Doctor/Patient Privacy, No More

[OULobo]

http://www.philly.com/mld/philly/living/health/9345310.htm?1c

Brief: A Penn. man went to the doctor about a cardiac related issue and when the doc asked the usual questions, do use drugs, do you use alcohol, do you smoke, the man confided that he drank about a six pack a day. The doctor after completing the visit and sending the man home, contacted the Penn. DMV and commented that he may be a hazard to the roads. The DMV revolked his license. The aftermath is that, after suing to get his license back, the judge stated that if the man doesn't have the common sense to stop killing himself with alcohol, then he doesn't have the common sense to not be a driving hazard. The judge allowed the man to have his license only if he paid out of his own pocket (over $1000) to have a device put into his car that would not allow him to start the car unless his BAC was .03 below the legal limit.

 

[OULobo]

Points of discussion:

-Does this show that doctors are no longer worthy of patient's trust and will it mean that patients will now no longer tell thier doctors of problems that may effect their health, but also have issues of legality?

-The man comitted no crime and shows no pattern of criminal behavior, but still is denied a privilage that is usually only denied to criminals that abuse it.

-Is the judge covering for the state in finding against the man?

-Does this mean a breech of the binding and legal hypocratic oath of the doctor and his patient?

 

[OUMoose]

Just because the guy said he drank 6 beers a day isn't enough to do something like that. Now, if the guy had come to the doctor drunk, and the doc knew he drove to the office, there might have been something there.

Also, the Judge was in the wrong for enforcing that penalty. His job is to interpret the law, not make judgements on "common sense". Gotta love the judicial system. guilty until proven innocent.... wait... isnt that supposed to be the other way around?

 

[OULobo]

Not to mention that the guy is 6'4" and 250lbs. By the states own alcohol consumption tables, he wouldn't even be over the state limit if he had that six pack in 2 hours.

Moose, you tell'em how much build and wieght make a differance on the effect of consumed alcohol.

 

[Ceicei]

The CNN article on this same issue pointed out it was a state law in Penn for doctors to report to DMV if they knew patients were impaired in some way with their driving ability. I suppose if it wasn't for that law, the doctor wouldn't have a compelling reason to call DMV.

- Ceicei

 

[OULobo]

The CNN article on this same issue pointed out it was a state law in Penn for doctors to report to DMV if they knew patients were impaired in some way with their driving ability. I suppose if it wasn't for that law, the doctor wouldn't have a compelling reason to call DMV.

- Ceicei

Sure, but there is no proof that this guy was ever driving impared.

 

[Ceicei]

Sure, but there is no proof that this guy was ever driving impared.

Wasn't he? As I've learned a long time ago, there is usually more to the story than is told in news reports. I'd just take it with a grain of salt.

That said, this doesn't bode well for our privacy though.... Sure, we ought to "take care of each other" but there are other ways than having to involve "Big Brother", the government, in these issues to resolve every problem.

- Ceicei

 

[Baytor]

http://www.startribune.com/stories/467/4931728.html

We have an opposite situation in Minneapolis. The short version is that the police arrested a man who they said was drinking and then stabbed someone. The doctor refused to draw blood on the suspect without his consent. This is consistant with the hospital's policy. The police got a court order, and 6 hours later were able to have the blood drawn. The doctor was arrested for impeding an investigation. There is no plans to charge the doctor. The hospital, the police and the prosecutors office are all talking right now to work something out.

 

[Phoenix44]

If your health care is paid for by insurance, then you have voluntarily given up your privacy. Unfortunately, most of us have no choice. If we're lucky enough to have insurance, we can't afford to pay out of pocket. Take a look at what you sign the next time you're in the doctor's office.

 

[OULobo]

Wasn't he? As I've learned a long time ago, there is usually more to the story than is told in news reports. I'd just take it with a grain of salt.

- Ceicei

Quoted from the article link posted above.

"At a hearing here on July 29, Emerich testified that he did his drinking exclusively at night and on weekends, and that it had never caused him to pass out or miss a shift at work.

A toxicology report from his February visit to Good Samaritan Hospital showed that he was alcohol-free. Earlier that day, his family physician had detected an irregular heartbeat. That doctor, as well as those who subsequently examined Emerich at the hospital, advised him to cut back on beer for his heart's sake.

No one, he testified, suggested that he was not fit to drive or needed alcohol counseling.

PennDot, Emerich and his lawyer have not disclosed the names of the doctors involved. And the court records are sealed to protect the identity of the one who reported Emerich.

The one-page form had no written comments. There was a check at alcohol abuse, and one at yes in response to the question: "Do these conditions affect the patient's ability, from a medical standpoint only, to safely operate a motor vehicle?"

Doesn't sound to me like a risk at all. This is not a habitual drunk driver. It looks to me that he isn't a drunk driver at all.

 

[OULobo]

If your health care is paid for by insurance, then you have voluntarily given up your privacy. Unfortunately, most of us have no choice. If we're lucky enough to have insurance, we can't afford to pay out of pocket. Take a look at what you sign the next time you're in the doctor's office.

I have insurance, was just at the doctor's office on Tues. and read what I signed in completion. The form stated only that the information, other than in regards to billing, could be released to other medical personel for use in treatment only. I haven't signed over any privacy rights, except to other doctors that are bound by the same oath as my attending physician.

 

[Ceicei]

Maybe not, but drinking at nights and on weekends sounds like a lot to me. Not missing a shift and not passing out sounds good, but doesn't say about the quality of his work efforts. Of course, whether he could work better without beer is not the issue here.

There still may be more to the story. How severe was that heart problem? Why would that lead the dr (and not just one, but others) to say he needs to cut back on beer intake? Is not an advice to cut back on beer a form of alcohol counseling? Is a heart attack possibility at issue? A driver that may get a heart attack or some other heart problem (as a result of frequent drinking) while driving can be just as bad as having a driver who is impaired under the influence. The report did not state what the dr himself thought and his reasoning for why he felt he was compelled to report.

Whether the driver is a "habitual drinker" or not would depend on what is defined as a habit.

- Ceicei

 

[kenpo tiger]

One can have an irregular heartbeat from things other than drinking. I don't drink - ever. I do have an irregular heartbeat - what is referred to as a heart murmur (as does one of my sons and a good chunk of the population at large). It does not, in any way, impair my daily functioning nor is it indicated anywhere other than in my medical records.

As you said, CeiCei, one has to take these reports within context - and with a large grain of salt.

What toasts my cookies is still being referred to by my first name, but that's not the issue here. KT

 

[Mark Weiser]

In the Practice of Medicine there are oaths that I take as a Nurse that I will protect life and obey the laws of the State in which I am licensed.

Now if the Doctor is obligated under his current state Statues and Board of Healing Arts to report this kind of incident aka possibly a dangerous driver on the road then the Doctor has to do so or face penalities of his own.

Just as I as a Nurse am required to report any life threatening or harmful situations of my clients to the proper state authorities. The key is in any prosection is the INTENT of the person making the report.

 

[OULobo]

Maybe not, but drinking at nights and on weekends sounds like a lot to me. Not missing a shift and not passing out sounds good, but doesn't say about the quality of his work efforts. Of course, whether he could work better without beer is not the issue here.

I don't consider nights and weekends alot, and I definitly don't see it as a danger to the rest of society. The quality of his work efforts is a responsibility of his place of work or at best OSHA and not his doctor.

There still may be more to the story. How severe was that heart problem? Why would that lead the dr (and not just one, but others) to say he needs to cut back on beer intake? Is not an advice to cut back on beer a form of alcohol counseling? Is a heart attack possibility at issue? A driver that may get a heart attack or some other heart problem (as a result of frequent drinking) while driving can be just as bad as having a driver who is impaired under the influence. The report did not state what the dr himself thought and his reasoning for why he felt he was compelled to report.

The heart problem is moot, it was not what was labled as the issue in the DMV report. The consideration of alcohol as a contributing factor to a heart condition is not alcohol counciling, that is a medical opinion. Counciling involves dicussion and treatment for the issue at hand, in this case, alcohol consumption. That wasn't the purpose of his visit to the doctor. I would agree that the heart attack would be a danger to the road, but there are no other people that are taken off the road due to high risk of a heart attack and, again, that wasn't the reason the doctor listed on the DMV report. Lastly the report didn't state what the doctor's opinions were because he is protected by the law from being revealed by court papers. We may never hear why from him and so are robbed of being able to form a completely informed opinion by the same law that lets him report in the first place. I would wonder if the patient can state the doctor's name as I don't think he is bound by the same rules as the court reporters.

Whether the driver is a "habitual drinker" or not would depend on what is defined as a habit.

- Ceicei

I didn't say habitual drinker, I said habitual drunk driver, which is the heart of the issue. His driving ability, not his drinking habits.

 

[OULobo]

In the Practice of Medicine there are oaths that I take as a Nurse that I will protect life and obey the laws of the State in which I am licensed.

Now if the Doctor is obligated under his current state Statues and Board of Healing Arts to report this kind of incident aka possibly a dangerous driver on the road then the Doctor has to do so or face penalities of his own.

Just as I as a Nurse am required to report any life threatening or harmful situations of my clients to the proper state authorities. The key is in any prosection is the INTENT of the person making the report.

But the doctor faces no penalty if he is wrong, as the state grants immunity from legal action to all reporting doctors, and so there is no motivation against abuse of this privilage. The doctor also takes an oath, that is legally binding, to respect the privacy of the patient. Besides there is no standard as to what is "a possibly dangerous driver". The opinions of the doctors vary very widly. Theoretically, a doctor that doesn't drink and believes all drinking is harmful, could report every person that admits to drinking with any regularity, and in such have all their licences revolked without any possibility of a penalty to himself. He is essentially unjustly enforcing his personal and ethical beliefs on others.

 

[OUMoose]

I can't speak for other states, but I work in a hospital in Ohio. Privacy? I can't even look at my OWN medical records without getting a signoff somewhere.

As I said before, if that doctor had witnessed positive direct evidence of operation of a motor vehicle while intoxicated (Staggering, slurred speech, difficulty with occular control, etc), then by all means he should report the individual. That wasn't the case in this instance. The doctor took liberty with a power granted to him by the courts with no justification whatsoever. Lots of people have heart problems. Many even have liver problems without ever touching alcohol. I'd be curious to find out how far that prosecution immunity extends though. If it's only from criminal action, I'd be willing to be we'll see a civil suit brought against the doctor for damages cause by his actions.

As OULobo pointed out as well, I'm 6'6" and almost 400lbs. Guess what, I can drink ALOT before reaching the limit. Should my doctor turn me in to the authorities for being overweight, thereby having the ABILITY to drink alot and have the POSSIBILTY of driving drunk? Should a judge take away my driving privledges based on the assumption that my ability to imbibe massive quantities of alcoholic substances could possibly someday on an unknown date and time in the future cause me to operate a vehicle while inebriated?

Funny how things sound more important than they are the more lofty words you use.

As far as the one about no drawing blood, the LEO's should have taken it up with a supervisor or director. If it's hospital policy to do (or in this case, not do) something, that person was bound not to do it. It's the hospitals problem, not the lab tech.

 

[Taimishu]

I dont drink. Never have.
I've had 4 heart attacks.
I still drive with my insurance companies knowlege, also with the knowlege of the DVLA here in the UK.

My doctor will not (and has not) released my medical information to anyone without my permission or a court order.

David

 

[RandomPhantom700]

-Does this show that doctors are no longer worthy of patient's trust and will it mean that patients will now no longer tell thier doctors of problems that may effect their health, but also have issues of legality?

I don't think this means that the hypocratic oath is no longer valid for anyone, just that this particular doctor was an idiot, and a jerk. This is certainly a breach of doctor/patient confidentiality, and the doctor deserves some form of reprimand, if not have his license taken away. This would be like a doctor recommending that someone be put on house arrest because he's admitted to having an STD.

-The man comitted no crime and shows no pattern of criminal behavior, but still is denied a privilage that is usually only denied to criminals that abuse it.

All the more reason to blame the doctor for this. All the guy said was he had a six-pack a day. That could mean that he drinks all six at night after not driving anymore, which would be no danger to anyone (other than himself, although I don't think six a day is a huge problem).

-Does this mean a breech of the binding and legal hypocratic oath of the doctor and his patient?

Between these two? Absolutely. But I don't think that the hypocratic oath has fallen apart universally because of this.

 

[Phoenix44]

I haven't signed over any privacy rights, except to other doctors that are bound by the same oath as my attending physician.

Wrong. You've signed over all your medical information to your insurance company...every claims reviewer, utilization reviewer, clerk and telephone operator.

Do you think they're bound by the same oath as your attending physician?

Try applying for life insurance. Courtesy of your health insurer, your medical information is an open book.