health care, HIPAA, patient privacy laws

Crying Wolf? Hippocratic or just hypocrite?

miltonwolf

Dr. Milton Wolf, radiologist and candidate for U.S. Senate

A Kansas physician, Dr. Milton Wolf, has come under fire for posting “grisly images” on FB, images of patients he has served as a radiologist over the years—those of gunshot fatalities and medical injuries. The headlines draw us in at the very hint that a physician, America’s closest thing to royalty, may be guilty of impropriety or even poor judgment. Society likes to place physicians on a pedestal and too easily forgets that these folks are people first, physicians second. They are just as prone to making mistakes as the rest of us, except society seems held in delight and awe of their fall from grace, compared to regular folks.

MD on a pedestal

Society puts physicians on a pedestal

What those who do not work in health care fail to understand is that we need dark humor, behind closed doors, in order to cope with the burden of what we see and hear every day—human beings doing stupid things and then reacting with even greater stupidity. Worse, when stupidity is revealed, people don’t want to have any consequences from it or let the mistake be known.  Too often, the results are tragic and health care professionals use dark humor to cope, to survive. We wrap dark humor around us like a protective cloak, to keep the ugly off of us so we can live to treat others yet another day.

cloaked

cloaked in dark humor

However, judicious care must be taken when making private images public, regardless of the intent. If Dr. Wolf simply posts an x-ray of a shotgun blast to the chest, with no identifying markers, then arguably the x-ray could be anyone who has ever suffered a shotgun blast to the chest. However, for argument’s sake, let’s say it is circa 1993 and a radiographic image of a severed penis is posted publicly to the internet. How many men suffered amputation of their penis that year? Any such image that might surface that year, even void of identifying markers, would be presumed to be that of John Wayne Bobbit—even if it was not. Could it be argued that patient John Wayne Bobbit’s rights have been violated, even if the image of the severed penis did not, in fact, belong to Mr. Bobbit, given the media frenzy that followed the event? In the end, Mr. Bobbit’s reattachment was successful, but if it had not been, would he have become so well known or go on to star in adult films?

Using another example, I once cared for a hemicorpectomy patient—yes, a patient who had been traumatically cleaved in half. If I were to post radiographic images of this, it might narrow down the possibilities to one of fifty people each year in the US. However, if any additional details of this case were shared, like which year this occurred in or what city, I would no doubt violate HIPAA laws and risk inciting perturbed family members to respond in litigious ways. HIPAA is an acronym for Health Insurance Portability and Accountability Act.  According to hhs.gov, the privacy component of the HIPAA law  states that the major goal of the Privacy Rule is to assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public’s health and well-being.

My point of this post is that I am far from perfect, but I believe it is always best to behave in a way that will not necessitate an apology later. Dr. Wolf, U.S. Senate candidate, has publicly apologized for posting these images in question. At best, his actions were a lapse in judgment. At worst, they were a violation of the patients’ rights and possible courtroom fodder. As gaffes go for those who aspire to or are elected to public office, this is no blue dress or defining what “it” is, or inspiring second graders across the fruited plain to ask their parents what oral sex is.  But it also is something I would not have done under any circumstance. In a time of ever-increasing healthcare regulation, who really wants to thumb their nose at the HIPAA laws and risk being made an example of in the national spotlight?

lewinskydress

Bubba fancied The Blue Dress!

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divorce, higher education, medical school

The Practice Wife

personals

Reading the F seeking M ads one day, I came across an ad by a 6th grade social studies teacher who had placed an ad on a dare. The ad made her seem normal enough. Returning to Johnson County Community College for afternoon classes, I couldn’t shake the words from that ad out of my mind. When I returned home that evening, I began drafting my response. I was in nursing administration at a local hospital, looking for a life partner who also liked to breathe, drink water, et cetera, etc. Soon we were seeing other daily, cohabiting in the 1950’s style by maintaining two separate residences.

marathoner

Although I had always enjoyed running, Michelle soon showed me how to train for and complete a marathon. In return, I taught her how to ski and we skied in 6 countries. Our true passion, however, was making a fine art of getting into medical school. Almost two years after we met, she would have a seat in the Des Moines University class of 2005. I had been unconditionally accepted at the allopathic (MD) program at Kansas University on February 8th of 2001 and Michelle and I were notified by phone from DMU on February 22nd, 2001 that we were both accepted to DMU’s osteopathic program. But…I already had the golden ticket! I had been trying to gain a seat in KU’s program for 4 years, then suddenly I had one.

downhill skier

No way was I not going to be an MD like my little brother. Soon I was waiting for Michelle to be woman enough to say “you are my husband, we both have a ticket to DMU–you belong with me in Des Moines.” She was waiting for me to man up and do the right thing by joining her at DMU. We failed each other…and convinced ourselves that we could keep our marriage strong and study together on the weekends. How could I have known then that I married a woman like my mother’s mother La Verne–a social climber who would inevitably reject me when I got the boot from KU’s program and therefore would not become a physician?  I had been an RN for five years at KU–I knew it was a poisonous, unfriendly campus–but I wanted the MD degree anyway.  It makes me sick to my stomach to think that I missed some little cue that would have told me who she was and who she turned out to be.

Des Moines U

Michelle and I had fun.  We danced, ran, skied, and enjoyed being young and having too much money.  But that was all just a stage, a practice run at the institution that is marriage.  Michelle bailed on our marriage the moment the fun and easy part was over.  At that time of my life I was working in Des Moines on the weekends, staying at the Holiday Inn between shifts, and then returning to our marital home in eastern Iowa three hours away.  Lesson number one for thick-headed Norsemen: don’t choose a different medical school to attend than your young wife, 3 hours away.  Lesson number two for thick-headed Norsemen: don’t gut an entire home and then start the renovation over from that point–covering and uncovering the marital bed each day is a great way not to stress a marriage.  I was an idiot, and worse, I had invested in the wrong woman.

money pit      One September day in 2004, I returned home in eastern Iowa from my brother’s farm in SW Wisconsin to a manila envelope from Michelle.  She had moved out three weeks earlier and had sent me the divorce papers with a note asking me to attend to this because her clinicals demanded her time each day during normal business hours. I made a list of 12 errands to run that day, the last being to remove Michelle from my life insurance as the benefactor–keeping her in that position no longer seemed prudent.  I was standing in the doorway of the State Farm office in Maquoketa, IA making an off-handed remark to the secretary about going through a divorce when a young couple with a small child came through the door. I remarked what a big, beautiful girl she was and her father replied “yeah, you’d never know she got the start in life that she had.”  Sensing he was wanting to talk more about this, I took the bait.  We got started talking about little Lucy and Tetrology of Fallot, when her mother remarked about my ‘divorce’ comment.

divorce

“So, you’re going through a divorce, Eh? Well, I just happen to have this sister…” I cut her off.  “No, you don’t understand–I just came from the judge’s office right before coming here.  I am in NO WAY ready for this!” I protested.  Amy would not back down.  “Oh, she’s a good cook, she’s tall, comes from a good family.”  State Farm closed and pushed us out onto the sidewalk where Amy continued planning my future.  It was a heated election year and I knew 2/3rds of the registered voters in the county drank the blue Kool-Aid.  “Well, I am a Republican.  A staunch conservative, to be even more precise!”  I bellowed, hoping she would give up and walk away in disgust.  Instead, Amy’s face lit up and said “Well, so are we!  I mean, so is she!”  “Ah, crap” I thought.  Finally Amy added “wouldn’t it be nice at the end of a long day of renovating that old house if you had a friend in this area to go see a movie with?”  Bam.  She had me.  I was mighty lonely, reeling from the biggest, most personal type of rejection a human being can suffer.  “Okay, when do you plan to talk with her next?”  Amy, being Amy, said “oh, I’m gonna step around the corner and call her right now!” Many months later Sara would enlighten me to the real content of that conversation: Amy called Sara and said “I just met the father of your children.  Don’t eff this up!”

first date 2

The amazing part of this exchange is that after only about forty minutes of talking to me, Amy could discern that I was a suitable mate for her older sister.  Not just a suitable mate, but a life partner.  Wow.  That still makes me shake my head in wonder.  Later that same night I had three hours of windshield time with which to call Sara.  Although it started on an awkward note (Hi, I’m Erik–some random dude your sis was totally crunching on for you earlier at the State Farm), soon each of us loosened up and we arranged to talk again on the phone Saturday morning, Sunday, and then even Monday evening when I picked up an extra shift due to an ill call.  By the time I ever laid eyes on her, Sara and I had spent about 8 hours talking on the phone, sharing values, dreams, hopes, desires.  We agreed to meet in Davenport at the Border’s bookstore on 53rd at 5:30 p.m, 9/24/2004.  I was perusing Ann Coulter’s new book Treason when a tall drink of water with short brown hair and brown eyes came up to me and softly said “Erik?”  She bought my coffee, she insisted, because she didn’t want to feel ‘beholden’ to me at the end of the evening. I sat there, enjoying adult conversation with a kind woman with big, soulful brown eyes. It was great to not be so lonely, if only for a little while.  There were a handful of patrons sitting there when we sat down.  Three solid hours later, deep in conversation, we looked up and noticed older women quilting at every single table–as if a flash quilting mob had enveloped us.  We chuckled in wonderment at where they all had come from, us so completely unaware.

quilting bee

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