Healthcare Privacy in the 21st Century

While working as a physician for several decades, I’ve observed the dramatic changes in policies and attitudes relating to privacy.  These changes have a potentially negative impact on psychiatric care.

When I was growing up in the 1960’s and 1970’s, a doctor’s office was considered a safe place, where every employee had the patient’s best interest at heart.  Anything that was talked about was considered private.  I still remember a moment in 1978, when I told my doctor that I had tried marijuana at the age of 17,   I knew that regardless of the doctor’s relationship with my parents, the information that I shared about my own health would not be shared with anyone else, without my consent.

Fast-forward to my doctor’s appointment yesterday, where a nurse entered my health history into the healthcare network’s database.   There was no discussion about my options for sharing that information.  I received a sheaf of papers that contained information about privacy and signed a form related to HiPAA, but the text was far too small to read without my reading glasses (again, I’ve been a doctor for a long time!), and had I taken the time to read the form, the people in line behind me would likely have complained.

We did not discuss the article I saw in the news yesterday, that described the lack of security with digitalized healthcare records.  We did not discuss whether it is truly a good idea to put every person’s healthcare history  online, so that every doctor, nurse, or secretary affiliated with a clinic can read the things I tell my doctor.  We didn’t discuss what could happen in the future, when the government has access to my health history.  We didn’t discuss the difficulty I would likely have with getting life insurance, given my health history.  We didn’t discuss the ways that disclosure of my health history could someday affect my ability to find employment.

The experience made me wonder about the amount of privacy that patients should and do expect today, when they see a psychiatrist.  Do patients feel safe, disclosing personal information with their psychiatrist?   They should — because in many areas of mental health care, secrets keep us sick, by preventing appropriate care or counsel.

In the big picture, the crazy trend toward universal access to healthcare information interferes with the potential benefits to seeing a psychiatrist.  If patients have the thought that everything they say will someday be read by someone else, then they are not going to speak openly about their problems.  I’ve written about the problems with ‘mass-produced psychiatric care’, where patients are seen for 9 minutes and then prescribed psychotropic medications….   perhaps in that model of care, there is no time to say anything that really matters!  In that case, online medical histories are just ‘garbage in, garbage out’, and the loss of privacy is ‘no harm, no foul.’

I do not agree, though, that details are irrelevant.  People have different reasons for being depressed, and some minds work differently than others.   I know that I have a better chance of success in improving the quality of a patient’s life when I take the time to learn how that person understands and reacts to the world.   Patients therefore have an interest in being open with their psychiatrist about more than their medication history.

Patients who use my psychiatric services should know that their privacy will always be secure. I do not place patient records online, and I have no plans to do so in the future.  I type patient records myself, and do not use transcription services (where many strangers gain access to patient histories).

I want patients to feel comfortable allowing me to know their true selves, as that type of psychiatric relationship can be liberating.  To get there, patients should now that whatever they say, stays here.

2 thoughts on “Healthcare Privacy in the 21st Century

  1. alyssa gruhn

    Hello Doctor,

    I’m emailing you on half of my boss. This is in regard to his addiction, these are his words that he emailed me. Any information you can provide would be GREATLY appreciated. He has been seeking help, answers for a long time, but all doctors seem to lead him towards a darker path.

    Doctor, what happens in the case of an addict, (me) who hasn’t used opiates but one time in over 20 years who due to implant surgery is put on OxyContin though he explicitly told the Dr he was an addict. Then, due to an upcoming family trip
    I looked up alternatives, came across bupe, and went to the bupe Dr. I Told him my dilemma and that the other Dr wanted to prescribe MORE OxyContin (AFTER telling me it was non addictive) in cases such as mine, when inevitably I got addicted, offered to ” give you more to cover your vacation” and I replied, ” I’m an ADDICT!”

    For obvious reasons I found Dr. For Bupe. Then he ” misunderstands 20 years of sobriety for 20 years USING and prescribes me 32 mg!

    I have NO knowledge what this shit is, but read it’s good ( 2010), I go into withdrawals as directed, take bupe leave for Europe, get SICK, then better, …. Come home and after about 2 months find out from a friend in AA that this is “bad news” and my chances for getting off are ‘slim’

    I confront bupe Dr he sees his mistake… Says he dosed me as a “long-Term user who’ll never get clean” based on all “studies he’s read, and bottom line is he should have dosed me at 2 mg NOT 32!

    I tried to get off, went to Betty Ford, damn near killed me and here I am 3 years later.

    Pat, my boss. Is looking for advice on how to get clean from drugs all together. He is 63 years old and questioning if it would healthy for him to go off the medication at his age.

    Thank you very much Doctor!

    Have a good day,

    Alyssa Gruhn

  2. Karim Marouf

    Hi Dr Junig,
    Sorry to write you on this blog, but I could not find any contact email.
    I am an RN and paramedic writing a research paper on the opioid epidemic. I saw that you presented at the Wisconsin EMS Conference.
    I am interested in your thoughts on how EMS can be involved helping opiate addicts beyond just responding to overdose emergencies. Specifically, do you think there could be a role in community paramedics visiting patients and assisting them with medication-assisted treatment, helping them make their appointments, etc?
    Please email me at
    Thank you!


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