Doctors target gun violence as a social disease

[osageid]

Originally Posted by Frank Ettin

Pretty doubtful. Currently, medical records, including such things as a Medical History form filled out by a patient and made part of the medical chart, for Medicare or Medicaid patients aren't considered government forms.

Actually they are in all practicality, because they have access to them. If they do a chart audit they have access. Whether they will take note of a question regarding guns I am not sure... Hospitals and physicians are regularly audited at times for accrediting for participation to bill Medicare and medicaid. JACO for instance can audit any policy, procedure AND chart if refused you will not receive accreditation therefore won't be able to receive reimbursements for care administered to such patients.

My facility in which I practice is very gun friendly , most of active staff have CCW and even more are gun owners (ex long guns) I am the chairman of Medicine and I regularly train with the SWAT team as the team here has a Medic component and some are even deputized. The scrutiny placed on gun ownership will definitely be based on location.


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[mrbatchelor]

Edit: Not germane.

[scrubcedar]

Maybe I'm missing something here. Is there a harmless reason to include a question about gun ownership that is included in your chart and therefore a permanent record?
I was in a completely different part of nursing and got out just as HIPAA was in it's infancy so I can't speak to that, but these questions seemingly popping up in multiple places at once disturb me. There were no standard widely distributed questionaires for physicals that I knew of or any in the works and being on hospital wide nursing practice councils I probably would have heard about them. Is there anyone out there who has knowledge of this from healthcare provider side? The most likely answer I see has to do with insurances trying to increase their premiums for gun owners. If the Doc was using their form/questions so that he will get paid for the physical this makes sense. Considering that the Federal Government might be in charge of all of this soon the whole thing makes me uneasy.
If we accept the thought that crime involving guns is a social disease then owning guns would be symptom, a possible indicator. Owning multiple guns with ammunition for them would be a strong indicator and therefore should probably be reported in some form to the CDC so that if this patient's disease kills people the details can be used to develop solutions to the problem. You wait for multiple shootings.You then blame it on the guns, after all the indicator that these deaths had in common was gun and ammunition ownership by the perpetrator.
If you understand the way these researchers think this is an easy logical progression. Are there indications of this now? I don't think I'd stretch that far yet but the framework is there. We better make sure that they don't build a house on this framework while we're not looking.

[Frank Ettin]

Originally Posted by osageid

Actually they are in all practicality, because they have access to them. If they do a chart audit they have access. Whether they will take note of a question regarding guns I am not sure... Hospitals and physicians are regularly audited at times for accrediting for participation to bill Medicare and medicaid. JACO for instance can audit any policy, procedure AND chart if refused you will not receive accreditation therefore won't be able to receive reimbursements for care administered to such patients.....

You need to be vary careful about identifying who "they" really is. "They" will be providers, payors or what are known as business associates of either, all of whom are covered under the HIPAA privacy rules and are significantly constrained as to how they may use individually identifiable medical information and to whom, and for what purposes, it may be disclosed.

Chart audits are done in various ways to protect the identity of patients. Much information is not individually identifiable. Charts for things such as accreditation and QA audit are numbered, and access to the keys to matching chart number to patient identity is strictly controlled.

Such blinded audits are very common. The names of patients to be included in an audit sample would be reviewed to assure that they were all participants in the program and therefore should be included in the audit population. The charts audited would be a randomly selected from the audit population, and the identity of the patient coded so that the patient was not identifiable.

Billing audits are conducted by payor intermediaries or their contractor, and those organizations are subject to HIPAA. Information is heavily compartmentalized, and access to patient identifiable information is severely restricted in accordance with HIPAA.

In the years following the adoption of HIPAA confidentiality and data integrity rules, the medical care industry spent billions of dollars implementing procedures necessary to comply.

[mrbatchelor]

If we accept the thought that crime involving guns is a social disease then owning guns would be symptom, a possible indicator. Owning multiple guns with ammunition for them would be a strong indicator and therefore should probably be reported in some form to the CDC so that if this patient's disease kills people the details can be used to develop solutions to the problem. You wait for multiple shootings.You then blame it on the guns, after all the indicator that these deaths had in common was gun and ammunition ownership by the perpetrator.

If you understand the way these researchers think this is an easy logical progression. Are there indications of this now? I don't think I'd stretch that far yet but the framework is there. We better make sure that they don't build a house on this framework while we're not looking.

There is merit to this thinking. We ignore it at our peril.

I *HAVE* done some work with physicians and electronic medical records, and some of them are alarmed. One, a urologist, was specifically alarmed enough to ask me to remove the gun questions from his canned questionnaire because he expects everything to become centralized one day in the future. (Say what you want abut the SSN "never" being used for ID.)

The people who are *NOT* alarmed are the "social workers" in the medical field. Look up what someone with an MSW does. They look for ways to control your life.

Now I'm going to unsubscribe from this thread. I'm not going to get sucked in. But I worked with these people. They are not our friends, and they are not benign. They are not after you individually or personally. They may even like you personally.

But they are after us as a class. Remember all the rhetoric you hear on talk radio about class divisiveness. You must learn to think in term of class, not individuals or you cannot get the big picture.

They see no trees. It's a forest, or nothing. Don't get burned up in the forest fire defending the trees.

[44 AMP]

, after all the indicator that these deaths had in common was gun and ammunition ownership by the perpetrator.

While true, it is a a fallacy to believe that correlation is causation.

It is virtually certain that every one of the mass shooters ate bread or a bread product within 30 days of going on their shooting rampage.

The correlation is there. But is it a cause? Should we watch people who eat bread, because of this? Ban bread? Require a background check before approving the sale of an entire loaf of bread (hi-cap package)?

And what about those who will skirt the law by eating rice?

Don't fall into that trap.

[FloridaVeteran]

I was not able to renew my FL drivers license without giving my SSN. The lady behind the glass would not and could not provide printed proof that this was required. I asked her if she understood that this is the equivalent of a back-door national ID card and I received a blank stare in return.

If I am asked about firearms I will not respond. Period.

[Silver Bullet]

FE:

Currently, medical records, including such things as a Medical History form filled out by a patient and made part of the medical chart, for Medicare or Medicaid patients aren't considered government forms

SB:

"Currently" .

FE:

Provide some solid evidence that a change could seriously be considered a real possibility

SB:

How could it NOT be considered a real possibility?

FE:

The possibility of abuse always exist, no matter what.

That’s what I said.

See if you can respond in a manner other than deleting my response this time.

[scrubcedar]

44 AMP I agree with you on the differences, however when you get a chance sort through some of what is considered medical research.
People still aren't getting their children vaccinated over a flawed(at best) medical study that has even been refuted by it's author.
When I would have to wade through medical studies trying to figure out what was good research and should be put into practice and what wasn't good enough to be of value you absolutely would not believe what trash I found. Government studies quite often had a political motivation, it was normal. The reason I mentioned the CDC in particular was because while they are capable of being the best source possible for information they have also put out pure political trash in an effort to curry favor in funding. I can see these guys doing this and I've read a fair amount of stuff they've produced. I have no idea how many hours I spent looking at research but it's been quite a few and this sort of thing fits right in unfortunately.

[Frank Ettin]

Originally Posted by Silver Bullet

...See if you can respond in a manner other than deleting my response this time.

There's nothing to respond to.

Edited: If you wish to spar with me, take it to PM. But please do not clutter up this thread with your personal jibes at me.

Furthermore, no one could reasonably guess your issues from your unsupported one-line comments, and I'm not going to try to decipher your meaning. Some of the issues you seem to be alluded to were addressed by me in post 71. And of course one needs to read the entire post, not just single sentences taken out of context.

[zukiphile]

Originally Posted by Frank Ettin

If something is a threat, act. But if one can't articulate why or how, in real life, something is an actual threat, stand down and watch.

The problem with that standard is that it doesn't account potential abuses and abuses we've not heard articulated.

I hadn't heard the Apple/Amazon hacking fiasco articulated before it happened, yet it was real. However, it still seemed circumspect to keep personal information close to the vest.

As to the matter of potential misuse, one can imagine that people who objected to Social Security Retirement and the associated account number as a de facto federal ID# would not have passed the standard above. However, after the program was entrenched people not even in the retirement/employment system were required to obtain a number. Today, I can't open a checking account without this number.

Originally Posted by Aquila Blanca

I am MUCH more interested in not having the information compromised in the first place than I am in a basically useless "We screwed up" letter after the fact.

Indeed. One might trust an entity with gratuitous collection of confidential information, but one's trust isn't an impediment to misuse. Not permitting the collection in the first place is an impediment into which one can place real trust.

There also appear to be two distinguishable but related issues discussed here. One is abuse of information given in confidence. A general practitioner paid in cash can do that.

The second issue is the capacity of the party with whom a confidence is shared to use it against you. For this second issue, a lone GP seems much less threatening than than a large provider network, or a quasi-governmental payment system.

[MLeake]

I agree with pretty much everything zukiphile said in his last post.

[Glenn E. Meyer]

In today's age, I'll bet you every gun owner who every used an electronic medium to purchase something will be known by the evil forces in a few seconds.

I've given much more gun info through media than any doctor question.

Just for another layer of tinfoil. It's not hard to ID gun owners - like with my three CCW or CHLs over the years?

[osageid]

Originally Posted by Frank Ettin

You need to be vary careful about identifying who "they" really is. "They" will be providers, payors or what are known as business associates of either, all of whom are covered under the HIPAA privacy rules and are significantly constrained as to how they may use individually identifiable medical information and to whom, and for what purposes, it may be disclosed.

Chart audits are done in various ways to protect the identity of patients. Much information is not individually identifiable. Charts for things such as accreditation and QA audit are numbered, and access to the keys to matching chart number to patient identity is strictly controlled.

Such blinded audits are very common. The names of patients to be included in an audit sample would be reviewed to assure that they were all participants in the program and therefore should be included in the audit population. The charts audited would be a randomly selected from the audit population, and the identity of the patient coded so that the patient was not identifiable.

Billing audits are conducted by payor intermediaries or their contractor, and those organizations are subject to HIPAA. Information is heavily compartmentalized, and access to patient identifiable information is severely restricted in accordance with HIPAA.

In the years following the adoption of HIPAA confidentiality and data integrity rules, the medical care industry spent billions of dollars implementing procedures necessary to comply.

Well said Frank !


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[Slamfire]

Since medical Doctors kill about 200,000 Americans every year due to poor processes, dirty hospitals, and incompetence, I don’t think they should be throwing rocks at gunowners till they get their mess straightened out.
Doctors kill more people than car crashes and firearms (most of which are suicides) combined.

Doctors are a menace to society!

http://www.plg-pllc.com/resources/ar...cident-lawyer/
http://www.cancure.org/medical_errors.htm

http://www.relfe.com/doctors_kill.html

[Frank Ettin]

Originally Posted by zukiphile

The problem with that standard is that it doesn't account potential abuses and abuses we've not heard articulated...

Okay, let me rephrase my statement slightly. If you can't articulate why or how, in real life, something in particular is, or could be, an actual threat, stand down and watch.

And while you're quoting me, I also wrote:

Originally Posted by Frank Ettin

...Constant vigilance and taking action when something concrete to act upon or against shows up is one thing. Gnashing of teeth and rending of garments over mere, undefined vague possibilities in another....

Originally Posted by zukiphile

...it still seemed circumspect to keep personal information close to the vest...

That's fine, but there are limits on the extent to which you can reasonably expect to keep personal information absolutely private.

If you want a loan, you need to expect to have to disclose personal information to a prospective lender. If you want your medical bill paid, your health insurer will need to have access to a variety of your private information. If you want good medical care, your providers will need access to your private information. If you invest your money or keep a bank account, your broker/banker/investment manager will need access to private information about you. And if you do any sort of business electronically, a lot of your personal information is going to be out there in cyberspace.

Originally Posted by zukiphile

...The second issue is the capacity of the party with whom a confidence is shared to use it against you. For this second issue, a lone GP seems much less threatening than than a large provider network, or a quasi-governmental payment system.

But that horse left the barn fifty years ago.

[zukiphile]

Originally Posted by Frank Ettin

That's fine, but there are limits on the extent to which you can reasonably expect to keep personal information absolutely private.

If you want a loan, you need to expect to have to disclose personal information to a prospective lender. If you want your medical bill paid, your health insurer will need to have access to a variety of your private information. If you want good medical care, your providers will need access to your private information. If you invest your money or keep a bank account, your broker/banker/investment manager will need access to private information about you. And if you do any sort of business electronically, a lot of your personal information is going to be out there in cyberspace.

I concur, and that is the reason you may see a general discomfort with docs collecting information about whether one keeps a firearm. Surely you've heard someone at sometime recommend that if one needs treatment for depression, he should do it in a way that leaves no record. Otherwise, he will have trouble obtaining life insurance at a reasonable rate.

It seems unlikely that a person seeking medical treatment for depression would foresee that life insurance danger unless warned about it.

Certainly there are limits on the extent to which you can reasonably expect to keep personal information absolutely private, but distributing information to people who don't need it doesn't increase any reasonable expection of privacy.

It's fair to note a difference between prudence and paranoia, but the apparently paranoid conclusion isn't categorically wrong.

[Frank Ettin]

Originally Posted by zukiphile

...Surely you've heard someone at sometime recommend that if one needs treatment for depression, he should do it in a way that leaves no record. Otherwise, he will have trouble obtaining life insurance at a reasonable rate.

It seems unlikely that a person seeking medical treatment for depression would foresee that life insurance danger unless warned about it....

True, but on the other hand --

1. It's tough to seek decent medical care without leaving any record. Physicians keep records. And, to use your example, if one is being treated for clinical depression, he will be prescribed drugs; and there will be a record of the prescriptions and drug purchases.
   
   
2. Now if our depression patient buys life insurance without disclosing his prior treatment, and the carrier later discovers it (there will, after all, be some trail somewhere), he risks the carrier rescinding the coverage for material non-disclosure.
   
   
3. And if our depression patient needs treatment for some other condition and fails to let that physician know about the prior treatment for depression and the drugs he is taking, he risks the other physician making uninformed, and therefore poor, decisions perhaps resulting in a bad medical outcome. And of course if the patient does disclose his prior history and current medication, that will be documented in the records of the physician treating him for the new condition.

Originally Posted by zukiphile

...It's fair to note a difference between prudence and paranoia, but the apparently paranoid conclusion isn't categorically wrong.

At the same time, isn't it amazing how readily people needless disclose all manner of personal, and even intimate, information about themselves, including their most cherished beliefs, values, intentions, knowledge and ignorance, on Internet forums open to everyone in the world with Internet access, in the apparent belief that the use of a pseudonym is sufficient privacy protection.

[zukiphile]

Originally Posted by Frank Ettin

At the same time, isn't it amazing how readily people needless disclose all manner of personal, and even intimate, information about themselves, including their most cherished beliefs, values, intentions, knowledge and ignorance, on Internet forums open to everyone in the world with Internet access, in the apparent belief that the use of a pseudonym is sufficient privacy protection.

That would surprise me, since I would think that most people techonologically knowledgable enough to use the internet would imagine that all publicly disclosed information is public. I don't imagine that is why you used a pseudonym. I would expect that most adults wouldn't publish anything online that they would be embarrassed to have their names attached to.

I am more suprised by the willingness of people to give information over the telephone to anonymous voices, and the response to emails from nigerian princes or online IRS notices. Someone must respond to both, since they still get sent out.

All of that goes to the failure of foresight and why we shouldn't necessarily demand specificity in it.

[Frank Ettin]

Originally Posted by zukiphile

That would surprise me, ...I would expect that most adults wouldn't publish anything online that they would be embarrassed to have their names attached to....

Well, surprise! Just wander around this and some other gun forums and read such things as people proclaiming an intent or desire to use violence inappropriately, or a disposition to violate laws, or admissions of past illegal conduct. And then there are the posts containing racial slurs, bigoted remarks and the like that staff has removed or edited.

A good while ago, on another forum, I recall a long time member starting a thread about how he and a buddy took a woman to Las Vegas and later abandoned her there.

Some time ago, on a forum I'm staff on, was contacted by a member asking that a bunch of very old posts of his be deleted because he now regrets some of the things he said.

Originally Posted by zukiphile

...I am more suprised by the willingness of people to give information over the telephone to anonymous voices,...

I agree that it's very bizarre. Sometimes the person who will cheerfully give a stranger a credit card number over the telephone will get wrapped around the axle because a doctor who he has consulted to treat his current illness asks if he has ever had an STD.

[guntotingchick]

I have read some of the posts here regarding health/mental information going into NICS background checks and possibly using that to deny rights to ownership. I work in the healthcare profession, and HIPAA law strictly forbids health information going into the wrong hands without the patient's consent. Legally the gun-grabbers would have a hard time challenging HIPAA. Hopefully

[Frank Ettin]

Originally Posted by guntotingchick

I have read some of the posts here regarding health/mental information going into NICS background checks and possibly using that to deny rights to ownership. I work in the healthcare profession, and HIPAA law strictly forbids health information going into the wrong hands without the patient's consent. Legally the gun-grabbers would have a hard time challenging HIPAA....

You're correct both about HIPAA and about many not fully understanding the scope and depth of various privacy laws in place.

[Aguila Blanca]

Memo to guntotingchick and to Frank Ettin:

Laws can be changed. Data once in a system can be VERY difficult to eradicate, and even to control. Yes, I keep a few tinfoil hats in the closet, but IMHO the best protection is to not allow any medical professional to have information about things that do not DIRECTLY impact your treatment by that medical professional.

Perhaps I am more sensitive to this because I am a veteran, and I am acutely aware of the initiatives to automatically classify any veteran who has ever sought help for PTSD as a prohibited person ... for life.

Thanks, but no thanks. That's not in the Constitution I swore an oath to defend.

[scrubcedar]

How hard would it be for congress to write a law saying that to qualify to buy a gun you have to pass a mental hygiene test and anything written in your medical chart was germane? As a part of the law the HIPAA rules could be violated for the public good. Not a sarcastic question, any of our legal guys want take a crack at this?

[Frank Ettin]

Originally Posted by Aguila Blanca

Memo to guntotingchick and to Frank Ettin:

Laws can be changed. Data once in a system can be VERY difficult to eradicate, and even to control....

But considering the political history of HIPAA and other privacy laws, any change in the direction of opening them up is pretty unlikely.

Originally Posted by Aguila Blanca

...the best protection is to not allow any medical professional to have information about things that do not DIRECTLY impact your treatment by that medical professional...

The issue there is that in my experience, dealing professionally with medical issues, doctors and quality of care matters, patients often don't have a very good handle on what information is, or is not, material to a physician. I've seen many bad outcomes which resulted from a physician not having information about a patient's medical history because the patient withheld the information as "irrelevant."