Surviving in the Next Millennium

NEWS FLASH OF THE CENTURY: NORCAL recently announced that starting in January 2000, it will provide physicians with administrative defense coverage of up to $25,000 at no additional cost.

Live and learn: Last month I saw a patient in pulmonary consultation who spoke no English. He handed us a card from an interpreter agency and motioned us to call them for him. About two weeks later we received a bill for an interpretation fee, for which the two-hour minimum was $130 and the mileage charge $11, for a total of $141. Expected reimbursement for the consultation is about $96. Such a deal. Spend twice as much to see a patient as you get paid for helping him with his asthma. He was from the Ukraine where, I understand, such deals are the norm.

A reflex answer: Recently a surgeon provided outpatient care for a fracture. A week later the patient's mother called to tell him her son had died of a massive pulmonary embolus and demanded to know why he didn't warn her son of this possible complication. The surgeon couldn't remember if he had warned the patient of that complication and seemed apologetic. The reflex answer should always be, "He was told." It is impossible for a patient to get through the hospital permit and informed consent process without being adequately warned. We are so concerned about our patients and we feel so guilty that we forget that we have to answer like a lawyer when the other side has already retained one.

Paranoia or Just Good Sense for the Telecom Century: Remember when people who avoided electronic debits from their banking accounts and refused to acquire credit cards were thought to be a little paranoid? Well, The Economist, the British newsmagazine, doesn't think they were and gives more advice along this vein: Use cash when you can. Do not give your phone number, social security number or address unless you absolutely have to. Do not fill in questionnaires or respond to telemarketers. Demand that credit and data-marketing firms produce all the information they have on you, correct errors, and remove you from marketing lists. Check your medical records and never sign a release for those records unless absolutely necessary. If you suspect a government agency has a file on you, demand to see it. Block caller ID on your phone, and keep your number unlisted. Never use electronic toll booths on roads. Never leave your mobile phone on - your movements can be traced. Use your cellular only when you are first paged. Do not use store credit or discount cards. If you must use the Internet, encrypt your e-mail, reject all "cookies," and never give your real name when registering at Web sites. Better still, use somebody else's computer. At work assume that calls, voice mail, e-mail, and computer use are all monitored...

This advice, offered by the more zealous of today's privacy campaigners, is no longer considered extreme. These precautions only restore the level of privacy available to all people 20 years ago. Attempts to protect privacy through new laws will fail - as they have in the past. Fortunately, the same technology that is destroying privacy also makes it easier to trap stalkers, detect fraud, prosecute criminals and hold the government to account. Thus, less privacy may also lead to more security for the law abiding.

And one last thing. Remember, cath labs and other rooms in hospitals are video monitored. Don't get into a compromising situation at work. The administrators just love to pore over these videos. But that's good advice to live by. You don't ever want to hear those three loving words while making love, "Honey, I'm home!"

delmeyer@healthcarecom.net

www.delmeyer.net