by Jennifer A. Katze, M.D.
[Winter 1996; Vol. 23 No. 4]
Political activity in the Maryland Psychiatric Society has been a whole new world to me during this past year when I’ve been an active but ambivalent and one-issue, participant. It’s led me to ponder those dedicated psychiatrists who are long-term political activists for our profession--our officers and long term committee members at MPS--and what about the process keeps them involved.
In my out-of-office pursuits, I have been an apolitical, unrepentant dilettante, moving from one personal interest or hobby to another, with volunteerism near the bottom of my list. But this past year my outside time has been spent working with many others at MPS on Medical Privacy-especially focusing on the publicity end--certain that this would be another short term activity. I suspect I’m a sprinter in my interests because our work as psychotherapists requires a marathoner mentality, and counterpoint is a refreshing relief. I like switching gears.
When the Notice-and-Consent bill for the HCACC Data Base failed in the legislature this past Spring, I was ready for a change, and now even more so. But this privacy crusade requires persistence if, as a psychiatrist, I really believe in the need for a truly confidential relationship with patients.
An esteemed colleague told me recently that he’d followed the press on this Maryland Data Base, and it seemed to him there was some hysteria about it, that it’s a cause that pales in comparison with others. Another fine colleague wondered if I was becoming obsessive. Take your pick, both thoughts deserved consideration. in the scheme of world priorities, HCACC may be a pretty small problem, and issues like environmental preservation, for example are closer to my bones.
But I couldn’t readily agree with them either. Asking my permission to know my deepest secrets--medical and psychiatric illnesses often are that--does seem very important to me and to some, if not all, of my patients. It’s a chunk of our personal freedom. As for the hysteria, in this publicity work with MPS, I have learned the hard way that well-measured and bland reporting of facts captures little political or media attention, though the facts themselves must be kept accurate. Obsessiveness provides the personal energy.
Another prestigious colleague suggested we mark time until we see what’s happening with medical privacy at the national level. Now that’s a bigger fish for sure. So I thought seriously about that too. But apart from APA/AMA work and MPS’ support of that, there are few national level forums in which to fight. I’m reminded of that bumper sticker: Think globally, act locally. If we wait for national trends to take over, we’ll have utterly lost our opportunity, our momentum in the right direction, here in Maryland. There is a crucial technicality related to this: Whatever federal privacy legislation occurs, the likelihood is that state legislation will take precedence over it. Repeat: if we have protective medical privacy laws in Maryland, we may be spared the effects of lapses in federal government privacy protection.
That alone means we simply MUST pursue the Maryland legislative path, giving it MPS’ all. How so? Because the Kassebaum-Kennedy Health Insurance Reform Act passed in the last hours of the pre-August Congress break, its privacy flaws ignored so that Congressmen could take home results, visible progress in the health care arena. It had a big, fat flaw: It facilitates the circulation of patient-specific diagnoses and treatments without patient consent. However, this national bill does not supercede state law in critical respects, thanks to fast work by the AMA, the APA, the ACLU, The Coalition for Patient Rights, and other privacy advocates.
Colleagues have widely varying opinions about managed care’s pros and cons. Mine are clear; managed care inquiries have been the single largest source of medical privacy destruction, bar none. I am certainly not impressed that overall medical costs have been reduced as a tradeoff for this loss, if we consider the profits of managed care businesses and the indirect costs to society of giving more limited, poorer, medical care. I see managed care, as it currently exists, as an amoral, dangerous, voracious monster which itself gobbles dollars and gives patients less than nothing to show for it. That’s my opinion, with all due hysteria.
Can we hope to slay the managed care dragon-monster, as our current APA President, Harold Eist, implores us to try? I certainly don’t know, and I’m not a born optimist. But curtailing confidentiality incursions is one small piece of doing just exactly that. Prohibit these for-mega-profit businesses from feeling entitled to ask for each and every bit of clinical information that they wish--they are just looking for a loophole through which to justify denying care--and you’ve clipped their broad wings just that much. And there is a strong ethical basis to that particular approach. That’s a goal I can embrace wholeheartedly.
Still, I wonder how my admirable, enduring colleagues keep slugging away, year in and year out, at our profession’s politics. I wonder whether I’ll stick it out with MPS political pursuits, at the expense of spending more satisfying time as a clinician and otherwise fancy-free dilettante.
I wonder if I have much of a choice any longer, if I can be the clinician that I want to be without fighting in this undeclared war to preserve our profession.