Should Doctors Be Allowed To Check Your Receipts?

-- By Gabriel Unger - 01 Feb 2015

Introduction

Many companies have been accused of using consumer data for marketing products, providing discounts (or concealing them), and determining credit limits for potential or current borrowers. However, one previously unexplored use of consumer data is for doctors. Shannon Pettypiece and Jordan Robertson, in Hospitals Are Mining Patients' Credit Card Data to Predict Who Will Get Sick, note that as medical care grows increasingly expensive and information becomes more available, some hospitals have toyed with the idea of obtaining information about their patient’s consumer behavior to provide more efficient healthcare. For example, Carolinas HealthCare? purchases data from brokers who specialize in gathering information from public records, store loyalty program transactions, and credit card purchases. Based on this data, Carolinas HealthCare? identifies high risk patients, labeling them with a risk score and provides those scores to hospitals in the hope that the doctors can intervene and suggest recommendations before the patients become ill.

At this point, the data collection agencies restrict Carolinas HealthCare? to sharing only the risk scores with doctors, keeping the actual consumer information confidential. However, Carolinas HealthCare? has stated its intention to renegotiate so that doctors can obtain actual records of their patient’s consumer habits in order to provide the best medical care possible. The question I would like to address is whether this step in the use of consumer information is a good thing. I believe the dissemination of consumer data to doctors is uniquely worthy of analysis because it is clear that your personal information is being used (as opposed to the NSA or credit card companies that conceal such use) and unlike marketing, one cannot avoid doctors by simply choosing to not click on a button. Further, it poses very clear benefits to both patients and society as a whole, warranting it special consideration.

Patient and Economy Benefits

The positives of doctors having access to more information about their patients are intuitive. Patients frequently do not consider the full effects of their behavior on their health. The instant gratification of eating one more jar of cookies frequently overwhelms the thought of one’s long term health. If a doctor is aware that his or her patient is not eating well, he or she can intervene before serious illness arises. Further, even if without prior intervention, they can more effectively treat their patients, possibly saving lives.

Additionally, healthcare poses a major drain on our economy and providing more information to doctors can save taxpayers from subsidizing poor habits and therefore, it is better for the society as a whole for doctors to have access to this information. Also, there is an argument to be made that the use of consumer information is already widespread and simply extending it to doctors will not fundamentally change how others use consumer information. Either way, when Congress or another agency chooses to legislate on the usage of consumer data, it will address this issue.

The Challenges of Increased Information

On the other hand, allowing doctors access to consumer information in order to provide more informed medical care may constitute an unprecedented and potentially dangerous step in the world of patient care and data privacy. First, it gives doctors considerably more information before they even meet the patient, increasingly the likelihood that doctors will have preconceived notions about the patient before he or she can convey their story or their side. There is no guarantee that the risk ratings or the information is fully representative of the patient’s behaviors but it may very well influence the doctor’s view. Further, it can potentially change the relationship between doctor and patient where the doctor is no longer learning about the patient but is constantly demanding changes in their behavior.

However, besides for the medical challenges that such disclosures raise, it implicates concerns about data collection and its uses generally. Having a doctor call you unsolicited to discuss a recent purchase intuitively appears as highly intrusive. While someone may not mind being inundated with ads that they can simply choose not to click on, the personal relationship with one’s doctor is not as easily avoidable. While one can choose to switch to a doctor who forgoes the information technology, this is not a desirable option for one who has an established relationship with a doctor over many years. Furthermore, it severely limits one’s choice of medical care and people may not wish to compromise their ability to obtain the best doctor available for the personal relationship.

Further, there is a slippery slope argument to be made here. Until now, the public use of consumer information has rarely interfered with one’s personal life beyond recommendations or advertising. While the Snowden revelations showed that governments use our data for surveillance, this was done surreptitiously and there was considerable embarrassment after the discoveries. Similarly, the NYT reported in an article entitled, American Express Kept a (Very) Watchful Eye on Charges, that American Express as well as many other companies insist that they do not use consumer information for determining lines of credit. The press places a check on companies who would use spending habits to make decisions on loans. Doctors however, may very avoid this scrutiny since due to the argument that it contributes to the public good. The precedent that it will set for the use of consumer data may lead to the use of data collection in other less savory areas. At that point, people may be less reluctant to the idea of companies tracking their consumer behavior since they experience it frequently in healthcare despite the fact that it could be far more harmful.

Conclusion

Considering the significant benefits involved in providing additional healthcare information to doctors and the very real dangers of allowing it, I would propose that the best resolution is permitting the use of consumer data but only with the informed consent of the patients. This may avoid the steady habituation to the use of consumer data since patients are aware of the fact that they consented to its use and could always back out.