As a neophyte techie, an adolescent-medicine physician, and a card-carrying member of the ACLU, I read Joe Flower's article "The Other Revolution in Health Care" (Wired 2.01, page 108) with interest and concern.
My qualms with the piece have to do with an individually identifiable medical record that could be accessed by a paramedic. This scenario has promise, but what if I use my access code as a physician to browse Michael Jackson's medical record because I am curious to see if he really has a selective testosterone deficiency? My curiosity does not justify the invasion of his privacy.
OK, so we carry a card that we present to the health care provider that has to be "swiped" - much like a credit card at the grocery store - before access is given to the medical record by the provider. This implied consent, if you will, is superior to no controls whatsoever.
Of greater concern is the fact that health care providers would continue to be judgmental or not afford confidentiality to users of the health care system for matters related to family planning, abortion, sexually transmitted disease treatment, or mental health care.
I can foresee an underground health care system developing, or continuing, whereby adolescents receive care for family planning off the "net" so that their friendly general practitioner would not be able to access those records and make inappropriate or judgmental comments, or, even worse, alert the teen's parents to an issue that may have been one of great contention or even physical abuse.
It may be best for the patient that I know that he has HIV, or that she is on the pill, but a universal health card and medical record will not replace a nonjudgmental physician who gains the respect of the patient through careful questioning and respect for the privacy of that individual. In fact, without such health care providers, the system described in Mr. Flower's article will quickly become one of underground care in an attempt to avoid the all-reaching eyes of "Big Brother" health-net.
Scott Spear, MD
HCSJS@utxdp.dp.utexas.edu
We enjoyed your recent article on the health care revolution. Telecommunications represents a godsend for those of us in rural health care delivery. Here in Montana, a project to bring the benefits of being connected to health care professionals began in 1988. From its humble start as a single-line BBS for rural Montana health professionals, The Virtual Medical Center has grown to 1,000 active users from across the United States, who have made more than 20,000 calls over the past twelve months, now averaging 100 calls per day. Any health professional is welcome to use the VMC. Additionally, nearly all state agencies, and several national organizations, are connected to the VMC, and they constantly use the service for disseminating information. In addition to continuing education, drug information, and other clinical support services, the VMC offers that important opportunity for peer interaction. We look forward to expanding that peer base with plans to connect the VMC to the Internet this spring as a destination site.
Randale C. Sechrest, MD
rsechrest@delphi.com
Robert J. Flaherty, MD
iwmrf@trex.oscs.montana.edu
RANTS & RAVES
Health Care Gets Wired
