Q: 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
A: 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, 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. If they are rejected, 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. Wise social policy must not abandon such people.
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. 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.
Q: At a spa, my girlfriend and I found two unoccupied lounge chairs — they are much in demand — with towels and a bag placed on top by people who wished to reserve them. I removed those things, and we used them. When that other couple returned, they were angry. Was my behavior OK? — Karsten Roth, Berlin, Germany
A: Why should a sun bed lie fallow when many people want to use it? A better way to avoid squabbles would be for the hotel to establish and post its reservation policy — a sign-up sheet? First come, first served? Either will do.
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