I recently endured my third round of invasion by the Joint Commission, or JCAHO (Joint Commission on Accreditation of Healthcare Organizations). I am still reeling from the experience. Without my consent and without warning, the investigator invited herself into the sanctum of our exam room, explaining that she had verbal consent from the patient to observe, “and we learn so much!” I was caught completely off guard, and working as a private contractor in a government sponsored facility, I didn’t resist, but I can say now in retrospect…it will never happen to me again.

Never in more than 20 years of medical practice have I had a government agent invade the sacred space of my private exam room. Oh yes, I have acceded to the review of my private medical records by their auditors, holy ground that never should have been given, but this was too much. Ah, but she had HIPAA in her hand.

It has taken me a while to get the big picture. At first when I heard of HIPAA (Health Insurance Portability and Accountability Act of 1996) I was mystified, why should we need such a law? After all, the idea of doctor-patient confidentiality has been an essential foundation of western medicine for two thousand years before there ever was a United States of America, so we surely didn’t just think it up. Furthermore, if the King’s Court jesters (or shall we say ‘Supreme Court’) can find an “implied right to privacy” in the US Constitution for a woman to kill her unborn baby, why in the world would we need a new set of laws to protect privacy between a doctor and patient?

It’s really quite simple, the cost of medicine today has escaped us. When my Grand daddy was still around, he either paid for his medical care out of his pocket, or he didn’t get it, simple as that. Today, nobody can afford to pay their own medical costs, why a small cut on your finger with a trip to the emergency room for a few stitches could run over a thousand dollars, and a woman recently confided to me that her hysterectomy cost in excess of $65,000! Now think about how many women in this country will need a hysterectomy this year, can we afford this? How about a $90,000 heart catheterization and stent followed by a new blood thinner drug that will cost $2000 a month to keep it working? So we see that more and more we have to rely on our government to foot the bill of the things we could never pay for.

There it is… if the government is going to pay for health care, they want to get the ‘most bang for their buck’ so they need a way to measure, and to measure, they need beans to count, and to have beans to count, they have to have records, and to have records—they can’t be in a safe paper chart in some doctors office, they need to be electronic and available, hence the advent of the EHR (Electronic Health Record). Nobody honestly finds this actually facilitates patient care (everyone I talk to finds that all this data entry increases the time need to see one patient), but it sure gives the government beans to count.

Now for them to sell us on this idea, they had to create the illusion of protecting the privacy of medical information when in reality the foxes were just letting themselves into the hen house! Remember, the “P” in HIPAA does not stand for privacy like they want us to believe, but for portability, so it’s easier for them to access. The government now has an information highway to the most private thing you have, your own medical record. And remember, next time you sit down with your doctor in confidence, you may look up and find they have invited themselves to sit in, after all, “they can learn so much!” Welcome to the 21st century and a brave new world (soon to be ‘Logan’s Run’).

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AUTHOR’S NOTE: I would like to respond to concerns raised in response to the above article regarding the Joint Commission. Let me clarify, JCAHO was not originally created by the Federal Government nor is it directly funded by Federal moneys. And if my use of the term “agent” created that misunderstanding, I extend my apologies, that was not my intent. Rather my intent is to point out that Joint Commission has become a tool of the Federal machine. Joint Commission accreditation has become a primary measure by which health organizations can qualify for Medicare participation and, in many states, Medicaid participation as well. Medicare funds are clearly of Federal origin, and to put it simply, a health organization which doesn’t have Joint Commission accreditation or, worse yet, fails their accreditation will find it very difficult to access those Federal moneys. Thus, JCAHO is operationally an agent of the Federal system, and reflects Federal intrusion. One cannot deny that Joint Commission is required to comply with Federal regulations in its reporting and that Joint Commission reflects the requirements of CMS (Center for Medicare Services) standards, thus playing a regulatory role for the Federal government.