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Is there anything that I shouldn’t tell my doctor about my life and is there anything about which the doctor shouldn’t ask?
"Is there anything that I shouldn’t tell my doctor about my life and is there anything about which the doctor shouldn’t ask?"
Besides a personal password…what else?
In 2006 the Virginia lower legislative chamber offered a law that would prohibit health care professionals from asking a patient about gun possession, ownership or storage unless the patient was being treated for an injury related to guns or asks for safety counseling about them. A pediatrician who asks a child's parent about firearms in their home could lose his or her license or be disciplined under that legislation The National Rifle Association supported the bill because it will protect gun owners "from intrusive, unnecessary questions from medical professionals," Fortunately, later, the Virginia Senate voted down the legislation.
Physicians take a medical history, both a present illness and past history to attempt to get facts that may or may not be immediately useful in making a diagnosis or in teaching the patient about health matters. The past history may include a variety of psycho-social questions and other questions including questions about understanding about risks for physical injury including controlling those risks. These may include not wearing helmets, not using seat belts, using illicit drugs, sexual behavior, unlocked medicine cabinets accessible to children and risky management of guns in the household. These are only what the physician believes are pertinent questions for the patient to answer if the patient wishes to. Note that the responses are not made under oath. Patients may refuse to answer or may provide an answer to the physician that is inaccurate or intentionally a lie.
Confidentiality is not only a medical professional duty but also in the United States a federal law. Hopefully, while telling the physician their story, patients will feel assured that this duty will be honored. Also hopefully, all physicians will explain to patients the reasons for asking the question.
Another curious example of this topic came from a lady writing to my bioethics blog who stated that she was "embarrassed" and unwilling to answer her male physician's question about her menstrual symptoms. She stated that he would have never experienced menstruation personally and therefor would not really understand her response.
But I repeat now to the Medpedia readers: “Is the anything that I shouldn’t tell my doctor about my life and is there anything about which the doctor shouldn’t ask?” ..Maurice.
Besides a personal password…what else?
In 2006 the Virginia lower legislative chamber offered a law that would prohibit health care professionals from asking a patient about gun possession, ownership or storage unless the patient was being treated for an injury related to guns or asks for safety counseling about them. A pediatrician who asks a child's parent about firearms in their home could lose his or her license or be disciplined under that legislation The National Rifle Association supported the bill because it will protect gun owners "from intrusive, unnecessary questions from medical professionals," Fortunately, later, the Virginia Senate voted down the legislation.
Physicians take a medical history, both a present illness and past history to attempt to get facts that may or may not be immediately useful in making a diagnosis or in teaching the patient about health matters. The past history may include a variety of psycho-social questions and other questions including questions about understanding about risks for physical injury including controlling those risks. These may include not wearing helmets, not using seat belts, using illicit drugs, sexual behavior, unlocked medicine cabinets accessible to children and risky management of guns in the household. These are only what the physician believes are pertinent questions for the patient to answer if the patient wishes to. Note that the responses are not made under oath. Patients may refuse to answer or may provide an answer to the physician that is inaccurate or intentionally a lie.
Confidentiality is not only a medical professional duty but also in the United States a federal law. Hopefully, while telling the physician their story, patients will feel assured that this duty will be honored. Also hopefully, all physicians will explain to patients the reasons for asking the question.
Another curious example of this topic came from a lady writing to my bioethics blog who stated that she was "embarrassed" and unwilling to answer her male physician's question about her menstrual symptoms. She stated that he would have never experienced menstruation personally and therefor would not really understand her response.
But I repeat now to the Medpedia readers: “Is the anything that I shouldn’t tell my doctor about my life and is there anything about which the doctor shouldn’t ask?” ..Maurice.
asked May 12, 2010 at 03:13PM in Other
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1Votes
answered May 14, 2010 at 11:28AMThe answer to this question is much more complicated now then it was only a few years ago. There is nothing a physician should be afraid, or even reluctant to ask a patient because even the smallest detail may lead to significantly better diagnosis and treatment. Likewise, while I know some subjects are difficult to discuss with their physician, it is a problem that they need to get past if they want the best possible medical care. There is, however, a downside to this unlimited openness and honesty.
While it is true that physician-patient interactions are confidential by law, it is a law with multiple exceptions. These include, among others, medical records (and physicians) that are required to provide the information by a court, search and seizure by government agents (especially after passage of the Patriot Act), and even simple lawsuits where medical records can be obtained via subpoena and entered into evidence (making them public) if they are germane to the underlying issues in the lawsuit. For example, a lawsuit claiming particular injuries may uncover medical records that reveal confidential information unrelated to the case (there are steps that can be taken to exclude the unrelated evidence, but they are not always successful).
I suspect the best answer to the question is for a physician to ask about everything they feel is important and relevant, and for the patient to answer truthfully, but where sensitive information is involved, they may ask the physician not to include it in their chart. That way, it can be considered but not available for publication. This is hardly a perfect solution, and there are still "holes" in it, but it is better than the alternatives. -
1Votesanswered May 14, 2010 at 10:19PMEric, not including pertinent history whether "sensitive" or not might be difficult for a physician to defend in court, if that absence led to a misdiagnosis or inappropriate treatment. The chart itself, as I understand it, is the property of the physician but the contents must be made available to the patient at the patient's request. I am not sure whether patients have a right themselves to physically or electronically alter the content of "their" chart. They probably have the right to request that the doctor revise the wording as an addendum but I don't really know and I look to you as a JD to provide an answer. ..Maurice.
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1Votesanswered May 15, 2010 at 08:02AMMaurice,
First, as I said, ultimately this is not a perfect solution, and your observation(s) is one of the holes I was referring to. Yes, not including pertinent information in the patient's chart would be difficult (although not impossible) to defend in court. On the other hand, if our primary interest is in patient care, it would provide a method to get information considered important for making a diagnosis or initiating treatment that would not otherwise be available. The patient could answer, "yes, I use [fill in name of illegal drug] daily; but please don't write it down." The physician would know and be able to use the information, but it would not be available if the records needed to be copied for various purposes including, but not limited to documentation for billing purposes.
Secondly, no one, least of all me, is suggesting that patients have the right to alter or add to their copies of medical records in any way. As you said, they have the right to request that the physician add an addendum, or even change the wording (at the time it is first written), but nothing else. For that matter, the physician should NEVER alter the record once recorded. If there is an error, it can be noted and the correct entry made afterward including the date and time the addition was recorded, but the original should still be visible, perhaps with a single line through the incorrect portion.
As I said, this is not the approach I would recommend either as a physician or as an attorney. On the other hand, as long as we live in a society where our personal information can become available to unknown people and entities in unanticipated ways and come back to haunt us, it may be a temporary fix to keep patient care high and allow sensitive information to remain confidential, thus maintaining confidence in the physician-patient relationship. Ultimately, though, it would be up to each individual physician to decide whether to include the information in the patient's record; a decision each doctor makes during every patient visit anyway. -
0Votesanswered Sep 02, 2010 at 09:13PMI have extended this issue on another Question ( http://www.medpedia.com/questions/1729-is-it-ok-for-patients-to-lie-to-their-doctor ) "Is it OK for patients to lie to their doctor?" I want the discussion to go beyond simply withholding information but actually lying, actively and intentionally denying, distorting or creating a history which could suggest that it was the patient's intent to deceive. Let's continue any further discussion about witholding information, the rationale and significance here but go to the new Question regarding patient lying since I think the intent may not be the same. ..Maurice.
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..Maurice.