Novel shows the dark side of computers and managed care

Psychologists who transmit patient information to managed-care companies may hesitate after reading Michael Freeny's novel "Terminal Consent."

Freeny, a licensed clinical social worker in Florida, has seized on what many practitioners fear about managed care and uses the novel format to hammer at his belief that there's a danger looming out there. "Terminal Consent" (William Austin Press, Inc., 1998) demonstrates how easy it is for managed-care companies to limit patient care and unwittingly compromise patient confidentiality with computers.

The novel is also used as a teaching tool. Mental health professionals and nurses, are eligible for continuing-education credit after reading the novel and a short nonfiction article entitled "Do The Walls Have Ears?" from the September/ October 1995 issue of Family Therapy Networker. Psychologists can receive 10 continuing-education credits through Barry University in Miami Shores, Fla.

The continuing-education course focuses on how technology affects the practice of psychology. Computer technology intimidates most health-care providers, Freeny says, but they need to understand how it works so they can protect their clients' privacy.

"The best way to teach providers about technology is to make it a fun and thrilling read that speaks to their experiences as clinicians and even as consumers," he says.

In the novel, Jenny Barrett, a young psychologist working at a managed-care company, discovers her employer is using a Multiaxial Outcome Management computer system--MOM for short--to calculate the most profitable course of medicine for patients.

In some cases, MOM determines that the most lucrative strategy is no treatment. For example, MOM calculates that people in pain die faster, so doctors are told to keep pain medication to a minimum so patients will die quicker, saving the insurance company money.

This scenario is not farfetched, Freeny says, because increasingly managed-care companies are using computers to determine the best course of medicine. The machines, processes and protocols described in the novel are used every day by managed-care companies, he says. For example, Freeny says, when a provider calls a managed-care company for treatment authorization, the caseworker will often use a computer to determine the diagnosis.

"They're not making the decisions," he says, "the computer is making the decisions."

Computers can also compromise patient confidentiality, another theme of the novel, Freeny notes. Computers collect and categorize patient information for a nationwide medical database. Information provided to managed-care companies often becomes part of a large computerized medical database at the Medical Information Bureau (MIB) in Westwood, Mass. Insurance companies query MIB about a patient's past medical or mental health history before granting them health, life or disability insurance, Freeny says. "More providers, whether they realize it or not, are hooked into a proliferating information system," he says.

Freeny's characters find that database sales of client information are highly profitable and easily transmitted to fax machines, printers and over the Internet. Freeny says he recently demonstrated this reality when he was visiting a teaching hospital in the Mid-Atlantic. Within three minutes of sitting at the hospital's computer, Freeny says, he was able to locate the hospital's substance abuse records on the computer's hard drive. With one click, Freeny could have dumped those records on the Internet. Freeny says this is troublesome since he is a clinician, not a computer hacker.

The novel has received compliments from health-care providers, among them Martin E. P. Seligman, PhD, APA's past president, who lists "Terminal Consent" among his five favorite books and calls Freeny the Robin Cook of managed care.

For more information on the book and continuing-education credits, log onto web site www.terminalconsent.com or call (800) 638-0028.

--L. Rabasca

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