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Database Nation by Simson Garfinkel

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The Medical Records Fairy Tale

From the outside, Daniel looked as if he was certainly vice president material. In his seven years with the company, he had relocated twice, revamped a division, and become a senior director. But then, one evening, Daniel's boss discovered a prescription bottle inside Daniel's medicine cabinet when she was over for dinner (she had been looking for an aspirin). A few telephone calls revealed that the drug was used for controlling hypertension—and that Daniel had a 15-year history of high blood pressure. The company's doctor said that people with Daniel's condition usually die within 5 to 30 years—but every case is different. So when Daniel's annual review came up, he got a hefty raise but not a promotion. After all, why give the guy more stress? And why groom a person to be one of the company's top executives when he might not be around in 10 years?

Once upon a time, medical records had a very specific purpose: they provided a detailed record of a person's encounters with the medical establishment so that future encounters might have a higher chance of having a positive outcome. People had a vested interest in making sure that their medical records were correct.

Today, medical records have an expanded role—a role that doesn't involve primary healthcare. They are used by employers and insurance companies to decide who should be hired and insured. They are used by hospitals and religious organizations to solicit donations. Even marketers are buying up medical ...

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