A DOCTOR'S NOTES

[okarol]

I just read this column and it reminded me of all the years that I kept a secret. I never told any of my doctor's (OB/GYN, primary care) that my dad had polycystic kidney disease. Our friend who is an internists had cautioned me that this info, if noted in my medical files, could jeopardize my ability to get health insurance if I ever had to purchase a policy. So I omitted it.

OPINION

A DOCTOR'S NOTES

Sun Mar 2, 8:01 PM ET

I am an internist. A life-insurance company rejected a patient of mine when it saw on his medical records, read with his consent, that he has used drugs recreationally. He angrily told me he didn't know this would be in his records (although he saw me taking notes during his visits). Should I include such things in patients' records and emphasize that I'm doing so, even if it leads my patients to withhold important information? -- Michael Wohlfeiler, M.D., Miami Beach
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You should be sure your patients understand what is in their medical records, the possible consequences of an insurer reviewing these records and the medical implications of a patient's withholding information from his physician. It is the patient's right to decide, with your guidance, how to balance these factors.

You've suggested one possible, if unsettling, alternative: Omit certain information from the records. This may best serve your patient, your primary obligation, but it misleads insurers, which have a legal right to this information once the patient releases his records. They may reject those who engage in some risky behavior. Many people would defend an insurer's right to deny coverage to someone whose hobby is drunken mountain biking on the slopes of an active volcano. Blindfolded. If naked, drunken, sightless lava-bikers, why not chain-smoking, crack-using, unprotected-sex enthusiasts? It is reasonable to reject -- or raise the rates for -- those who choose to place themselves in peril.

It is a different matter when that peril is not volitional. This may be the case for someone with a congenital disease or whose DNA suggests he is at risk for certain maladies. Wise social policy must not abandon such people.

It is also different when considering not life but health insurance. Everyone has a moral right to health care. Current public policy, built around private insurers, can thwart that access by denying coverage or making it prohibitively expensive for those who have a serious medical condition like HIV, for example, or engage in risky conduct. Under this system, it is difficult to imagine a really good course of action for a physician. Only a change in public policy can truly solve your problem.

Randy Cohen is an Emmy Award-winning comedy writer who has worked with David Letterman and Rosie O’Donnell

[Roadrunner]

I can understand the problem.  My daughter had a serious spinal condition that needed surgery or the chances of her dying or at best being a paraplegic would occur.  In the surgical report the surgeon wrote that it "MAY" have been a congenital condition.  Guess what.  The insurance wouldn't pay. (they don't pay for preexisting conditions) If the doctor had talked to me about it I could have told him how I think the situation happened and he could have worded it differently.   

Doctors are unaware of the problems some of the things they write or do cause.  It is the same with the price of medicine.  My husband told the doctor that one of the medicines he prescribed cost over $100 per month and was not covered by insurance.  This took the doctor completely by surprise. He had no idea it was so expensive.  He said there are others that he could take and we found one that the insurance covered. 

Our neph said that Procrit was expensive when he prescribed it and I was thinking $100 or so.  When I went to the drug store the pharmacist asked for over $900 for a month's supply (5 years ago).  When she saw the expression on my face she said she would give me a weeks supply and told me how to talk to my insurance and doctor to get this for the $15 copay.  I did get the approval or we would be destitute by now.

[rose1999]

I'm thankful we have the NHS here - it's not perfect (not by a long way sometimes)  but at least it's free at delivery and available to all.

[paddbear0000]

When my now husband had proposed to me in November of 2005, we set a date of 6 months later to get married. At that point, I got enough refills on all of my meds to last that long and completely stopped seeing any doctors related to my kidneys and diabetes, even my primary care doc. The reason I did that was because my husband's insurance had a 6 month pre-existing condition clause. When I first used the insurance 9at new doctor's of course), the insurance company wanted records from any doctors I'd seen in the previous 6 months. As far as they know, I was a perfectly healthy person before getting married! If they had known I was diabetic and in kidney failure before, I wouldn't have been covered for a year after our wedding! We'd still be paying out of pocket now. We'd be bankrupt--or I'd be dead!  Insurance companies suck!