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Doctors in a Surveillance Society By Angelique Omega If you believe that doctors think they are gods, soon they will become nearly omnipotent and prove you right. Renown (formerly but forever, WASHOE MED), will be rolling out the mother of all computer systems, EPIC , in a few years. Epic Information System is a comprehensive electronic medical record package. Right now they use a baby version of software, HealthConnect, for patient records. Since Bush wants all Americans’ medical information to be converted to electronic by the year 2014, that means we are one more step toward becoming a Surveillance Society. These systems, touted so innocently and proudly by hospitals such as Renown, obviously spread your medical records to every terminal connected through the software. Within these data networks, patients do not have the right to decide who has access to their records. After all, even doctors are human; nurses are human, office workers are human, and the more exposure you have to these infallible humans, the more likely is that you might piss someone off down the line. “I have worries about technology being used to identify classes of people who present some sort of risk to society,” says Richard Thomas, a British Information Commissioner. Known as a “Freedom Fighter,” Thomas says, “We are waking up in a surveillance society.” Why should the average healthy patient be concerned that they might end up in a class of people who “present a risk to society”? Even if you are healthy now, the chances are good that one day you might develop one or more chronic illnesses. That means many more visits to the doctor, and much more exposure to medical narcissism – a centuries old, perhaps unintended, entrenched tradition found in the halls of medical schools. Since doctors are, in reality, human, they can actually get sick of seeing your grumpy face in their office and write things about you in a negative slant. A nurse or medical technician, likewise, might be insulted by something inadvertently said, and suddenly you are furtively labeled a “problem patient.” Chronic patients are definitely at risk. So are mental health patients. Tell me, who isn’t taking some sort of Prozac or psychiatric meds these days in Reno? Doctors have a whole set of undisclosed rules for their patients, and if you unknowingly break them, it brings up red flags which can lead to the undesirable label of “problem patient.” For some doctors, canceling too many appointments or missing an appointment completely is a cardinal sin. You’d better pray to the goddess that you never become a chronic pain patient. Stephen Ariens, retired pharmacist and webmaster of the Chronic Pain Resource Center.com site, lists several unspoken rules that could get you labeled with probably the most dreaded marker of them all, a “drug seeker.” Some invisible lines you’d best not dare cross include: routinely failing to keep appointments, calling and wanting refills, calling after hours, emailing your doctor, saying your prescription got lost, and being a first-time patient with no past medical records available. Fortunately for them, the latter option will soon no longer be viable. Unfortunately for us, we’ve lost precious ground with our privacy. There are a whole lot more surreptitious rules which, if broken, could change your name in medical circles to “Mud,” including: raising your voice to the office staff (even if they are sarcastic, abusive, or yell at you), changing doctors too often, complaining about a treatment, not agreeing with a narcissistic doctor, suing a doctor, complaining to an agency about a doctor or hospital, too many physical complaints – especially if they are in multiple “body systems,” and more. Then, when they have exaggerated your mistakes thoroughly in your medical records, and added their own retaliatory spin to them, you have just unofficially become a blacklisted patient. Patients are blacklisted – or blackballed - through their records. The definition of blacklisting is, “A list of persons or organizations that have incurred disapproval or suspicion or are to be boycotted or otherwise penalized.” This is exactly what the electronic data sharing and medical Surveillance Society is all about; compiling and penalizing that list of people who might, somehow, pose a “risk to society.” And penalizing, once their narcissistic rage has been peeked, can be a doctor’s true specialty. Filing a complaint with the Nevada Board of Medical Examiners will most often get you absolutely nowhere. Worse, hospital managements routinely digress into a knee-jerk, primitive, defensive mode when complaints are filed, where you might even be called delusional in order to protect their reputation with governing agencies. How a “problem patient” may pose a threat to others besides being a “drug seeker” is not exactly known, but a physician’s paranoia over litigation is always uppermost in his mind. Their all-encompassing, self centered grandiosity is such that a doctor may even confuse a litigation risk patient as a “threat to society.” Or he may imagine that if the patient is a problem to him or his staff, then that means the patient is a violent person, possibly even one who could be reported to authorities. I was once told in a phone call by a Renown E.R. nurse, after she very quickly looked up my name in their computer, that I’d “better not ever show my face there ever again.” This was after I had filed complaints for being denied health care. Being blacklisted from Renown is just about the worse case scenario of health insecurity imaginable if you happen to be a Reno citizen with chronic illnesses. You could end up in some ambulance, unconscious, being taken there. Medical blacklisting is not some vague Orwellian theory or futuristic scenario. Blacklisting is happening right now all over the world even among doctors who aren’t connected through computer software systems. Although doctors have AMA and ACP guidelines on how to terminate a patient’s care, these guidelines are often not followed at all. There are many ways that a doctor’s office can discourage you from signing on as a patient. In my case, an employee of Renown’s took me into a little room and proceeded to repetitively state that I couldn’t possibly afford their services. Most patient rejections are much more restrained and may involve rationing of care, substandard care, or avoiding referrals for your chronic illnesses. The American Medical Association says that a doctor has the right to choose who they treat and who they don’t. It gets complicated when they work for hospital systems that are bound to provide health care to everyone, regardless of their inability to pay. It gets real complicated when they join a professional association or are employed by a hospital that has a Code of Ethics they must adhere to. That forces them to conceive of ever more subtle and underhanded ways to terminate a patient’s care. Here is one article that quotes a doctor as saying, “The new doctor in town may have a blacklist 50 pages long, but there will be no way for his patients to find out.” The gravity of the situation really hit home with me when I was told in September 2005 by advocate Al Munson of the Nevada Disability and Advocacy Law Center (NDALC) that, “they [the doctors] talk amongst themselves.” He proceeded to cite one chronic pain patient “who has to drive all the way from Gardnerville to Reno to get care.” Al, I can go one up on you. I was a Reno citizen for 18 years who was forced to leave family and move to California to get health care. My story, with accompanying documentation can be found at patientblacklisting.org.