The Patient Was…

The patient was a middle-aged white male, a well-known politician with a national reputation, an iconic individual. He was intelligent, egotistical, opinionated, argumentative, and charming. I liked him a lot.

He was referred to me because his general practitioner had found that he had hypertension (high blood pressure). Except for elevated blood pressure, which I confirmed, the rest of his examination was normal. On his first and all subsequent visits with me, he refused to take any medication despite my warnings of potential serious consequences of untreated hypertension.

On one occasion, when I said, “You know, your untreated high blood pressure can lead to you having a stroke,” he replied, “It wouldn’t dare!”

Around this time, a relatively new phenomenon was occurring in general society: gathering, analyzing, and monetizing personal data of people going about their normal and ordinary activities. Data on where people went, whom they saw, what they bought, what they read, what they wrote, and so on, were captured. Algorithms were developed to predict their future consumer and political behavior in response to targeted appeals and promotions.

Among the data-gathering initiatives with particular relevance to medical care was the purchase of physicians’ prescribing records. Companies bought the data from pharmacies  —  patient identification was removed so patient privacy was maintained  —  and sold it to pharmaceutical companies which, in turn, turned it into information useful in their sales and marketing activities to individual physicians. The idea was analogous to the proven fund-raising concept that if you want to raise money for a specific cause go to those who have already given. In pharmaceutical marketing and sales terms, if you want physicians to write more prescriptions for specific medications, target your efforts to those who already write scripts for those drugs.

My skepticism about the accuracy, and therefore the value, of these data was shattered when, in my role as medical director of a large pharmaceutical advertising agency, my own data were revealed to me. I resented the fact that this information was available to commercial entities; even though pharmaceutical companies were clients of our agency, I felt it to be a violation of my privacy and, therefore, that of any physician whose data were collected.

Since I knew that my politician patient had considerable public influence, and wasn’t shy about expressing his opinions, I raised the issue with him during one of our office visits. To my surprise, he vehemently disagreed with me. The public, he opined, even if it be a commercial entity, has a right to know about the prescribing habits of individuals physicians. Unless a physician is doing something wrong, why should he or she resent that information being available?

I thought about this for a few moments, and then I said, “Let me paint a picture for you. Imagine this scenario: You are running for re-election. Questions are raised about your health because you are known to visit a physician regularly. You offer to have your doctor  —  say it’s me  —  issue a statement attesting to your good health. Your political opponent, and the media, access my prescribing information and let’s say they find that I frequently prescribe anti-anxiety and anti-depression medicines. Now, I may see lots of people who need those medications, but nobody knows anything about those patients.”

I stopped for a moment because I could see a look of concern on my patient’s face. He seemed to sense where I was going with my argument.

Then I continued. “Suppose your opponent says publicly that since you see a doctor who seems to treat lots of people who need medications for emotional problems, perhaps you have emotional problems, perhaps you’re not a stable person, perhaps in a crisis you might fall apart, blah, blah, blah.”

“Outrageous!” yelled my patient. “It’s a total invasion of privacy. Nobody should have access to doctors’ prescriptions.”

In the end, nothing changed except his viewpoint. He continued to refuse to take medication for his blood pressure. He did have a stroke. And he never again ran for political office.