A patient presented to the ER with a benign complaint at 3 am. She was incidentally noted to have moderately elevated blood pressure, and she appeared much more awake and talkative than the usual 3 am patient. She admitted to recent cocaine use but requested that I not mention that fact in the medical record for fear of possible repercussions. She was a HENRY
with good insurance and didn't want to jeopardize those things if her secret were somehow discovered.
Since the blood pressure wasn't dangerously high and the drug use was not even tangentially related to her initial presenting complaint, I complied with her request, documenting only that we discussed lifestyle modifications and secondary causes of hypertension, etc.
When electronic medical records become more common and more widely (if not universally) accessible, I suspect there are going to be an increasing number of patients who will be hesitant to tell us
embarrassing and potentially career-threatening information about themselves. Perhaps big brother shouldn't have any more information about us than necessary.
With the possibility of a nationalized healthcare system and the subsequent rationing of care and passive culling of the herd that looms on the horizon, even a one-time chart notation of serious drug use might make receiving certain services more difficult when viewed through the eyes of a cold-blooded single-payer bureaucrat charged with distributing scarce resources. If one happens to need a kidney transplant in a decade or so, it might be better to have a clean record.
But when patients don't give us the whole story
, it can make our job very difficult
Labels: defensive medicine, health care crisis, patients