tag:blogger.com,1999:blog-5883634615775822475.post3749310126019684168..comments2024-03-26T16:46:21.764-04:00Comments on Doctor Grumpy in the House: Things that make me grumpyGrumpy, M.D.http://www.blogger.com/profile/09858110332436246760noreply@blogger.comBlogger71125tag:blogger.com,1999:blog-5883634615775822475.post-67756783416602615552011-02-26T15:41:14.519-05:002011-02-26T15:41:14.519-05:00There's a perfectly safe way to handle reading...There's a perfectly safe way to handle reading the PDFs. You have a machine for the purpose and it's running something like DeepFreeze. Don't worry about viruses, when you're done reading the file you simply reboot the computer. Everything gets reset so any malware is gone.<br /><br />I do agree with the idea of keeping copies of your labs although I handle it a bit differently--they all go on a spreadsheet. It's a lot more concise and makes it easy to view any changes over time.Loren Pechtelhttps://www.blogger.com/profile/08348494458707790769noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-134551421081468622010-09-12T16:03:45.884-04:002010-09-12T16:03:45.884-04:00Do the dateabase!! So, hey, I'll give up a lit...Do the dateabase!! So, hey, I'll give up a little privacy.<br /><br />I know this is a huge public confession, but my serum creatinine is 1.<br /><br />I hope my friends and family will forgive me.The Ole' Apothecaryhttp://oleapothecary.blogspot.comnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-15321143263714802972010-09-10T23:30:42.864-04:002010-09-10T23:30:42.864-04:00As mentioned: Ontario. A single-payer system like ...As mentioned: Ontario. A single-payer system like the Canadian one solves this, and many other problems. The US could do it better.<br /><br />Considering that my insurance company ends up knowing enough to call my pharmacist and tell him not to dispense my refill until I'm nearly out of meds, in <i>spite, for pity's sake</i> of the fact that my insurance doesn't actually cover my meds, I am sure it'd be far from difficult to actually keep track of people's tests with a centralized system.<br /><br />I used to work for a vet and never heard of any animal developing a problem with the chips. They are ceramic-coated. Sarcomas around them sounds like an urban legend, or a confusion (certain formulations of rabies vaccine are associated with sarcomas around the injection site, in cats). The chips do not have RAM and record only a number. The data is associated with that number in a computer system. Leading to the amusing yet tragic problem of finding lost animals that have chips with numbers that aren't associated with anything because the vet or owner never sent in the paperwork.<br /><br />I was, as a vet tech, and am now as a reader of these comments, shocked at how many people think microchipping human beings is a good idea. It makes me think of certain yellow stars and blue tattoos. It is also amazing because when people describe potential uses for chips in humans and even the placement of the damn thing (medical records, financial records, put it in the hand) they never seem to notice that their proposal fits the description of 'The Mark of the Beast' in the Bible. I'm an atheist, but I still don't think the mark of the beast is cool. Sheesh, people.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-46481502588276321722010-09-10T01:39:36.455-04:002010-09-10T01:39:36.455-04:00When my neurologist & my internist ordered 4 o...When my neurologist & my internist ordered 4 of the same labs, I asked the lab if they could just do one set of the 4 labs and just fwd a copy of the labs to the other doc. They said they could. Later, I got my bill and my results. They didn't. They reran the everything and double billed me. =( And I still paid. =(<br /><br />Sometimes even when the pt tries, the system just won't work with themAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-60803097512966581972010-09-09T23:48:14.510-04:002010-09-09T23:48:14.510-04:00@Quixote: Good point. But as I have been living an...@Quixote: Good point. But as I have been living and working in the US (Pac NW) since mid-2004, I am starting to think that I perhaps was just lucky in my choice of GPs. (I call them "GPs" because my school taught British English -- I grew up in Austria and later worked with Britishers, too.)<br /><br />I would *love* a centralised database, but the problem is one of trust, leaving aside bugs that lead to vulnerabilities.<br /><br />If I could, every time that someone wishes to see or alter an entry in "my" part of the database, check: who this is; why the access happens; and what is being looked at; then I could approve or not, as the case may be. But it starts with the "who": Unless the person is known to me and sitting right next to me, it is actually quite difficult to prove identity. Usually we just accept proxies like "if you know Felix's password, we'll say you are he" or "if you have Felix's smartcard, we'll consider that proof of you being Felix". You think a health care worker might stay logged in if he just needs to run to the bathroom?<br /><br />Worse yet: With insurance billing and such, thousands of people need access to your health records; at the very least, an insurance will check that Dr. X, who claimed to have done Y to you, didn't charge more than $Z. So your insurance company now knows that you got treated for a social disease -- but, at least it stays with your insurance company instead of being accessible state-wide.<br /><br />Anyway, all that has already happened. Remember when a couple or three hospitals fired employees for accessing the admittance records of some B-list celebrity or other? If it's impossible to control a few hundred employees with a clear data access policy and in one location -- imagine the problems if you scale this up by a factor of 100,000.<br /><br />The only option that I see is one that was mentioned in this thread: I carry my own data around (card, USB stick, chip under my skin -- but a physical object that, like a smartcard, should be unique and should be keyed only to me). I delegate access for certain parts to certain people, with certain restrictions. Examples:<br /><br />- Allow reading and changing and adding to Dr. X<br />- Allow Dr. X to delegate his permissions to all persons who are employees of his practice<br />- Allow Dr. X to allow reading to my insurance carrier, but only information that was added by his practice<br />- Allow all access to any EMT and any doctor after they identify themselves to my chip, certifying an emergent condition<br />- Allow EMTs and doctors to delegate access ...<br /><br />and so on. The problems are obvious: Unless it works as simply and intuitively as the lock on your door, it's not going to get used. Then: Who are my doctor's employees? What assurance do I have that his employee list is secure from tampering, not to mention that is must be kept up to date when employees leave? How can I be assured that all accesses are logged and reported to me if I cannot verify that the program at hospital A is a fully secure and compliant implementation? And if I do get those reports, how can I tell legitimate accesses from illicit ones without (a) having a degree in CompSci and (b) wading through a hundred pages of log entries per month?<br /><br />I deal with this stuff daily, so I know it. I don't expect my sister, whose specialty is something different, to know the ins and outs -- but she, like you, knows that it may be harder than it looks at first glance. What I find unforgivable are politicians who use my taxes to pay their cronies as "subject matter experts" and who still are either ignorant of these problems, or who are willfully hiding them.<br /><br />Cheers,<br />Felix.Felix Kaszahttps://www.blogger.com/profile/16632822169351276667noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-58699270292122873712010-09-09T21:38:01.303-04:002010-09-09T21:38:01.303-04:00I think we need to start identifying ourselves by ...I think we need to start identifying ourselves by country. Felix, for instance, finds it easy to get records and talks about a "GP." So he's probably in Britain or Australia or some civilized country.<br /><br />My experience is much more like Emmy's. And I'd be willing to bet she, like me, is in the US. HIPAA and legal CYA and insurers and paranoia have well and truly stuffed up our system. <br /><br />I've thought a complete centralized database could be an answer, but security professionals, like Felix, always seem to feel it's a terrible idea. And they ought to know.<br /><br />So how to protect privacy *and* compensate for the desire to forget about all that icky medical stuff as fast as possible? Maybe some kind of centralized database where records can only be accessed if the patient is one of those providing a multifactor key? I realize anything central can be hacked. But anything not central can be forgotten. An enigma wrapped in a dilemma.quixotehttps://www.blogger.com/profile/12650030894065858444noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-55597177417325701692010-09-09T20:32:49.478-04:002010-09-09T20:32:49.478-04:00All of the docs associated with Vanderbilt (two of...All of the docs associated with Vanderbilt (two of my specialists are there two or is it three? of my husbands) are integrated into their system. They do a proper med history when you come in to see if anything has changed.<br /><br />My pcp is a family practitioner who has know me for ages. Any time I see a new specialist I immediately sign a paper requesting that they send any and all information from their office to her. I check with her periodically to make sure she's getting it and then call whoever <b>isn't</b> whatfor. ::narrows eyes::<br /><br />Frankly, I'd love a safe way to electronically connect all of the doctors, pharmacists etc. Think about how many lives could be saved.<br /><br />stsymo - smart system most (needed)Kat's Katshttps://www.blogger.com/profile/05519016601947528061noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-83895990580534223602010-09-09T17:44:47.264-04:002010-09-09T17:44:47.264-04:00@Emmy: "I would really like to know how you f...@Emmy: "I would really like to know how you find it so easy to get all of your medical records."<br /><br />I am sorry you have so much hassle getting your labs and other test results. For me, it's easy. My insurance covers pretty much everything at 100%, no copay, no deductible, no coinsurance, and no referrals or pre-auth required, either. But I still choose to see an internist as "my" doctor, and he is kind enough to coordinate my care. So when I do go see a specialist (I am diabetic and a repeat customer for orthopaedic surgery), it's with a little note from my GP, and I also expressly ask that my GP be kept up to date on everything.<br /><br />For routine bloodwork, that happens in my internist's practice anyway: Standard stuff like HbA1c is done right there, others are sent out.<br /><br />In all cases, the results get added to my chart at my internist's -- and the chart has a sticker saying "mail copies of all labs and tests to patient". And that is all it takes. If your GP is not willing to make that effort, I would consider whether he or she is really so good that it is worth the hassle of having to fight for labs.<br /><br />In hospitals, I found it easiest to approach a nurse at the nurse's station, in the middle of the night, when it's least busy, and ask for a printed copy of my chart -- after making sure that the hospitalist on duty or my attending doctor doesn't mind. Worst case, I get the data a week later from my internist.<br /><br />Again, I am sorry for all the annoyances you are experiencing. It shouldn't be that way.<br /><br />Felix Kasza.Felix Kaszahttps://www.blogger.com/profile/16632822169351276667noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-53469009876025621982010-09-09T16:56:05.492-04:002010-09-09T16:56:05.492-04:00@Felix Kasza - I would really like to know how you...@Felix Kasza - I would really like to know how you find it so easy to get all of your medical records. If you could write down step by step instructions, it would probably sell like wildfire. My experience goes something like this: In the doctors office. The doctor comes in decides on a test. I go to the lab and have the test drawn. I ask the nurse and the lab assitant to please send me a copy of the results. They tell me they aren't allowed to send it until after the doctor reviews it. Several days later, the nurse (if I'm lucky) calls and says "your triglycerides were a little high, continue taking your medications and get a little more exercise." I say "can I get the actual results" I hear a pause, like she can't believe I would want to know and then she quickly reads me the results. Then I say "no, I mean can you send them to me because I'd like to have them available for my other doctors." Then she says, "oh, we'll send a report to Dr. A." "Fine but I'd like a copy" Then I'm told to send a fax requesting the records and I may or may not ever actually get the results. Hospitals are much worse, because you can't ask for a copy each time a test is done or a result is recorded. If you ask for a copy of the report you are referred to an outside company who charges a huge amount of money for your records. Technically it's illegal for them to do it, but HIPPA failed to define what a reasonable cost is. So they can charge whatever they want.Lisa https://www.blogger.com/profile/09324961653370110887noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-44158839588181014932010-09-09T14:54:55.067-04:002010-09-09T14:54:55.067-04:00I was told a while back a that a CRP test costs £6...I was told a while back a that a CRP test costs £60 each.<br /><br />I'm not even going to think about how much money is wasted on repeat CRP tests.Dr Jrhttps://www.blogger.com/profile/03651022494583120571noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-59526937738303500602010-09-09T13:38:34.511-04:002010-09-09T13:38:34.511-04:00I wonder if you could work out a system like Grump...I wonder if you could work out a system like Grumpy's been writing about regarding prescription meds?<br />That is, a doctor could pull up records on what tests have been run within the past year or so...and find out who ordered them, if not results directly. Granted, this means results might have to be tracked down to the doctor who ordered them, but it would avoid privacy concerns.<br />Didn't Microsoft spearhead some gigantic effort to create a medical records system? There was a big fuss (including privacy issues) when it first made news....wonder if they dropped it.Oliviahttps://www.blogger.com/profile/09983586189259538140noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-53100469900533295552010-09-09T11:42:27.102-04:002010-09-09T11:42:27.102-04:00"Every insurer has a completely different sys..."Every insurer has a completely different system."<br /><br />And that's where so many of the problems come from, isn't it?<br />We can definitely try to learn from other countries, but so much is not applicable here because of:<br />1. the enormous mess caused by competing insurance companies; and 2. privacy regulations such as HIPPA.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-63948391752774825252010-09-09T11:10:41.242-04:002010-09-09T11:10:41.242-04:00I love the "smart card" idea, but it'...I love the "smart card" idea, but it's already been attempted by a start-up in my town that tried to develop one across insurers. The problem is that each mega insurance company has to play along, allowing access to their record-keeping systems, personnel and customer base. Every insurer has a completely different system. One major company got greedy and halted development, figuring it could someday create its own branded card and reader. And of course, years later, the start-up's out of business and nothing's been created.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-53077645893841201992010-09-09T10:38:28.784-04:002010-09-09T10:38:28.784-04:00A couple of distinct thoughts:
1: Given the curre...A couple of distinct thoughts:<br /><br />1: Given the current settup it seems that the quickest way to set this up is through the insurance companies. They are already paying the bills and are trusted (like it or not) with our sensitive medical data.<br />Would not take much for them to track lab results in s a doctor friendly format.<br /><br />2: The base security issue should not be keeping your SSN secret. The system must be fixed so that simply possesion of one broadly required number does not allow identity theft.<br />If banks and other institution were required to physicaly verify ID (picture + signature etc) before granting credit most of the identity theft issues would instantly vanish.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-6047682958668891662010-09-09T10:33:46.990-04:002010-09-09T10:33:46.990-04:00Rotten deal about this whole thing is that there i...Rotten deal about this whole thing is that there is already a central database of everyone's medical records.<br /><br />Well pretty close. There is a company called the Medical Information Bureau. Health Insurance Companies use it like a credit reporting agency. <br /><br />They submit information about what services you use, how much they paid etc. If you apply for health insurance from a different company and they check with MIB and find out you weren't honest about your medical history, you can be turned down for coverage or have claims disallowed.<br /><br />There maybe some scaling problems, but if MIB already has a medical history clearinghouse, it would seem fairly reasonable that they could do some enhancements and become a central records clearinghouse for hospitals and doctors, not just insurance companies.<br /><br />I think that HIPAA is a stumbling block to a true central records system for the whole country. No one is willing to build a system because the liability if someone should accidently access the wrong records would be huge.Donhttps://www.blogger.com/profile/01287039093284613915noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-32509180530567015782010-09-09T08:16:10.713-04:002010-09-09T08:16:10.713-04:00I second Amy's post re: vet med... Our clients...I second Amy's post re: vet med... Our clients, for better or worse, know the cost for each test we run and so are more likely to remember that we've run them (although still not always- clients will tell me their pet has "never had bloodwork" and then medical records from their primary vet show CBC/Chem/UA results from a month or two ago, or they'll tell me a "biopsy" of a mass was performed when the pet actually had a heartworm test done or something). It is exhausting having to explain the rationale for running every test we want to run, but at the same time I think having to justify our diagnostics to clients keeps us from running tests that aren't really necessary.Meganhttps://www.blogger.com/profile/16500262565313489986noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-27075403082081747482010-09-09T07:03:16.611-04:002010-09-09T07:03:16.611-04:00Amy the vet (re: repeat labs on sick animals)..
....Amy the vet (re: repeat labs on sick animals)..<br /><br />...This just shows the major divide between human and vet medicine, as in the latter the costs aren't magnified and hidden in a third party carrier package. Trust me, if Mrs. Olde or her family had to pay out of pocket for these four sets of labs, they would have found a way to communicate the first set to other docs. I am sure Mrs. Olde is much more frugal with the health care of her aging Yorkie, "Sweetums".<br /><br />When dinosaurs roamed the earth and people directly paid their medical bills, they knew what stuff cost and likely valued the care at a psychological level as well.<br /><br />Pattie, RNAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-72512405672795117012010-09-09T05:19:18.384-04:002010-09-09T05:19:18.384-04:00Re: credit card sized record.
Parents can't ev...Re: credit card sized record.<br />Parents can't even remember to bring vaccine cards to their kids' check ups. <br />I can't recall how many times I've heard "if you think he needs it, just give it to him. "Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-23644580795208711312010-09-09T03:13:54.240-04:002010-09-09T03:13:54.240-04:00Inland Northwest Health Services (INHS) has a fant...Inland Northwest Health Services (INHS) has a fantastic model in Washington State! A handful of hospitals and health providers got together to share electronic medical records, so a neurologist who participates in one group can see the labs ordered by a doctor at a different hospital. Cool stuff. HIPAA approved and all.Amyhttps://www.blogger.com/profile/04535912314165290428noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-70490657423218151112010-09-09T02:04:14.991-04:002010-09-09T02:04:14.991-04:00This seems like something I may need to refer to d...This seems like something I may need to refer to during at least one of my multiple med school interviews coming up. But back on topic, I agree...our healthcare system needs some serious work. It would benefit almost everyone, except for maybe insurance companies. I think we should just get rid of them...lolMsCeehttps://www.blogger.com/profile/00930232220650335384noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-66830384883288797762010-09-09T00:19:42.441-04:002010-09-09T00:19:42.441-04:00place a microchip into their hand. Every time the...place a microchip into their hand. Every time they go to the doctor, scan the microchip number, then the doc has access to all the records of that chip number.The Bus Driverhttps://www.blogger.com/profile/04259280794473075615noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-54203373771737403972010-09-09T00:07:47.178-04:002010-09-09T00:07:47.178-04:00Best thing is to have everything run through your ...Best thing is to have everything run through your G.P. And if you are unable to remember things, either write them down or have an advocate attend appts. with you. If I am due for my annual bloodwork, my G.P. always checks the records and if there are any recent tests, then He only does the remaining ones that are neccesary.middle childhttps://www.blogger.com/profile/09805863175279915034noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-52617864166133669912010-09-09T00:06:02.797-04:002010-09-09T00:06:02.797-04:00@Amy:
I'm a dev, too. Actually, I am a develo...@Amy:<br /><br />I'm a dev, too. Actually, I am a developer working on security software -- crypto, access control, identification, all that stuff. And _I_ am not going to hand my data to a government or anybody else of that kind.<br /><br />My insurance already collects way too much stuff for my taste, and when I look around and see that neither the government nor companies are able to protect my SSN or my credit card number, I fail to see how a centralised database of the most private information ever could be anything by a complete and unmitigated disaster.<br /><br />Or would you like every hospital employee in the state to find out whether you ever had an abotion, a discreditable disease, or worse? Would you like insurers and ERISA employers bribing your doctor's receptionist to find out how expensive you'll be if they insure you?<br /><br />And no, I am not a pessimist. If I learned anything in this field, it's that I am still too much the optimist. :-(<br /><br />Cheers,<br />Felix.Felix Kaszahttps://www.blogger.com/profile/16632822169351276667noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-21476192196900149922010-09-08T23:59:53.232-04:002010-09-08T23:59:53.232-04:00@Kim, @Watercolor:
Of course you can get a copy o...@Kim, @Watercolor:<br /><br />Of course you can get a copy of your results. In my experience, if you ask for it at the time of your blood draw, they'll gladly mail you a copy -- and since they won't have to dig up anything that was last week and thousands of patients ago, the lab or doctor usually won't even charge you.<br /><br />Cheers,<br />Felix.Felix Kaszahttps://www.blogger.com/profile/16632822169351276667noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-328265452468255042010-09-08T22:19:07.802-04:002010-09-08T22:19:07.802-04:00Our local lab will mail you your test results for ...Our local lab will mail you your test results for free provided that you ask for them & sign a consent form at the time of the blood draw. They don't offer this information to you, I found out from one of our patients.Anonymousnoreply@blogger.com