For many years since medicine has been established as an ethical profession and gained widespread credence people have believed that they could and should tell their doctor everything even remotely pertinent to their health and that it was held in the strictest confidence. Furthermore, how can the physician make accurate judgments when important or significant information is missing? This system worked very well until relatively recently but there now exists a breach of this confidence that people should know about and this breach has developed from the advent of third party investigations into people's backgrounds. Your medical records are no longer confidential because you are forced to reveal them. Let us look at some scenarios.

When visiting your doctor's office on a Monday not feeling well you tell him/her that you occasionally drink a half case of beer over the weekend. Believing in the confidentially of your records you forget about it. Some time later when you apply for life insurance the company requires you to sign a release for your medical records. (No release, no application.) The underwriters peruse your records, note the extra beer, and subsequently rate your premiums higher making you pay extra for decades, thousands of dollars.

You complain to your doctor of recurrent chest pain. Investigation reveals nothing, the discomfort resolves permanently and you have no further follow-up to document the benign resolution. Everything is O.K. Ah, but not really. Those words sit there permanently in the record. Later you apply for a mortgage or health insurance or life insurance, signing a release of your records. You are turned down flat or at least rated a higher premium.

Perhaps you have occasion to mention to your doctor that you have stress, marital discord, job problems, and mental/emotional problems, etc. You later apply for a job requiring security clearance or background checks. These jobs are many and include police, security and just about any job involving real responsibility. Despite having resolved 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 you punched a wall in anger. It could be the only time you ever did something like that but guess what? Those words will sit there forever and be taken as evidence of emotional instability. Want to try for a responsible job?

It really is a shame to see someone pay higher life insurance premiums for decades or be passed over for a job they really want because of an entry in their medical record.

What can be done about this dilemma? (Webster: A predicament that defies a satisfactory solution.) Your concerns must be balanced against the doctor's need for information and his real need to document what he/she concluded and why. A correct solution would be very welcome but one is not apparent.

The best approach might be the following: Tell your doctor the truth and discuss with him/her your concerns regarding your record coming back to hurt you and how this can be managed in the best way. In the case of your problem turning out to be benign then make sure the record reflects this outcome and is satisfactory to you AT THAT TIME. Don't be required to scramble around years later trying to correct it. That's lame 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 no choice but to have it in your record. That's life.

When faced with a dilemma all one can do is make the most carefully considered decision one can. Work with your doctor and 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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