Doctor and activist

My Health. Should you opt out? 25/7/18


It is good to have a health record available for a complicated case. It saves doctors a lot of time.  When Records started to be computerised in the early 1980s the people at North Shore Hospital where I worked had a working party. I offered to help, but they said that they had it pretty well sorted.  I left the hospital system and did not go back till 2012- over 30 years later.  At that time I was working in Emergency Department and the ED records did not actually integrate with the ward records. Added to that, if someone had been seen by 3 doctors and 4 nurses, there were 7 separate entries, and if you wanted not to duplicate all their work, you took a punt on which record to open and copied a bit of it. No summary existed. It was quite a lot of work to find their first blood pressure reading, when you might have expected that they would all be there in order.  A lot of effort was put into entering data- much less to using it sensibly. Presumably the management outputs, Key Performance Indicators, such as waiting times or number of patients per doctor per shift, were well organised, but far less effort had gone into having the systems help the people actually working in it.

Now, working in a General Practice with Workers Compensation and Motor Vehicle Accidents, I am most concerned about the confidentiality of medical records. These can be subpoenaed at will by the legal system or any solicitor. They are written and kept on the assumption that they are confidential and all aspects of health are put in together.  Paper records are hard to redact as it is always obvious, and computer records are impossible as every entry and deletion is recorded and most systems can only be changed on the day of entry. Under CTP and Workers Compensation insurance there is an increasing tendency to find some previous problem such as back pain or mental health problems that will allow the insurer to dispute the claim. The use of private investigators is endemic and the insurance companies are ruthless.  As the governments starve Medicare to death and support private insurers, these take an increasing role.  Who is to guarantee that using medical records to deny treatments will not become the standard as new health insurers only accept new conditions?  Australia has very poor privacy laws, and SIRA (State Insurance Regulatory Authority) is hopelessly pro-insurer, as the NSW government’s agenda is to lessen premium costs.

If you need treatment in an emergency, the treatment protocols are pretty generic and unless you have something unusual that doctors need to know about, you can probably rely on the system to do a reasonable job.  If you are complicated and have a lot of medications, it will take a new doctor longer to sort all this out, which is what happens now. The patients give histories if they are sensible, though a lot of people do not know all their medications. Ideally a constant GP can be contacted, thought they rarely are, they are not available 24/7, and many people do not have their own constant GP. The starving of Medicare so that the rebate to GPs is only 46% of the AMA fee has weakened the structure of general practice as patients are rushed through. My Health could theoretically collect all the data that a GP would collect and more, but given the lack of clarity of who would enter what and when, and the very poor use of doctors’ time and computer information in existing systems, I am not hopeful.

The My Health record is supposedly to help improve treatment availability, but there is a real risk that it may worsen it.  I am quite unsure whether to advise my patients to opt out. I do not think it is even safe to wear a Fitbitz watch.  Is your exercise frequency, distance run and pulse rate for sale? 

If there were a single universal system where treatment was guaranteed things might be different. But health is a commodity and there is a lot of money to be made providing it or denying its provision.  We could change that by fixing Medicare, but that is another story.

In the meantime we have 3 months to decide to trust the government or opt out of My Health.

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