If privacy is not an extinct phenomenon, it certainly is an endangered
one. Entrepreneurs—often using questionable tactics—offer access
to private data about persons famous and obscure.1
More insidiously, "electronic busybodies" gather endless information about
us all, as we check out at supermarkets, make purchases with credit cards,
and browse Web sites where every click of a mouse reveals something about
our peculiarities and preferences.2,3
There is, increasingly, no place to hide. Although the contraction of privacy
in other spheres may be cause for concern, in medicine the problem is particularly
difficult. Demands for access to medical information are put forward in the
name of cost savings, quality improvement, public health, advances in research,
and other laudable goals.4 Managed care companies
insist on reviewing medical charts to determine if care should be authorized;
accrediting bodies want to ascertain that clinicians' notes are detailed and
complete; government agencies seek identifiable information for planning purposes
and to prevent fraud5; and law enforcement
agencies see in medical records a means to identify and convict wrongdoers.
Most of the time, access to these records is sought without patients' knowledge
or (in more than a formalistic way) consent.
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