The Health Insurance Portability and Accountability Act is an interesting piece of legislation that came close to costing me my job today. OK, maybe a bit dramatic, but maybe not. Being a physician in the same hospital as all of J's doctors does create potential hazards. My hospital takes an extreme position in interpreting this and all other laws. They don't want to even come close to the line. As such, any visit into J's medical chart can be grounds for discipline including up to termination of employment. I always need to be on my toes.
The working plan with the kidney stones was to assess how many kidney stones were present on the PET scan, and where they were located. Depending on the results (although I don't know the real decision making that was going to be employed) the urologist was going to take a look at the ureter, remove any stones, and downsize the stent. I was supposed to inform him of what the PET scan showed. I decided to wait until the report was finalized, but sadly that had not happened by noon today, so I paged the urologist with a brief summary, and my contact information. He must have forgotten that I was supposed to give him results. Instead of simply responding to me, he sent a message to one of the pediatric radiologists (who doesn't read PET scans) and asked him to review it with him and I could be there (that way I wouldn't need to access his records). Unfortunately he sent the message through our electronic medical record's messaging system, and linked the message to J's chart. If the message is opened, the chart is opened with it. They have software in place to monitor inappropriate access to medical records. I have every reason to believe that my activity was flagged for reading a message from one of J's doctors. I called are Information Security Office and surrendered my life and three of my children as payment for this violation. Actually, they know that this can happen innocently, so I gave my name and they recorded it for when they review flags in the system. A tedious problem, but J's confidentiality was preserved, so it was worth it. And while my job was in jeopardy, it wasn't really.
Yesterday J had repeat blood counts. His white blood cells had dropped significantly from last Friday. He had stopped receiving the injections to boost the blood cells, and this is what happened. We still had two more doses at home, and we were instructed to give them to him. His platelets also dropped farther, down to 21. Below 100 is low. Below 50, nobody feels very comfortable doing a procedure, especially if there is no urgent need to do the procedure. The risk of bleeding uncontrollably is too great. I shared the platelet results with the urologist as well. He decided we were better off waiting until after the next round of chemotherapy before we attempt to remove any stones or the stent. J was sad. He actually cried. He has pain whenever he urinates, and it's probably related to the stent and a stone in the end of the ureter, both of which can cause irritation of the bladder and ureter, causing pain. He was excited for that pain to end. Poor kiddo. We weren't as sad. The surgery was scheduled for 3:00, and that's assuming all the other cases are finished on time. Didn't sound like a fun day to starve a kid for a late afternoon surgery. We'll revisit the kidney stones sometime in the future.
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