HIPAA is destroying healthcare

Last week I made a trip to Tijuana, Mexico. The trip was prompted by my 81 year old mother who had discovered a certain doctor with a good reputation for helping people with joint pain and other ailments. I can’t say that I was going down for anything in particular, in fact I’m feeling fine. However, I’m glad I went for one reason… It showed me how healthcare could be.

This doctor operates outside the Mexican socialized healthcare system. In fact it’s probably the most capitalistic healthcare scenario you could imagine. You pay for what you use. However, what was amazing about the experience was how human it was.

One of the most common remedies of this doctor was something called Chelation. (removal of heavy metals) It’s a procedure that is available here in the United States as well. As everybody in the room is gearing up to get their Chelation IV put in, the nursing staff made their rounds by giving everybody a hug while calling them by name or mentioning something endearing. The patients were sitting in armchairs literally knee to knee while they all laughed and anguished about personal stories. Some of the patients there had terminal illnesses, others were supporting a spouse, and some just wanted a regular tune-up. The nurses and patient challenges were openly discussed amongst the crowd.

Now it came to my turn to go see the doctor. He pricked my finger and we analyzed my blood together. He didn’t go hide in a corner to do his study of my blood, instead we did it together. I could see my blood cells on a big screen and we discussed them. Staff came in and out and we discussed strategies for health and wellness. Later on during my visit both my brother and I were in the Doctor's office. While He was taking his stem cell shots (in the same room) the doctor and I discussed some of my brothers healthcare challenges. Then it struck me… this could never happen in the United States. I was instantly sad. Sad to see what had happened to American healthcare. (I remember our family doctor back in the early 80’s) Sad to internalize how impersonal it all had become. Sad to see our legal system destroy the human element of caring for each other, by mandating cold autocracy in every step of patient care. We Americans are more than capable of caring for eachother. We have big hearts, but we are also paranoid about the law. And our legal system has squashed the care in healthcare.

HIPAA is one of the culprits. In the name of patient privacy, we’ve built walls EVERYWHERE with legalese. Nobody on earth knows everything about HIPAA. There are entire legal firms that are hired to understand it. Heck, you couldn’t even tell me how many words are in the law because by HHS’s own admission,

“The HIPAA Rules are flexible and scalable to accommodate the enormous range in types and sizes of entities that must comply with them. This means that there is no single standardized program that could appropriately train employees of all entities.” https://www.hhs.gov/hipaa/for-professionals/training/index.html

And yet, doctors, nurses, and hospital administrators are individually expected to live by its every word. And HIPAA is just the tip of the iceberg, add in the Affordable Care Act, and the entire healthcare system turns into a plaque of do’s and don’ts. So what’s the end result? We have hospitals feigning care by following what an enterprise software system tells them to fill out. Because, in that system, the “care” is legal, thus impervious to lawsuits. So instead of the patient getting cared for, the patient gets processed. The analysis and decisioning process is taken away from the patient and sterilized before it can be discussed. Just in case a lawsuit get whipped up about the consultation. Walls, walls, walls, and more walls.

Don’t mistake my disgust with HIPAA for a desire to return to a paper based system. The two are not joined at the hip. The essence of my gripe is the density of law, and its impact on human behavior. HIPAA is just a byproduct of that desire to paint every corner of human behavior with a rule. Philip K Howard delivered a masterful talk on the topic of laws impact on human behavior:

Do we really want such a dehumanized system in the name of patient privacy or patient protection? Do we want to be “processed” through the healthcare factory so we can check all the boxes in some enterprise software program? Is the awareness of each others flaws such a taboo as to warrant a system that forces us to close our eyes to their very existence? How can we care for each other if we’re not even aware of each other’s pains? It’s like our healthcare system is a reflection of our perfect Facebook profiles, perfect on the outside and sick on the inside.

The experience in Mexico taught me about patient care. It showed me that when doctors and nurses aren’t distracted they can be human. As in so many things I’m saddened by the future of healthcare in the US. Whatever direction it goes, there seems to be no shaking the legal plaque that is building up to take it over.

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