next »

[soymilk]

I am in a bit of a mess here. Here is the situation (I posted a portion of this to the Money thread): I had a phone interview for a life insurance company several weeks ago. At that time, I answered truthfully about my family medical history, including the fact that I had two different family members with a history of cancer.
Since answering these questions, I learned my sister has breast cancer. At the time I learned, my file was still in underwriting. As of this moment, the file is still under review. As part of the application, I gave permission for the life insurance company to contact my medical & mental health providers.
I have been upfront about my medical history with these providers. For example, I told the internist why I wanted a mammogram (I was overdue anyway) and she was fine with leaving the information about my sister's condition out of my record. Then, today, my OB-GYN told me I was asking her to commit medical fraud by discussing my sister's cancer and then asking her to not put it in the record. We discussed it a little bit, and then she said "we have already discussed it too much". She was clearly very distressed by the situation, wanting to discuss my new risks (I am already quite familiar with my risks) but not wanting to do so. I want to find a new OB-GYN, my sister says this will be construed as further evidence that I am attempting fraud. That was not my intent, I'm just uncomfortable with the reaction of this provider. Thoughts?

[wet_blanket]

I don't know about fraud, but you were certainly asking the OB-GYN to commit malpractice.

[helpful]

I don't understand; are you applying to work with a life insurance company?

[jmargerum]

Well. . . if you're asking to have the material left out of your file so that you get a less expensive rate on your insurance. . . yes, that sounds dishonest.  I'm not a lawyer and don't play one on TV, so I don't know if "fraud" is the right term.

Jon

[wet_blanket]

I don't understand; are you applying to work with a life insurance company?

I assume the OP is trying to buy insurance, and is concerned the family history will increase her premium or get her declined.

[sea_and_ski]

I don't know about fraud, but you were certainly asking the OB-GYN to commit malpractice.

I've always understood malpractice as treatment below the (local) standard of care that leads to patient harm.  I think this is closer to fraud (depending on the nature of the insurer's request to the MD) or simple dishonesty, though it would be interesting to hear a lawyer's opinion.

To the OP, I think you're the victim of poor timing here.  You were truthful when you applied for the insurance, but new data have come in during the underwriting process.  These data may affect your life expectancy (in an actuarial sense), so if they are available to the company it's appropriate that they use them in calculating rates.  Hopefully, either the insurance company won't come across those data of, if they do, it won't too negatively impact your rates or insurability.  Good luck!

[wet_blanket]

I don't know about fraud, but you were certainly asking the OB-GYN to commit malpractice.

I've always understood malpractice as treatment below the (local) standard of care that leads to patient harm.  I think this is closer to fraud (depending on the nature of the insurer's request to the MD) or simple dishonesty, though it would be interesting to hear a lawyer's opinion.

Standard of care includes keeping accurate and complete records, and discussing things like the implications of a close family member being diagnosed with a condition that has a genetic component.  It's about the potential for harm, not just actual harm.  Maybe it's fraud as well, but it's definitely malpractice.

[mtnman]

It could be insurance fraud if the OP were asking a third party to pay for services not related to the physician's billing records. For instance, if you wish to discuss/treat a particular health condition and request it be billed under a different code. It is important for health care providers to maintain thorough documentation reflecting the actual medical care provided. Failure to maintain such documentation is malpractice.

I bet the OB/GYN was simply telling you that they thought you were asking them to "hide" information from insurance.

[soymilk]

Thanks for everyone's input. I am really embarrassed about this entire situation, especially because I have done research in health care settings and never heard of this particular issue. I had always taken the view that patients have a lot of control over their health care, and since the medical record is about me, I get some control over it also. I have never before had a health care provider raise an objection in the few times this has been an issue. I certainly understand that I could not take a blood test or undergo a procedure without it going in the medical record. However, information about my family can come only from me, and in that sense it belongs to me and not to the health care provider.
If I understand everyone's logic here, suppose a person learns they have HIV through anonymous testing. I'm sure this happens a lot. Then, they go to a physician for a regular check-up and mention their HIV status (for the sake of argument assume they are not yet taking medication or are getting it elsewhere and so don't need a prescription from the doctor). Must the physician disclose the HIV information in the record the very first time it is mentioned, even though they are not the ones who performed the testing?

[helpful]

Any competent physician would ask you to take a blood test to verify your status.

[eigen]

And yes, my understanding is that they would. You have a lot of control over the record itself, and what is done with it, but not with what is entered into the record. Release of your medical records requires your permission (in the case of your insurance company) or a court order (in other cases).

So you have doctor-patient confidentiality (the doctor can't just tell anyone else that you have HIV), but they also have an obligation to keep your confidential medical record accurate.

So going back to the HIV example- if you told them you were HIV positive, they would be required to put it in your chart. They would also not be able to tell, say, your spouse that you were HIV positive if he/she was also a patient of theirs, since the fact that you are HIV positive would be confidential information.

[kaysixteen]

Medical records are legal documents, right, and 'confidentiality' extends only to the legal extent of the law governing it... IOW, if those records were lawfully subpoenaed, well?

[eigen]

Hence my statement about a court order.

Generally, from my understanding, there has to be a distinctly compelling reason for a court to grant access to someones medical records, however.

[mtnman]

It appears your original question was answered, but I'll bite on the new scenario you presented.

I do believe that HIV is a condition required to be reported to the local health department in my state. I'm not for sure, but I think it is. There is a list of diseases that must be reported to the health department.

As far as reporting HIV status to others (i.e., a spouse), that could fall under "duty to warn". This means that if another person is in immediate or foreseeable danger (i.e., a sexual partner) due to the actions on your patient, you are legally obligated to warn the person in danger. This is always a lively scenario to discuss in ethics practice courses.