How much information about your health should the government have?
(Editor’s note: A version of this commentary ran in
Michigan Capitol Confidential on Oct. 11, 2011.)
Gov. Rick Snyder recently proposed an unprecedented
plan to have doctors report the body mass index of individual children into a
state database and tracking system (the Michigan Care Improvement Registry).
Contrary to the governor’s claim, this is not anonymous reporting.
The records in this database would be accessible not just to doctors and
nurses, but also to schools, day care providers and insurance companies — all
without parental consent. Specific children could be tracked over time, as
could their compliance (or lack thereof) with a doctor’s recommendations.
“Reinventing Michigan” shouldn’t mean whimsically implementing programs designed under a previous administration or mimicking costly and failed programs from other states.
and statistical reality of this intrusiveness is impossible to ignore. The data
gathered will be spotty and incomplete; Black and Hispanic children will be
disproportionately affected; BMI reporting will not decrease childhood obesity;
and the community wellness programs this would presumably facilitate do not
have a record of decreasing childhood obesity.
Finally, from a purely practical standpoint, the
time spent reporting is not insignificant. In a typical office with 10,000
patients in the tracking system, at a rate of one minute per record, a
full-time nurse would spend more than one month each year just reporting BMI
But all those details pale alongside the deeper
ethical issues involved. Gov. Snyder is asking and expecting doctors to violate
our Hippocratic Oath. Sadly, in some realms of our society, promises are
routinely broken and privacy is passé. Medicine, however, is a calling,
comparable in some ways to the clergy. I speak for the vast majority of practicing
physicians when I say that our oath to “first do no harm” still means
something. Among other things, it creates a duty to protect patient
confidentiality, just as the clergy has a duty to protect what is often called
the “seal of the confessional.”
Exploiting the privileged, private relationship
that patients entrust to their doctor to pursue transient political and
governmental purposes would be a serious breach of our oath. Suggesting that
government bureaucrats can better manage health decisions than a doctor,
patient and family working together reflects a breathtaking arrogance.
Offering doctors government-approved nutrition
brochures and posters in exchange for reporting our private data is simply
insulting. Any doctor worth his or her salt is already following the American
Academy of Pediatrics and American Medical Association recommendations to track
BMI and discuss it at routine physical exams. To extrapolate these
recommendations into a suggestion that the AAP and AMA endorse this new policy
is a misrepresentation of the policies we already adhere to.
“Reinventing Michigan” shouldn’t mean whimsically
implementing programs designed under a previous administration or mimicking
costly and failed programs from other states. It shouldn’t involve supposed
rule changes that actually amount to an executive order that bypasses the
Michigan can do better. We should respect
evidence-based medicine, rather than embrace fuzzy feel-good concepts. We can
respect the confidentiality of the doctor-patient relationship, not compromise
it. We can respect the individual right to consent, not obscure it with this
system’s tricky “opt-out.” A program that is genuinely excellent can withstand
the full legislative process; circumventing that speaks loudly to the poor
quality of this program.
The Legislature’s Joint Committee on
Administrative Rules should soundly reject this proposed rule change. Governor
Snyder should start again from a foundation that is based in evidence, respects
the private medical record, respects the right to consent, and follows a full
Dr. Megan Edison is a
pediatrician in Grand Rapids and vice president of the Michigan chapter of
Docs4PatientCare. The Mackinac Center for Public Policy is a research and educational
institute headquartered in Midland, Mich. Permission to reprint in whole or in part is hereby granted, provided
that the author and the Center are properly cited.