
My Doctor's Office Asked me to Lie (2011) - brandonhsiao
http://stallman.org/articles/asked_to_lie.html
======
haldujai
IANAL but I'm responsible for HIPAA compliance in my startup:

Assuming this is a standard private practice, this office has several
violations of 45 CFR §164.520(a)(b)(c), assuming that he was also not provided
this privacy statement within 30 days with a reason for why it was not
provided on the first visit.

This makes them liable for $50,000 in fines per failure to a max of $1.5 mm
(this would be a clear cut case of reckless indifference.) The DHHS OCR is
always looking for some head to serve on a platter to justify themselves as
well.

His amendment to the form is damning evidence and that receptionist should be
fired, there is no excuse for basic HIPAA noncompliance in 2011 (8 years after
the fact).

Edit: What some people don't seem to understand is that signing the privacy
practices notice (the form in question here) _does not_ mean you agree to the
terms and conditions outlined. You only sign that you have _received_ them.
Additionally, whether you sign the form or not it applies to you, and whatever
that form states HIPAA clearly outlines what powers the covered entity (the
doctor in this case) has over your information.

~~~
shmageggy
So are you saying that in order to comply, the office needs to furnish every
patient with a 3000 page binder of privacy practices and that systematic
failure to do so should mean over a million dollars in fines? I really hope
I'm misunderstanding something because this seems insane.

~~~
polemic
It's insane that a privacy policy is 3000 pages, yes. It's _not_ insane that
they should comply.

~~~
cmiles74
I've worked in healthcare for many years and I am extremely confident that
this is not true, that the document is likely a more manageable three-to-five
pages and at worst ten-or-so. I'm sure the receptionist said this in order to
deter him from wanting to see the actual document that she clearly didn't
have.

------
antiterra
While I doubt the policy was anywhere near 3000 pages, this kind of thing is
indeed ridiculous. Reading the document means very little in regards to
understanding what it says, much less what it means in regards to court
doctrine. I also insist on reading the privacy policy at doctors offices.
Once, a receptionist gave me a great deal of grief, then finally handed me
their only printed copy. It was just one two-sided page, but it was ragged,
creased and stained. Classy.

What's less pointless and far more upsetting is the practice of pharmacies
instructing customers to sign/check the "I do not wish to have a consultation"
area on forms when buying prescription medicine. That has happened to me at a
number of pharmacies in NYC. When I ignore their instructions and start
signing the area that requests a consultation they sternly tell me I'm signing
in the wrong place. Then there's a big sigh when I say I actually want to talk
to the pharmacist. Inexcusable and disgusting.

~~~
maqr
I've seen that "I do not wish to have a consultation" box countless times, but
I've never questioned why it's there. What happens if you request the
consultation? My understanding has always been that pharmacies are drug
dispensaries with very little to offer in the way of medical consultations, as
that's the role of the doctor who prescribed the drugs. I'm not even sure what
they would consult with you about.

~~~
travisp
Actual pharmacists are very knowledgeable about the drugs that they give out,
in some cases more so than the doctors prescribing them (as many doctors will
readily tell you). Doctors in hospitals frequently consult the hospital's
pharmacists with questions about particular things (like drug interactions).

~~~
TillE
Yes, it's entirely normal in Germany to just walk in and consult a pharmacist
about minor problems. They're generally quite friendly and not too busy, even
in the middle of Berlin.

~~~
cmiles74
This used to be common in the US as well, but no longer. This is something
that seems to have disappeared as the larger chain stores have take over the
field.

~~~
mkopinsky
Even at chain stores in the US, one of the people behind the counter is a
pharmacist who went to grad school for five years studying this stuff. (The
person actually giving you your medication may only be a pharmacy tech, but
they have to have a pharmacist behind the counter whenever they're open.)

~~~
Turing_Machine
Yes. The pharmacist almost certainly knows much more about drugs in general
than a doctor does. The doctor is familiar with the drugs he prescribes, sure,
but may not be at all familiar with the drugs that your other doctor
prescribed. That is, your dermatologist knows all about dermatology drugs, but
may not know much about your blood pressure or antidepressant medicine (in
particular, that one of those drugs has a bad interaction with the dermatology
medicine he's prescribing).

That's also why it's important to always go to the same pharmacy if you can.
If you switch to a new one, make sure to switch all your prescriptions at the
same time.

------
zdw
This is an example of engineering by lawyers.

To get rid of this, I recommend the follows - a mandatory "minimum reading
period" given for any document, that prevents it from being turned in,
calculated from the average HS graduate reading speed.

Also, before any meetings regarding revisions of said document, everyone
involved in revising the document must A: be present, and B: serially, read a
copy of the document, invoking the reading penalty multiple times over.

Optionally, to avoid this process, the document can be totally scrapped and
replaced with an entirely new document, provided the new document is limited
to 1/10th the reading length.

This would greatly reduce the amount of stupid long documents, and I see no
downside.

~~~
jamesaguilar
You'd have to start by simplifying the legal code. Part of the reason that
these long legal documents are necessary is the huge variety of theories of
liability that companies are exposed to. If you want to avoid long
disclaimers, you also have to remove the things companies need to disclaim to
avoid huge legal expenses.

~~~
seldo
The first thing we do, let's kill all the lawyers.

[http://shakespeare.mit.edu/2henryvi/2henryvi.4.2.html](http://shakespeare.mit.edu/2henryvi/2henryvi.4.2.html)

~~~
jamesaguilar
Everyone likes to blame the lawyers, but is the companies and non-company
organizations that lobby for complicated laws to be made, and who employ
lawyers to sue each other.

~~~
lmm
It's a classic tragedy of the commons. Every little special case in the law
helps the organization that lobbied for it, and hurts everyone else.

------
philwebster
Previous discussion here:
[https://news.ycombinator.com/item?id=3958627](https://news.ycombinator.com/item?id=3958627)

~~~
lowmagnet
This is the polite way of saying 'repost'. Submitter: please put the year in
brackets in the future. (in this case [2011])

~~~
gus_massa
This is also useful to read the previous discussion and to see whether it has
been debunked or there is some additional information. I prefer more
information. My favorite format is:

[http://news.ycombinator.com/item?id=3958627](http://news.ycombinator.com/item?id=3958627)
(516 points, 442 days ago, 234 comments)

~~~
soganess
I think that, in and of itself, would be a wonderful feature to promote the
movement of discourse on a reoccurring subject.

(1)I post something.

(2)We discuss.

(3)After a time(likely a function of the # of stories that get pushed to HN a
day), we stop discussion[1].

(4)Someone, after an arbitrary period of time, reposts.

(5)HN automatically moves the older comments over to the newer post[2].

[1]This is not to imply the conversation, has been resolved in any meaningful
way, merely that we've elected to move on.

[2]This allows the conversation to grow without much re-treading of the old.

------
jlgaddis
I do the same thing that RMS did on many (but not all) occasions and it really
annoys the hell out of people.

A year or two ago, I rented one of those storage units to put a bunch of stuff
in (although really I should probably just get rid of it). The guy hands me a
copy of a "rental agreement" to sign that's several pages long (printed on
both sides) and says, "Just flip to the back page and sign there at the
bottom."

Having never rented one of these units before, I was completely ignorant as to
the "rules" or what might even be included in such an agreement so I really
did want to read it (whereas most of us can probably guess 98% of what the
standard HIPAA/Privacy Policy says).

When I get to the bottom of the front of the first page, I look up and the guy
is clearly annoyed (despite the fact that he didn't appear to be doing
anything important when I walked in -- he was on Facebook on his computer).

I apologized to him and explained, saying, "I'm sorry, I've never rented one
of these before so I really don't know what's allowed and I want to make sure
I don't do anything wrong." At the time I was genuinely curious as to what
could or couldn't be stored in the unit. Could I keep some really old guns in
there? Maybe I could park my motorcycle in it during the wintertime and free
up some space in my garage?

I asked him if he had a FAX machine in his office and he said that he did.
"How about if I take this with me so I can read it at home and then I'll sign
the back page and FAX it to you?" I asked, thinking that he'd be happy that he
didn't have to sit impatiently and watch me for the next 20 minutes as I
finished reading the document.

"Okay, that'll work." I slid the document back over to him and asked him to
write the FAX number on it. I gave him my credit card to cover the initial
payment, he ran it and I walked out.

I actually did sit and read the whole document when I got home but I didn't
really like that I was required to give them 90 days notice prior to
terminating the agreement (30 days would be more reasonable, IMO). If I
decided today that I was going to move everything out of the unit tomorrow,
I'd still have to pay for the next three months (at $46 USD per month) even
though I wasn't using it any longer.

I never signed the document and I never FAX'd it back. I'm sure the guy
probably forgot all about it before I even made it home and I haven't been
contacted by the company since -- regarding the document or anything else.
Every month they charge my credit card $46 and life goes on.

I'll be moving everything out of there in a few weeks. When I do, I fully
intend to walk into the office, hand them the key, and point out that I never
signed the document and will fight any attempts to charge me the next three
months worth of rent.

Like most people, I usually just blindly click through EULA's and sign
whatever documents wherever somebody tells me to but in this case not doing so
paid off. I certainly wouldn't have expected that I'd be required to give them
90 days notice before vacating the storage unit.

~~~
brandonbloom

        I fully intend to walk into the office, hand them
        the key, and point out that I never signed the
        document and will fight any attempts to charge me
        the next three months worth of rent.
    

I hate to break it to you, but that contract is enforceable. Pretending for a
moment that this is something that would ever make it to court, you would be
found in breach.

In reality, what will happen is this: You'll refuse to pay. They'll casually
send your account to collections. You'll get some phone calls from a
collection agency and it will hurt your credit report. Ultimately, you'll pay
them to protect your credit score.

~~~
ggchappell
> I hate to break it to you, but that contract is enforceable.

Please explain. How can they enforce a contract he never signed?

~~~
ajross
Perhaps because he carefully read the contract, provided payment knowing the
contract terms, specifically conspired to violate said terms, and _then posted
the whole story to the internet_ might qualify? There's a concept of "good
faith" in the law. This is just vile, sorry. If you don't like the terms you
have an obligation not to buy the service.

~~~
jlgaddis
I wasn't aware of the 90-day policy until after I had already bought the
service, FWIW.

~~~
eCa
Wouldn't the right thing to do be this: Go back the next day and say that you
don't accept these terms and demand a refund of any payment made?

I would assume that the continued use of said storage unit makes acceptance of
contract implicit.

------
gamerDude
I love how not only do you sign for something that you didn't read. But they
can then change the privacy policy without sending you a new copy to agree to.

Seems a bit odd.

~~~
haldujai
This is factually incorrect.

Under 45 CFR §164.520(c)(2)(iv) any changes must be distributed to patients
within 60 days. Additionally unlike most other agreements, for HIPAA notices
of privacy practices you do not sign that you _agree_ to the terms rather that
you have _seen_ the terms.

------
skore
I suspect there is some kind of mathematical ratio concerning EULAs (in
whatever form) that somebody figured out and that is just getting more and
more absurd with each year that passes.

The basic idea is that the user wants something (in this case medical
treatment, but it could also be music via iTunes) and that's all nice and well
- BUT! - one last caveat, we need you to sign this thing here.

Now the ratio kicks in - if your desire for "the thing" is big enough, "the
thing you need to sign" just needs to look both terribly _unimportant_ ("yadda
yadda, nobody reads this") but at the same time _important_ enough to be
understood as necessary ("oh everybody has legalese upfront these days, that's
just the way things work, who cares"). Bonus points if the process you're
going through happens very often to a lot of people ("everybody just clicks OK
and chuckles about it").

Asking anybody to sign 3000 pages of legal statements without giving it too
much thought is bonkers, but everybody just assumes "well, they probably can't
do anything terrible, because our laws prevent that, right?". So we click
through EULAs and sign agreements that are now just nuisances getting
inbetween us and our desire for "the thing we want".

The people who make these agreements do them because they are required to have
them, by law or circumstance (CYAs). Not having an agreement is not an option.
The people who sign the agreements do that because they have already decided
that they want "that thing" no matter what. Not having the thing is not an
option.

What a profoundly weird situation. Through what I would guess were a couple of
outlandish precedents, we now have established a custom that none of the
involved parties cares about nor has anything to gain from, really. But we
still do it.

It's like two sides playing soundwaves with opposite phases, cancelling
eachother out. Everybody assumes that's ok, because it's quiet. But you could
just as well simply stop playing the damn sounds.

------
justgottasay
I have heard that these Privacy policy statements also make the doctor (or his
assignee) a 'co-author' of anything that you may write about your experience
in their office. This allows them to issue take-downs on bad reviews that end
up online.

~~~
ceejayoz
Yep. Some doctors have sued patients over bad reviews.
[http://www.techdirt.com/articles/20101110/19053611809/doctor...](http://www.techdirt.com/articles/20101110/19053611809/doctor-
sues-patients-over-bad-yelp-reviews.shtml)

------
bambax
When I take cash out of the bank I'm usually handed a form that says that I
have received the money _that I have to sign in order to receive the money_.

I say very politely that I can't say that I have received the money until I
actually have.

Usually the teller has this smile that means "here's another one of them".
Sometimes they don't smile at all, and I had to really argue once or twice,
but in the end they all accept my reasoning.

~~~
imrehg
Here in Taiwan businesses have to give a so called "fapiao", which is an
invoice and a receipt in the same time. If another company wants to buy
something from your company, you have to give them fapiao (since it's a
'invoice') and pay your taxes based on that to the government immediately
(since it's a 'receipt' as well), even if you haven't received a dime yet.

And since in its receipt capacity there's no other thing to issue to the
company once they pay, they could pretty much just not pay and say "why would
I have gotten a fapiao[receipt] if I haven't paid, dude?"

It's just amazing how many truly stupid things keep being done with finance,
and I'm puzzled about how could they be fixed.

------
stefanix
Amending contracts before signing is a perfectly fine practice and should be
done more often. I routinely do this to some reasonable extend.

I once singed up for a gym membership that had terrible stipulation to the
point it was offending. I plastered the entire contract with "no" and "not"
additions. It still went through.

------
8ig8
The whole song and dance bugs me. It's not practical. What patient is really
going to read a 3,000 page document? How long would that even take? How much
would a typical patient even understand?

Who benefits here? Lawyers? Insurance companies?

It's like that fine print on TV commercials. No human can read it given the
size and the duration on screen, but that company covered their ass by having
it there.

~~~
lnanek2
I couldn't care less personally, but theoretically there are people who
wouldn't want their treatment information shared. I suppose if they have
diseases such as HIV or something. It's kind of a bummer it makes it so tough
to do startups in the field.

I suppose I do like the provisions that prevent sharing information with
marketers that came along with all the other laws, but would have been just as
happy if that was left up to the free market. E.g. check this box for $50
dollars more expensive treatment or we might share your records with pharma
companies that will market medicine to you.

~~~
jessaustin
_...theoretically there are people who wouldn 't want..._

Whatever the patient wants, how will she find that topic addressed in two
paragraphs out of 3,000 (or even 20) pages? It's hard copy; there's not even a
search function! A situation in which people are forced to surrender rights in
order to receive service, especially if they've gone to some inconvenience
even to get an appointment, is neither equitable nor just.

------
jonknee
I usually just do not sign without saying anything and have not had a problem
returning doctors forms mostly empty (especially no SSN, that's asking for
trouble). It's highly likely that no one at the office has any more insight
into why the information is being asked than you do. If it's critical they
won't leave it to a line on one of many forms.

------
ivanbrussik
its just a waste of everyone's time. no one cares even if you are able to
prove a point we all know there are rooms off the grid where their are agents
that can make you do or say anything they want. but I forget you are in the
USA and I am in Russia.

------
laurenstill
I never understood, since HIPAA is theoretically designed to protect the
patient's privacy, why doctors/practioners aren't required to sign
notices/contracts to the patient.

------
_ak
Nobody reads Software License Agreements. Barely anyone reads (and is able to
fully understand) the GPL (no matter which version). That's real life. Suck it
up, Stallman.

~~~
daurnimator
Or you know, try and enact some change by loudly complaining?

~~~
jakethehuman
Yes, but to the proper people in a proper manner.

Otherwise you may as well just take a megaphone to null.

