:

The first image below is a poster seen on BART (Bay Area Rapid Transit) running between Berkeley and San Francisco in August 2005. The second image is a street sign seen upon entering Berkeley, CA in July 2005. Both have everything to do with this article about a person's rights to privacy. 

In short, our privacy has been reduced to something less than myth. In this land of the free and home of the brave, neither are to be found. Everybody has burglar alarms on their houses and cars, and yet burglars remain undeterred. Everybody has medical insurance and yet doctors know not how to maintain our health. The wealthy send their children to private schools, and yet they learn not an ounce of common sense.

The bomb is our government.
Have you detected it yet?

At the bottom of University Ave in Berkeley, one of the traffic photo enforcement systems that this sign warns motorists about has about 18 individual cameras, a radar detection unit, plus flash units that are powerful enough to take a picture of your face while driving through at 60 m.p.h. at midnight. The ticket is automatically sent to the registered owner of the vehicle, with not a single human hand having touched it until yours opens the envelope. We think it should be illegal to drive through red lights at intersections, but taking law enforcement to such extremes should also be illegal. 

Both of the methods employed by these signs are tearing a hole in whatever substance is left in society in the USofA.

Being a good citizen is not about ratting on your neighbor OR putting up with this type of harassment. In fact, being a good citizen is very much about resisting this fascism we are experiencing.

To send us your comments, questions, and suggestions click here
The home page of this website is www.mindfully.org
Please see our Fair Use Notice