Psyched Out

Thanks to Susan Palwick for publishing Haunted and Ashamed in Grand Rounds this week, and to Sandy Szwarc for all of her praise and for linking Psyched Out from the best science blog I've ever read, Junkfood Science. I feel honored by their recognition, especially considering that I adore both of their blogs and read both every time they post.

UPDATE:

My stress test and a CT revealed no heart disease or cornonary artery disease. I do have a pulmonary nodule but after confirming that I have never smoked Dr. Godling seemed unworried and told me he'll be monitoring it every six months to be sure nothing's wrong, but they are usually benign. If he's not worried I'm not. I am upping my asthma meds and being scheduled to see a neurologist.

So someone at work anonymously posted the following NYT article
at work the other day, with pertinent sections highlighted. It addressed the culture of secrecy and frustration in the health care community since HIPAA has been ridiculously overinterpreted. This panic has been going on since about 2000. Even when it would benefit a patient, I can't talk to their relatives or partners who *regularly attend appointments with them* without a signed release "because of HIPAA." Check this out:

Hipaa was designed to allow Americans to take their health insurance coverage with them when they changed jobs, with provisions to keep medical information confidential. But new studies have found that some health care providers apply Hipaa regulations overzealously, leaving family members, caretakers, public health and law enforcement authorities stymied in their efforts to get information.

Experts say many providers do not understand the law, have not trained their staff members to apply it judiciously, or are fearful of the threat of fines and jail terms — although no penalty has been levied in four years.

Some reports blame the language of the law itself, which says health care providers may share information with others unless the patient objects, but does not require them to do so. Thus, disclosures are voluntary and health care providers are left with broad discretion.

The unnecessary secrecy is a “significant problem,” said Mark Rothstein, chairman of a privacy subcommittee that advises the Department of Health and Human Services, which administers Hipaa. “It’s drummed into them that there are rules they have to follow without any perspective,” he said about health care providers. “So, surprise, surprise, they approach it in a defensive, somewhat arbitrary and unreasonable way.”

I have believed what I've been told about HIPAA requirements, but apparently the extent of the law has been exaggerated. We take HIPAA privacy so far that we aren't even allowed to use full patient names in our internal emails to need to know staff. It's not like I'm going to argue with our corporate compliance officer, who can fire me. But it's good even in the abstract to know that the law isn't as short sighted and harmful as we've all been led to believe.

I was nervous all morning and downright anxious by the time I got to the office. Would my usually fat friendly doctor dismiss my problem as weight when my weight has been steady?

All the worry was in vain. Dr. A was his usual thoughtful, kind self. He listened to me seriously, thought, wrote out some referrals and explained that he was having me checked for heart trouble. Oh, and he tossed in a mammogram too because I'm forty now. Yippee. :/ So I got six tubes of blood and two xrays taken today and have appointments being made for me for the other tests. His description of the stress test relieved me somewhat because he said all they do is get your heart beating at a high rate and then you're done. He also said he had one and it was hard for him and everybody else he knew.

And then he said things no doctor has ever said before as far as I can tell from personal experience, media and the fatosphere.

"Weight is only a very minor risk factor for heart disease."

"Overweight people know they're overweight, why should I harp on it?"

" I only really address it with people when they are in immediate danger of dying. And there is only one disease that's true of, fatty liver disease."

"When I was just out of medical school I practiced with a doctor who didn't treat overweight people for their problems. He just said, 'You're fat. Lose weight.' That was so wrong."

So he officially No Ordinary Mortal. :)