Patient confidentiality is an important principle that most physicians still respect. Patients trust physicians not to reveal their private, medical information to others. They expect that physicians will adhere to the Hippocratic ethic followed for thousands of years that states: “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men … I will keep to myself.” Patients might be surprised to learn that physicians sign insurance contracts with insurance companies with provisions similar to the following that was included in a contract once sent to me: “Provider shall readily make available to [Insurer], the Department, HCFA and any other government agency with regulatory authority, medical and health records of Beneficiaries receiving Contracted Services and all related administrative records.” This information is then readily available to insurance companies, future employees, and others who can decide a patient’s future. A front-page article from the Wall Street Journal entitled “Spread of Records Stirs Patients Fear of Privacy Erosion” described the public availability of supposedly protected information and its consequences. Privacy erosion, it seems, is not merely an unintended consequence of our tax-preferred, employer-based third-party payment system. It is actually mandated by the payers themselves. Breaching patient confidentiality cost the persons mentioned in that article a lot personally in terms of withheld disability payments, future employment, reputation, and chronic dysphoria from feeling violated. After reading articles like this, patients are likely to think twice before deciding what part of their person they are willing to entrust to medical professionals. Third-party payment for non-catastrophic medical care destroys the sanctity of the doctor-patient relationship. At direct primary care practices like mine, physicians have no obligations to third party payers — only to patients, who feel secure that no information is released to third parties except with their expressed consent. Therefore, physicians who sign such contracts breach patient confidentiality. Most don’t make a big deal about these contracts, and I didn’t for several years after finishing my residency. After all, how else can a physician make a living except by taking insurance? All doctors sign them; therefore, it must be all right. However, now that I have actually read and studied some of these contracts and have had more time to reflect on what it means to do so, I have come to a different conclusion. In order to accept third-party payment, I have to sign these contracts and abide by their terms. This, I believe, is where many of the problems within our health care system start and could potentially stop if more primary care physicians refused to sign them. Signing a contract is a big deal because you have, in essence, affixed your person to the contract. Doing so says to the world and to yourself: “This is who I am.” Not only does it demonstrate the type of person you are at the time you sign it, but it also determines the type of person you will eventually become over the long period of time the contract is in force. The 1960’s movie A Man for All Seasons put this well when Sir Thomas More said, “When a man takes an oath [or signs a contract], he’s holding his own self in his hands. Like water. And if he opens his fingers then — he needn’t hope to find himself again.” I believe physicians lost themselves and their professionalism when they agreed to sign contracts with provisions like the one above. Robert S. Berry is an internal medicine physician. Source
