Unlike the Laws of Physics, the Laws of Unintended Consequences are not immediately perceived. When they finally are felt, the passage of time has so blurred the link between cause and effect that one cannot even derive any educational benefit from the perception. You get bonked on the head once by an apple, you learn it’s safer to sit under an elm. You pass a government regulation with the best of intentions. But by the time it wends its way to implementation, it undergoes so many subjective permutations, it is hardly recognizable at the end and virtually never serves its original purpose. Which is one reason most people hate, or at least mistrust, government.
Take patient privacy in healthcare. Please.
The other day, I arrived at 7:55 a.m. for my 8:00 a.m. appointment at the clinic. I sauntered casually up to the counter and announced my arrival to the receptionist. I was asked to surrender, for copying, my insurance card and my driver’s license, which I did. I was given some forms to fill out and I was given a paging device. One of those coaster-sized thingys that’s round, black, and has flashing red lights that blink when the summoner presses a button. I looked at the receptionist skeptically.
“We won’t be calling you by name,” she assured me. “When it’s your turn, we’ll page you. You’ll know when the red lights start flashing, like this.” She pressed a hidden device and my pager lit up. I nodded and smiled, wondering how much of the cost of the pagers would be added to my bill and if it wouldn’t be simpler just to call me by my name.
I took my pager and my forms and took a seat in the spacious, sunlit lounge. I set the pager down on a table next to me and began filling out my paperwork, stealing a glance at my fellow patients every now and then. The waiting room was peopled with bored, middle-aged Hispanic couples. There was the usual complement of kids amusing themselves with whatever was available. A couple of other single women, an elderly couple, the woman was in a wheelchair.
We all periodically stole glances at one another while looking around the room, at the skylight, at the attendants—strangers all, but bound by the common rule of stealing glances in the waiting room: do not make eye contact. If you accidentally do, smile nervously and pretend it was accidental. And, above all, express no surprise at being given a pager.
I wondered whose pager would go off first as I completed my forms and stole my glances. I didn’t read any of the informed consent treatment forms I signed. I’ve signed plenty others and, besides, if you don’t consent to treatment, what’s the point? I noticed there were a couple of newer forms dealing with patient privacy. I’ve received dozens of “Our Privacy Policy!” notices from various companies that I do business with and I don’t read those, either. I think they’re irrelevant.
I live in a country where my government legislates privacy even as it shreds the Bill of Rights. As an enforcement measure, it has even created a giant bureaucracy to monitor industry’s, especially the health industry’s, compliance with privacy rules. On the one hand.
On the other hand, in an effort to save tax dollars and also because it cannot do this itself--not legally, anyway--my government outsources to private companies the task of collecting personal data on its citizens. And then purchases that data from those same companies. Companies such as the hapless Choicepoint, Inc., which was recently scammed by some people who set up several dummy companies to purchase data on 145,000 individuals in order to resell their identities on the black market.
If the soundtrack for the dawn of the 20th century was the hisssss, chonnk!, thud! clanggg! of the maturation of the industrial age, then the soundtrack for the 21st is the FWEEEEEE ooooooooooo hisssssssssss SCRCHSCRCHSCRCH BWEEDOBWEEDO-BWEEDOBWEEEEEeeee of modems calling out to one another, making contact, and transmitting information in a relentless round-robin of robotic precision.
Hermits in caves in Nepal enjoy privacy. The rest of us are living with plastic, security cameras, Paypal, ATMs, camera phones, and Google. If we have any anonymity at all, it is because we are of no interest, we raise no red flags, to the watchers.
I complete and sign my forms and I wait expectantly, stealing glances around the room at my fellow patients. I steal the occasional glance at my pager. The headcount in the waiting room does not appear to have changed, so I pick up my book and settle in for the long haul.
At last, I catch sight of lights flashing red in the periphery of my vision. Yes! It is my pager. Mine! It really is flashing. It is my turn! I obediently gather up my paperwork, my belongings and my pager and report triumphantly to the front counter where I’d checked in earlier. With a smile, the receptionist relieves me of my paperwork and my pager. She also returns to me the driver’s license and insurance card from which I’d been separated for the 45 minutes I was stealing glances at my pager. She beckons me to follow her to a second waiting room, which I do.
We enter the area adjacent to the radiology lab. She gives me a hospital gown and a tasteful, laminated, 8-1/2 x 11 black and white photo of bare, winter tree branches silhouetted against the sky. I understand what the gown is for. I look in askance at the photo.
My guide smiles at me patiently, anticipating my confusion, and tells me, “Remember what your picture looks like. We won’t call you by name. There’s an identical picture in your file. When it’s your turn, the technician will come out to where you’re waiting and hold up the picture from your file that matches yours. That will mean it’s your turn.” She darts out of the room before I can recover enough to think of anything to say.
Who thinks this stuff up? Why can’t they just call us by name? Did they learn this stuff from years of smuggling CIA assets out from behind the Iron Curtain? Is this how the French Resistance whittled away at the Nazi war machine? What am I supposed to do with this picture? Wave it around? Hold it in front of me? Place it in the seat next to me? What if someone wants to sit there? What happened to my pager? Why did she take it away? It worked just fine.
I don the hospital gown, a little less confident now, minus my clothes. I take a seat in the second waiting room and nervously finger my photo of dead tree branches. Lacking any logical context for this situation, I attempt to invent my own. I admire the photo, first holding it away from me, then examining it closely, appreciating its esthetic.
No. This is not working. This does not fit. This makes no sense. One does not admire photos in a hospital gown in a waiting room in a clinical setting, no matter how artistic the photos are. Dear God. Who in hell thinks black and white photos of dead branches in winter is what someone wants to look at while awaiting a cancer-screening procedure? Are the people who invented this system the same ones who are going to read my test results?
I doggedly continue to look nonchalant as the waiting room begins to fill with women carrying laminated, 8-1/2 x 11 black and white photos of artfully photographed, yet dreary scenes. Except for one woman next to me. SHE has a pink sheet of paper with a yellow daisy drawn on it. I look at her and wonder how she rates. She looks first at me then at my photo, in total bewilderment.
I quickly resume examining the esthetic of my photo before she can speak to me. I cannot explain the reason for the picture matching identification scheme any more than I can explain why she gets a daisy and I get death, so don’t ask me, lady, because if I had my druthers, I’d take the daisy, thank you very much.
After a very long time, a woman emerges from the X-ray area, bearing a laminated, 8-1/2 x 11 black and white photo of a giant agave silhouetted against a stand of bare-branched trees. She holds the photo up, and hopefully looks at each of us in turn. I ignore her, as there is no agave in my photo. I recall an old Sesame Street tune, “One of these things is not like the others…” I am annoyed.
No one responds to the unspoken plea of the technician with the arty photo of the agave. She nervously glances around the room at all of us, then tentatively approaches the woman to my right, who holds a laminated, 8-1/2 x 11 black and white photo of a mountain tastefully silhouetted against a desert sky.
The technician stage-whispers to the woman, "Are you Ms. Keller?” The woman shakes her head no.
I raise my photo, “I’m Ms. Keller!”
Relieved, she bustles over to me and we compare photos. No, they do not match, but for the trees. She laughs and tells me “they” must have put the wrong photo in my file as she leads me to the X-ray room in the back. I breathe a silent prayer of gratitude that the woman had sense enough to look for me by name or I’d have been there all day.
So, despite the best-laid plans of the healthcare privacy advocates, and through no fault of my own, I did not escape the clinic completely incognito. Meanwhile, somewhere in Nepal, a hermit has an epiphany and smiles.
Julie Ann Keller (formerly contributing as Ann Keller) contributes to the non-fiction sections of Unlikely 2.0 because she just can’t make stuff like this up.