Kenneth Beer, M.D.
Monday, June 27, 2005

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  Why should we care that Rush Limbaugh's medical records might be exposed during a trial for doctor shopping? Because once his records are revealed, our medical records as well as those for every patient in every physician are at risk. When this happens, your friends, relatives, employers and health insurers are going to know things about you that are simply not their business.

When I teach at The University of Miami, I see multiple patients with rashes that are not easily explained. Some of them have implications beyond the eruption that brought them in. For instance, the eruptions seen with sexually transmitted diseases or drug use require antibiotics to prevent their spread.

Many of the patients that are cared for are in this country illegally and they function at the fringes of our society and economy. These are the people that parhaps clean our homes or prepare our food, for example. I don't think it is in our interest to increase the rates of infectious diseases in these patients. Without the ability to question a patient and receive honest answers, there are many diseases that will go untreated.

We can expect that syphilis, HIV and a host of other diseases will remain untreated if this occurs. This will increase the healthcare burden imposed by these diseases. Perhaps more importantly than the financial cost is the epidemic that would occur. Patients who do not get adequate therapy will spread diseases in an unprecedented manner.

As we consider emergency room and primary care, the issue becomes even more vivid. Patients presenting with a simple laceration or bruise may be there to discuss domestic violence. Fearing public disclosure of their situation, the conversation will most likely not occur.

In the primary care arena, many complaints such as headaches and gastrointestinal problems are the opening that allows a patient to discuss family, financial or other problems that are intensely personal. There is no compelling reason that this should change.

Medical care is already taxed to the limits for both physician and patient and every opportunity to build bonds between these two people should be left in place. Without the chance to have a frank conversation in the 5-10 minutes allotted by most managed care plans or Medicare fees, the interaction will be rendered entirely useless.

Without unfettered access to a patient's medical history, a physician's job will get much more difficult. This will result in time and money wasted on irrelevant tests that could have been avoided had full disclosure from the patient been secured. An interaction in which the physician is left to guess at the patient's history will be devoid of significant benefit and runs the very real risk of increasing the rates of missed diagnoses.

The confidentiality of patient medical records should be breached when there is a clear and present danger that outweighs the risk of violating patient confidentiality. Such scenarios are, unfortunately, all too apparent in today's environment and one can imagine the need to know that some of the people that conducted an anthrax attack were at doctor's offices stocking up on antibiotics. A discussion that discloses plans to harm another individual seem to be fair games as well.

Some in the ACLU will balk at these types of disclosures but I think we need to make allowance for events that can cause irreparable harm.

Rush's case seems to me to be less about irreparable harm than about proving a political or social point. This does not warrant violating a tradition that has been as old as medicine itself.

Kenneth Beer who practices dermatology in Palm Beach, Florida.

Editor's note:
Rush Limbaugh Says the War for the Court Has Begun! Find Out Details – Click Here Now