In her March 15 Health & Science article, “Why would my patients not tell me the truth?,” Daphne Miller pointed out various reasons why patients are not wholly truthful with their doctors.
She reported another doctor’s suggestion that some information, such as that dealing with smoking, drinking, etc., might be recorded in a confidential section of the medical record not revealed to insurers or anyone other than the original treating doctor.
This approach carries both practical and ethical problems.
If the patient requests transfer of medical records to obtain treatment in a different location, important medical information necessary for proper care may be omitted.
Also, insurance companies may base their actuarial determinations about rates upon specific issues such as smoking. Statistics gathered by third parties about the effect of interventions may be erroneous if information is missing. Should a doctor knowingly conceal this information and not report it when asked for medical records? Such behavior is dishonest and, while beneficial in the short term for that individual patient, detrimental to the system as a whole. If the system is broken, and I think it is, doctors should work to fix it.
Before I retired as a gastroenterologist, when patients asked me to be untruthful — for example, to certify illness when there was none or to omit important information (such a specific diagnosis) from the medical record — I asked them: “Do you want to go to a doctor who is dishonest?” In my more than 40 years of practice, no one answered “yes.”
Herbert Rakatansky, Providence, R.I.