Not all that long ago, I walked into my internists office for a routine check-up. It is a large, active office with several physicians and physician assistants and with many examination rooms. I am sure you are in a similar situation where you go as well. I 
suppose the doctors were quite busy that day. For I was sitting in the exam room for quite a while. Of course the physician’s group dealt with multiple insurance carriers such as Aetna, Blue Cross/Blue Shield, United Healthcare and more.
The room had a computer screen (don’t they all?) and I glanced at it to notice the screen was open to a list of about 25 patients. Next to each patient’s name was a “chief complaint.” I really didn’t react and as I didn’t know any of them I went back to thumbing through a magazine that must have been 20 years old!
The physician’s assistant walked-in and immediately saw the computer.
“Was this on since this morning?” she asked.
“Beats me,” I said.
“This is in violation of all the HIPPA laws,” she said.
I’m thinking, “What do you want from me? I didn’t turn it on!”
The Aetna HIV Letter
I thought about the office experience as I was reviewing a recent news item in regard to a letter sent to patients by Aetna health insurance. On July 28, 2017, the company sent out a mailing to patients. The enveloped had a large window in the front. It showed the patients’ name, address, their personal claim number and worst of all, the options they had to fill their HIV medication prescriptions!
While I am sure it was accidental, like opening a computer screen and walking away, once the information was revealed, it was too late. In fact, more than 12,000 letters were sent out to HIV and AIDS patients.
Officials at Aetna said: “This type of mistake is unacceptable. We sincerely apologize to those affected by a mailing issue that inadvertently exposed the personal health information of some Aetna members.”
It is all well and good, but if 12,000 letters were mailed it means thousands of employers, HR departments, co-workers and other parties were also made aware of patient HIV status. I can’t help but wonder at the rumor mill activity, the behind doors discussions and for all I know, the terminations (for other reasons, of course) that resulted from this breach of privacy.
It is not “just a mistake,” it is another case where underlying ethical problems in regard to privacy laws are blatantly disregarded. It happens in doctor’s offices, in mailings, ambulances and operating room theaters. The question is “why?”
Losing Touch
In part, the answer to the question can be found in the open computer screen; the point at which once sensitive information is now shared and shared again. It is not just the sharing, but how it is shared, in a never-ending cycle back and forth between agencies, the insurers and the insured. It is an overwhelming case load in response to low reimbursements and underpaid and overworked staff. It is what I call an ethical callousness to the needs of the patients.
In short, the patient is often a field on a screen, a symptom, a disease and almost an obstacle rather than a focus. Do I think Aetna was intentional in its sending out 12,000 pieces of mail disclosing an intimate health detail? No, I do not. In fact, I don’t believe anyone in the organization had the slightest thought about it at all. That, in and of itself, is a head scratcher. No one thought. In fact, no one had an ethical thought. It is quite sad.
Obviously, if the president of Aetna had a son or daughter, niece or nephew with HIV and the letter came to their workplace, there would have been heck to pay. Maybe that is key to the discussion. We have taken most anything personal, most anything human out of healthcare. There is a solution; it is ethical training. It is a realization of “the other,” of the concept that the field on a computer screen is a person. That a letter being sent to a patient should be guarded by privacy laws and that there is an ethical responsibility to protect the patient as we would want to be protected ourselves.
Some might call it The Golden Rule. It is currently missing in healthcare. Ethical training can help to restore it.
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