What Not to Tell Your Doctor?

many years since Medicine has been established as anethical profession and gained widespread credence peoplehave believed that they could and should tell their doctoreverything even remotely pertinent to their health and thatit was held in the strictest confidence. Furthermore, howcan the physician make accurate judgments when important orsignificant information is missing? This system worked verywell until relatively recently but there now exists a breachof this confidence that people should know about and thisbreach has developed from the advent of third partyinvestigations into people's backgrounds. Your medicalrecords are no longer confidential because you are forced toreveal them. Let us look at some scenarios.

When visiting your doctor's office on a Monday not feelingwell you tell him/her that you occasionally drink a halfcase of beer over the weekend. Believing in theconfidentially of your records you forget about it. Sometime later when you apply for life insurance the companyrequires you to sign a release for your medical records. (Norelease, no application.) The underwriters peruse yourrecords, note the extra beer, and subsequently rate yourpremiums higher making you pay extra for decades, thousandsof dollars.

You complain to your doctor of recurrent chest pain.Investigation reveals nothing, the discomfort resolvespermanently and you have no further follow-up to documentthe benign resolution. Everything is O.K. Ah, but notreally. Those words sit there permanently in the record.Later you apply for a mortgage or health insurance or lifeinsurance, signing a release of your records. You are turneddown flat or at least rated a higher premium.

Perhaps you have occasion to mention to your doctor that youhave stress, marital discord, job problems, andmental/emotional problems, etc. You later apply for a jobrequiring security clearance or background checks. Thesejobs are many and include police, security and just aboutany job involving real responsibility. Despite havingresolved the problems guess who might not get the job?You may never find out why, either.

You injure your hand and you admit to your doctor that youpunched a wall in anger. It could be the only time you everdid something like that but guess what? Those words willsit there forever and be taken as evidence of emotionalinstability. Want to try for a responsible job?

It really is a shame to see someone pay higherlife insurance premiums for decades or be passed over for ajob they really want because of an entry in their medicalrecord.

What can be done about this dilemma? (Webster: A predicamentthat defies a satisfactory solution.) Your concerns must bebalanced against the doctor's need for information and hisreal need to document what he/she concluded and why. Acorrect solution would be very welcome but one is notapparent.

The best approach might be the following: Tell your doctorthe truth and discuss with him/her your concerns regardingyour record coming back to hurt you and how this can bemanagedin the best way. In the case of your problem turning outto be benign then make sure the record reflects thisoutcome andis satisfactory to you AT THAT TIME. Don't be required toscramble around years later trying to correct it. That'slame at best and you probably won't even get a chance.Besides, even doctors don't live forever.

If your problem turns out not to be benign, then there is nochoice but to have it in your record. That's life.

When faced with a dilemma all one can do is make the mostcarefully considered decision one can. Work with your doctorand try to obtain a result that is best for you. After all,it's your life.

Just be careful out there.

(c)Vincent R. Moloney MD

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