Charles Dickens’ A Christmas Carol is the story of sour and stingy Ebenezer Scrooge’s ideological, ethical, and emotional transformation after the supernatural visitations of his former business partner Jacob Marley and the Ghosts of Christmases Past, Present, and Yet to Come.
It’s the third spirit, the Ghost of Christmas Yet To Come, that interests me the most. The Ghost harrows Scrooge with dire visions of the future if he does not learn and act upon what he has witnessed. Scrooge’s own neglected and untended grave is revealed, prompting the miser to vow to change his ways in hopes of changing these “shadows of what may be.”
The same can be said about the notion floating around Washington to require patient consent as a condition for treatment, for payment of health care services, or for undertaking important operational activities. The “shadows of what may be” from this ill-advised idea are potentially dangerous to patients and to the health care system.
A “Scrooge” of an idea
Giving patients the responsibility to decide which portions of their medical records should be open to health care professionals is, at best, unreasonable, and, at worst, potentially deadly. It is highly unlikely that a patient without a medical background can make a sound decision on what information a physician might need to provide quality treatment. If a patient chooses to withhold information, and is subsequently negatively affected (i.e., experiences an adverse medical interaction or other complication), not only is the health of the patient compromised, but otherwise avoidable costs to the system are incurred.
Requiring providers to obtain consent for each use of patients’ information would seriously delay and disrupt the care of patients. Elderly patients would not be able to send a relative to a pharmacy to pick up a prescription without first going to the pharmacy to sign consent forms; pharmacies would not be able to fill prescriptions for patients phoned in by physicians; and emergency medical personnel could be forced to get consent forms signed before treating patients.
A consent requirement could also impact consumers’ relationships with their doctors, hospitals, insurers, and with the government. If patients do not fully trust the system, they may engage in what has been called “privacy protective” behaviors, the risks of which can be serious or even deadly. Such behaviors may include withholding information from a clinician; paying out-of-pocket for services that would otherwise be covered by their insurance; asking doctors to lie on official forms about their diagnosis; lying to providers; switching clinicians frequently to ensure that all of their information is not held in one place; and avoiding care altogether.
Good healthcare depends on good information. Putting the onus on the patient to consent to have her health information shared for treatment is impractical and potentially dangerous. And, if patients engage in privacy-protective behaviors, their care may suffer, clinicians’ ability to diagnose and treat a condition may be impaired, and research and public health goals may be undermined.
We need to preserve the vital flow of information that protects, extends and saves lives. Providers need to be able to trust that the data contained in their patient’s health record is accurate and complete. Similarly, patients need to be able to trust that they are receiving the right care at the right time.
The exclamation “Bah! Humbug!” entered the English language thanks to Dickens. It’s an apt response to efforts to require patient consent as a condition for treatment, for payment of health care services, or for undertaking important health care operational activities.