Health in­for­ma­tion: what does your doc­tor share?

Cape Breton Post - - CLASSIFIEDS/ADVICE - Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­corpo rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health news­let­ters at 628

DEAR DR. ROACH: If I share con­fi­den­tial in­for­ma­tion with my doc­tor, how much of that in­for­ma­tion is re­ported to my in­sur­ance com­pany? I am re­quired to sign the HIPAA form that al­lows in­for­ma­tion to be shared in or­der to pro­vide treat­ment. What are the lim­its and bound­aries of in­sur­ance com­pa­nies’ knowl­edge? Your an­swer de­ter­mines how hon­est I can be with a doc­tor. -- S.F.L.

AN­SWER: Your in­sur­ance com­pany has ac­cess to your med­i­cal records. It re­ceives the billing in­for­ma­tion from your doc­tor and can re­view the med­i­cal records to en­sure ap­pro­pri­ate billing and qual­ity. It may not dis­close this in­for­ma­tion ex­cept as pro­vided for in the Health In­sur­ance Porta­bil­ity and Ac­count­abil­ity Act of 1996 (HIPAA).

It hap­pens oc­ca­sion­ally to me that a pa­tient asks me not to put some per­sonal facts about hi­mor her­self into the med­i­cal record, and I al­ways agree not to do so, with the caveat that there are a very few sit­u­a­tions in which I, as a physi­cian, am re­quired to di­vulge priv­i­leged in­for­ma­tion. The most im­por­tant is if a pa­tient tells me he or she has a plan to in­jure a par­tic­u­lar per­son.

In my ex­pe­ri­ence, the most com­mon sit­u­a­tions in which a per­son doesn’t want some­thing in his or her record re­lates to a psy­chi­atric di­ag­no­sis, a history of as­sault and illegal ac­tiv­i­ties, es­pe­cially drug use. These all are im­por­tant for your doc­tor to know, so I hope you will be hon­est with your doc­tor about what­ever sit­u­a­tion you are con­cerned about, but I would en­cour­age you to dis­cuss pri­vacy, in­clud­ing your de­sire for the in­for­ma­tion not to be en­tered into the med­i­cal record.

You also have the op­tion of pay­ing for the visit your­self, in which case the in­sur­ance com­pany gets no in­for­ma­tion.

DEAR DR. ROACH: Plas­tic pill crush­ers and a mor­tar and pes­tle are very painful for my arthritic hands. The phar­ma­cist of­fered me no bet­ter op­tion for crush­ing pills. Then my ag­ing brain had a mo­ment of lu­cid­ity -- an elec­tric cof­fee grinder! It works per­fectly and can han­dle sev­eral dif­fer­ent pills at the same time. Please let your read­ers know. -- S.L.P.

AN­SWER: I think it’s bril­liant; how­ever, do make sure the ma- chine is clean, and I would use it only for medicine. Use a brush (also, used just for this task) to re­move all the pow­dered medicine af­ter each use. Fi­nally, check with the phar­ma­cist to make sure the pills can be safely crushed. Some can­not be, es­pe­cially those with an ex­tend­e­drelease for­mu­la­tion.

DEAR DR. ROACH: Can you tell me about the safety of ure­thane? Is it a safe ma­te­rial for shoes to be made with? I have al­ler­gies to many things and don’t want to or­der some­thing that might cause feet prob­lems. So many things are man-made these days in­stead of us­ing nat­u­ral and proven ma­te­ri­als. -F.L.G.

AN­SWER: I think you are talk­ing about polyurethane, a use­ful plas­tic poly­mer that is used in many ap­pli­ca­tions, in­clud­ing hard plas­tics and foam plas­tics. The short an­swer is that while a man-made prod­uct, polyurethane in shoes and in­serts are very likely safe.

Some foam mat­tresses and other prod­ucts made be­fore 2005 con­tain fire-re­tar­dant chem­i­cals called PBDEs, which can ac­cu­mu­late in the en­vi­ron­ment and may cause tox­i­c­ity. How­ever, shoes bought now us­ing polyurethane should be safe.

READ­ERS: The book­let on con­sti­pa­tion ex­plains this com­mon dis­or­der and its treat­ments. Read­ers can or­der a copy by writ­ing: Dr. Roach -- No. 504, 628 Vir­ginia Dr., Or­lando, FL 32803. En­close a check or money or­der (no cash) for $4.75 U.S./$5 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

Keith Roach To Your Good Health

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