- Michael Wohlfeiler, M.D., Miami Beach
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, your primary obligation, 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. Blindfolded. If naked, drunken, sightless lava-bikers, 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 or whose DNA suggests he is at risk for certain maladies. Wise social policy must not abandon such people.
It is also different when considering not life but health insurance. 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, or engage in risky conduct. 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.
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 the chairs. When that other couple returned, they were angry. Was my behavior OK?
- Karsten Roth,
Berlin, Germany
Your problem has a built-in (if long-term) solution. Heavy users of sunning lounge chairs may well die of some horrible skin disease. A neat, Darwinian resolution to the conflict. Pending the demise of that quarrelsome couple (or your own), you behaved reasonably. 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. I hate the spectacle of two really tan people stripped to the waist and punching it out.
No, wait: I love that spectacle.
