Monthly Archives: March 2014

A Little Privacy, Please

Our privacy is eroding. Some of this erosion is our own fault – we post to Facebook, Twitter, and other social media with reckless abandon. Some is the nature of modern communication – electronic trails are just as easy to find as paper trails (if not easier). Some of the privacy erosion really doesn’t bother me so much – if Target knows that I buy a lot of Cheerios, I’m happy to accept their General Mills coupon for $1.50 off my next breakfast cereal purchase. But there are some places where I expect and demand privacy.

Like in a doctor’s office. Or hospital. Or pharmacy.

But business has so inserted itself into so many aspects of life, including medicine, that my expectation of health-related privacy is being slammed into the wall. Although I really couldn’t care less if Target knows my cereal-buying habits, I certainly do care if they share the information when I purchase a pregnancy test. Or athlete’s foot spray, for that matter. Of course the store has no idea if I’m purchasing health-related items for my own family or for someone else, so it’s unlikely that this information will be used for anything other than targeted coupon offers, but it still really bugs me that people look at this information. And yes, I am aware that I can simply use cash when purchasing over-the-counter wart remover if I want complete privacy on that issue. But the fact that I have to consider it really bothers me.

What price convenience? And what price financial savings? I have a Target Red Card. It gives me 5% off the price of everything I buy at Target. It allows me to return items even if I’ve lost a receipt. It gives me coupons for things I buy. But I read an article a couple years ago that talked about a man finding out that his teenage daughter was pregnant because she started receiving store coupons in the mail for diapers and infant formula after she had purchased a pregnancy test and vitamins. This is a breach of privacy. And it could also cause harm aside from breach-of-privacy with its presumptions. For example, while some couples who purchased a pregnancy kit and then started purchasing vitamins may in fact be delightedly experiencing a pregnancy and happy to receive a coupon for a stroller, a couple experiencing fertility difficulty (or who experienced a miscarriage) might not appreciate receiving constant flyers for baby item sales. It’s one thing if someone actively opts-in or signs up to receive notification of promotions of certain types of items, but quite a different thing to have the automaticity and presumptuousness, and it’s a problem.

There are other financial “incentives” that erode our medical privacy. One that bothers me quite a bit is the extra charge for health insurance that many companies currently impose unless you have a yearly health screening and fill out an online, detailed, personal questionnaire about health-and-safety-related issues. Strange that this bothers me, considering what I do for a living. And considering that I am all about people taking responsibility for their health. And considering that I am all about educating people on health-and-safety-related issues and healthy lifestyles. And that I like when there are resources to help people. And that I understand deeply how addressing certain issues can significantly improve a person’s overall health and well-being (and in so doing, how it can have a positive financial impact as well).

But I figured out what it is that bugs me so much. I actually would have no problem with it if there were the same requirement for a yearly check-up with one’s own physician and if the questionnaire were between each individual and that person’s physician. My problem is with the online, one-size-fits-all survey/questionnaire with detailed, personal questions (many of which have nothing to do with modifiable risk factors) that goes to some random computer algorithm and perhaps some random person (who is not a doctor). Seriously, the lifestyle health coaching company does not need to know when someone’s first menstrual period was – they can simply ask if a woman has discussed breast exams and mammograms with her physician. My issue with the current system of monetarily penalizing those who don’t comply with this invasive questioning is the presumptuousness and the intrusion of someone else into my doctor-patient relationship. There are too many people in the exam room.

By all means, the companies should feel free to offer their support services as an option to those who decide they would like to use them, or to those whose doctors feel they would benefit. But if you are not my patient and you were not invited in by my patient, then get out of my office. And if I did not invite you, then get out of my doctor’s office.

Facebook and the Doctor’s Office

I like a lot of things about Facebook. It allows me to see pictures and video of my nephews and niece and of friends’ children, it quickly lets me know when something big (either happy or sad) is going on in people’s lives, it lets me know what people are thinking about, and it gives me the opportunity to share my own news, thoughts, pictures, or occasional videos with others.

But as much as it allows glimpses into other people’s lives, Facebook doesn’t give complete pictures. Each of us has our own public persona, an image we project to others, which is only part of who we are. On social media that persona is even more deliberate and whittled down. We share the highlights, the good stuff, the proud moments, major life events, perhaps some political thoughts, and when we complain about something we often do so in a humorous light. In our reporting, a lot of us tend to skew positive.

I’ve noticed that people tend to do this in their doctors’ offices as well. Appointments are short. There’s frequently only time to cover a few highlights. People don’t want to be seen as complainers or don’t want to “bother” their doctors. So when coming into the office for a check-up or to address a specific issue, the answer to the doc’s “How are you?” is a smile and a friendly “Fine, thanks!” Not that there’s anything wrong with pleasantries, but if it stops there and concerns aren’t voiced, that can be a problem.

When we’re patients, we cannot assume that our doctor will notice a hesitation in our voice or a look on our face, or experience clairvoyance that will enable her to know that something is bugging us. If something worries us, we need to express it. We need to write down our concerns before our appointments so that we don’t forget them or decide that they’re not really that important.

When we’re doctors, we cannot assume that our patients’ friendly smiles and polite answers to “how are you” questions indicate that they have no concerns. We have to dig deeper. We have to read the review-of-systems questionnaires of 500 symptoms with check boxes that we made our patients fill out before their appointments and address what is checked off as “yes.” We need to specifically ask if there is anything else bothering our patients or if there is any other concern they have about their health. We need to remember the facade that people are used to maintaining.

A visit with a doctor requires, from both sides, more than a glance and a click on a “like” button. It requires human interaction. It requires communication. It requires connection. When a patient is in a doctor’s office, it is because that patient needs something beyond a Google search of a symptom. Even when someone healthy is in for “just a check-up,” that person cares enough about their health to be there, and deserves to be encouraged to share any medical concerns. And a doctor deserves information from his patients so that he can do his job as well as possible.

Appointment slots are brief. They can seem a bit like a Facebook encounter (or in some cases, even a Twitter encounter). But a doctor’s visit is not a social media situation. It needs to be deeper. It needs to address the person behind the post. Interact. Communicate. Connect. I “like” that.