Medicine For People!

August 2002

  • New "Medical Privacy" Law
  • Save on Prescription Drugs
  • Exercise and Arthritis
  • Halitosis
  • Medical Insurance Coding

New "medical privacy regulations."

The new "medical privacy regulations" actually give your physician, hospital, and insurance company greater latitude in disclosing your medical records to other parties without your consent. Due to the nature of our practice we are not required to comply with these regulations. We will continue to keep your medical records private as noted below. Now, here are the details...

Health Insurance Portability and Accountability Act (HIPAA)
Comes now a new act of congress with the usual good news and bad news. The good news, I hope, is that this legislation lives up to its name and improves your ability to carry your health insurance from job to job. The bad news is that although this act addresses the issue of medical privacy, it does so in a very dishonest way. Contrary to what you might think, it lessens the confidentiality of your medical records rather than protecting them.

Medical Privacy as it used to be
According to the old rules of confidentiality, we kept your medical information private. Plain and simple. Here are the details. As you see, they are pretty straightforward.

  • If we know that someone is a danger to others, we are required to take action to prevent harm. This may involve releasing information to a State agency such as Adult Protective Services that itself is very mindful of the need to respect individual privacy. Disclosing this kind of information, as you might guess, is extremely unusual.
  • We are required to report certain conditions, such as measles, sexually transmitted diseases, and other communicable diseases to the Health Department. In such a case we always inform you first, and in the case of Direct-Access Lab Testing for communicable diseases, we secure written permission at the time we obtain the sample.
  • Sometimes you consult a specialist who calls us for further information. Unless we think you might wish to keep some personal medical detail private, we assume that you want us to give what help we can.
  • We give a diagnosis to laboratory and radiology facilities for their use in providing the proper test and for insurance billing. You carry the requisition with you so you are aware of the information shared. Occasionally we consult with the radiologist by telephone to ensure that the test is scheduled and set up properly.
  • Occasionally we discuss the relevant elements of a prescription problem with pharmacist Don Hoglund so that he can compound your medication properly.
  • When you come to us under the State Labor and Industries Act for an on-the-job injury, you sign a form authorizing us to release pertinent medical information to them.
  • When you send a claim to your insurance company, you sign a form authorizing us to send your medical records to them regarding that claim. We send no records without your signed authorization.
  • If we are going to discuss psychological issues with a counselor, we customarily require your signature.
  • If you telephone requesting a prescription refill, our nurse will examine your records to be sure we respond properly. In other cases, such as renewing school physicals, etc, one of our office staff will check your record to set up the renewal.
  • Your medical records are used by our office staff only if required to meet your requests; because we do not file insurance there is no need for billing clerks to access your records. Our staff confidentiality agreement specifies that betrayal of patient confidentiality results in dismissal. All office staff sign this agreement and understand that in a town as small as this one, unprofessional talk will not remain undiscovered for long.

Now, I know that seems like a long list of details. I hope you can see that each exception is necessary. We even ask permission before sharing information between spouses. I do not think you will find a medical office that keeps a tighter lid on your confidential medical information than we do. If we fail to follow these rules we face professional sanctions and possible litigation. That seems simple and straightforward enough to me.

The New Rules
First, the new rules are extremely complex. Here is a glance at the text of the legislation and the government's "explanation". Any reader who reads the entire rule (including revisions and commentaries) in less than 24 hours wins a free bottle of vitamin C!
Before I take a crack at interpreting them for you, you need to understand that these rules have been in development for several years and have been recently "technically corrected." There is debate about what exactly the language means.

The Government's Claims
The government claims that these rules protect your privacy by codifying how your health information can be used. Their initial rules prevented physicians from talking to a pharmacist or to a specialist about your care without prior completion of a government-specified permission form. This certainly protected your privacy but would have made it difficult to take care of you. They have now changed back to the "old" rules listed above. However, the really objectional parts of the legislation remain.

The Objections of the Critics
Major objections are these:

  • The rules are complex and expensive to follow. Employees at our small local hospital have already spent hundreds of hours preparing to comply with this rule. Just plug "HIPAA" into Google and check out all the companies selling consulting services to the thousands of physicians and hospitals that have to comply with this. Large health organizations will be spending hundreds of millions of dollars. There are many developing countries that spend less than this on their whole health system.
  • The rules give you no protection that you do not already have. In fact, they lessen your privacy. Once a hospital has released your records to an insurance company, for example, that company can share them with other companies, government agencies, or researchers without your permission. In fact, you will not get any accounting of whom has been able to see your records.
  • Under these laws, I suspect you'll find yourself getting sales materials relevant to your private medical concerns from pharmaceutical companies.

If you want to read more, click here.

How does this apply to you?
These rules are effective as of April 14, 2003. They affect the patients of healthcare providers who use electronic billing or other electronic transactions.
They will not apply to your services at our office as we are involved in no electronic transactions. We do not believe these regulations serve your interest and will make every effort to continue to keep your records private.

How to Save on Prescription Drug Costs

We are always searching for ways to reduce your prescription costs. (One of the best ways is to find non-pharmaceutical measures to treat illness.) However, if you do find your pharmacy bill is too stiff, try "Half-Off Meds." If you know of a better deal, let us know.

Arthritis and Exercise

Time was we told people with arthritis to "take it easy." Now we know that people with arthritis, even severe arthritis, have less pain and more mobility when they engage in proper exercise. The National Arthritis Foundation has developed exercises that can be done standing, sitting or in a pool.


There are far too many people who go through life convinced that they have halitosis when they don't. My personal scapegoat for this is the mouthwash ad that says "even your best friend won't tell you." However, sometimes people do have unpleasant odors on their breath. There is help! Here are a dozen causes and cures for bad breath from the British Dental Association.

Medical Insurance Coding

If you bill your own medical insurance for services at our office, you may have noticed that the medical coding book, complex as it is, frequently fails to contain a code that exactly describes the condition that you have or the service we provide. I was amused to see the February Family Practice News report that trained medical "coders" agreed on the proper billing code only 59% of the time. This was after ten years experience on the job.


Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.