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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health care, hip resurfacing, orthopedic surgery, surgery, Uncategorized

Humbled by Mortality

Today…I bought a cane.  A cane!  I am 46 years old. I am only 46!  I have inherited some bad genes.  Genes for coronary artery disease (CAD), genes for diabetes (which I have dodged so far), and genes for osteoarthritis (OA).  About one year ago I stopped taking the statins, those wretched, wretched drugs that are supposed to be wonder drugs that will bring naughty lipid profiles up to toe the line.  I predict Hupy & Abraham 1-800-BAD-DRUG commercials in the near future, featuring statins. I had started aching–my legs, arms, even the spinal erector muscles ached.  An endocrinologist in Monroe, WI named Dr. Bekx tweaked my regimen with CoEnzyme Q10, Niaspan, the water-soluble Crestor that had been touted as “the best of the best of the best” in that class of drugs.  Dr. Bekx is a brilliant man, and even among physicians he stands out.  Tweak as he may, the myalgias (muscle aches) persisted to the point I could not stand taking even the tiniest dose.  I began to list them as an intolerance.

pill bottles

Mr. Polypharmacy!

By July I thought the statins should be long gone from my system and the pain should therefore also be gone…but it wasn’t.  My primary doc set a referral to a rheumatologist, Dr. Wilson.  A reputation of being difficult to work with preceded her, but I found her to be delightfully candid with a fast, dry wit.  Upon exam, she brought each of my legs up to my chest and I nearly came off the table in pain!  After reviewing the family history and getting an anterior-posterior x-ray of my hip joints, she told me I had osteoarthritis in both hips.  Mine was so bad that I had bone on bone, grinding, in each hip.  Worse, I had bone spurs that had been laid down as part of the body’s response after it received a chemical signal that something was bad in each hip.

OA hip

Arthritic hip; both of mine are bone-on-bone

Next was a referral to the orthopedic surgeon, Dr. Wolff.  From Madison, WI, he has a stellar reputation and a great surgical history.  Better, he was well-liked.  I cared little about that part because I would rather have a sound, gifted surgeon than one who simply made me feel good about some gaffe that occurred intraoperatively.  Surgery was originally scheduled for early December, but I just couldn’t wrap my mind around the notion of a total hip replacement on each side–not at age 46!  Sure, just lop off the proximal end of each femur and shove some hardware down in the center of the remaining leg bone!  No way, not for me, not at 46.

total hip hardware

The more common “total hip” replacement

A salty mare of a charge nurse that we love and work with in the emergency department suggested I look into the program at Sauk Memorial Hospital.  So I did, and I realized they offered hip resurfacing–new titanium alloy surfaces covering the head of the femur and the corresponding cup that is attached to the hip bone in the acetabulum.  Touted as the ideal surgery option for a male in his 40s or 50s with OA who plans to return to a vigorous lifestyle of running and skiing, this sounded like my perfect solution.  I would not likely run marathons again, but I do plan to ski with my sons.  By choosing this option, I get to keep my bones but I just get new surfaces so my bones are no longer grinding together–the titanium parts are!  Now that sounded like a capital idea!  When I met and spoke with Dr. Arnold Rosenthal, I liked him immediately.  He confided that he had the hip resurfacing done years ago himself and has loved the outcome.  Suddenly the man had street cred with me…like a mom-to-be taking suggestions from her doc who had already had a baby herself.

hip resurfacing hardware

This is hip resurfacing hardware; generally titanium alloy

Having never been cut on and placed under a general anesthetic, I am scared witless about this surgery.  I have decided to have both hips resurfaced and the closest the surgeon will do them is 6 weeks apart.  So, six weeks it is.  I will be on FMLA from work for 12 weeks.  Since osteoarthritis is a degenerative process, my hips will never be better than they are today–they will only get worse.  I cannot continue to gobble up the tramadol, naproxen, acetaminophen, and motrin as I have been for months or my kidneys will begin to fail.  My physician even added hydrocodone recently to help manage the pain all the other times that I am not at work.  Ibuprofen causes my ANA or anti-nuclear antibodies to spike and then I begin to feel pretty cruddy, so I reserve that stuff for breakthrough pain while at work. I cannot imagine a day where I don’t have to take something to manage pain, but that is the ideal I strive for by committing to these two surgeries.  Living with chronic pain is pure hell.

chronic hip pain

Living with chronic pain

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