Introduction

Reviews

Getting Good Medical Care When You've Got An Addiction

Timothy B. McCall, M.D.

I make a point of asking my patients about potentially embarrassing topics like drug and alcohol use and sexuality. The reason is that I’ve learned not knowing this information can compromise the quality of the medical care I provide. But I understand that many patients have justifiable concerns about what will happen with information they give me.

Consider this case: a healthy looking man came to see me for an exam. Unexpectedly, his liver tests came back abnormal. It was only by asking this very straight-laced appearing man whether he’d ever used IV drugs that helped me sort out the problem. Yes it turned out he’d used heroin for a brief period many years ago. Without that piece of information, we would have had a hard time explaining his problem.

Even though many don’t do it, doctors should routinely incorporate questions about drug and alcohol use into the interview, even with people who show no signs of having a problem. If the physician suspects a problem, he or she may need to ask a few direct questions like Have you ever felt you should cut down on your drinking or Has anyone ever annoyed you by criticizing your pot smoking? And if your doctor neglects to ask, whenever possible you should volunteer the information.

But you need to be careful. Especially in this day of computerized medical records, what you think may only be for your doctor’s eyes may be read by others including insurance companies, credit bureaus and sometimes—although it’s against the law—employers.

But in order to provide top-notch medical care, doctors need complete access to very sensitive matters such as drug use, sexual habits and the like. We need our patients to trust that any personal information they provide will remain confidential. If a young man doesn’t feel comfortable telling a doctor he’s gay or shares needles, for example, then the doctor may misjudge the significance of a symptom, order the wrong tests, miss diagnoses and the opportunity to treat.

Some patients worry that their doctors will judge them if they volunteer information about drug use. Unfortunately, that’s sometimes true. A good doctor, though, will advise you of the health risks of such behavior but it should not otherwise affect your relationship. If it does, perhaps it’s time to find a different doctor.

Keep in mind that if you have ever been in treatment for an addiction that information is probably already in your medical records and known by insurance companies. In general, you have little additional risk by sharing that information with your current doctor.

If you have never told any doctors or nurses or other health care providers about your drug use, you will have to weigh the possible damage to the quality of your medical care from not telling the truth versus the possible consequences of the information going somewhere you never intended.

There are some attempts in Congress to pass legislation to close the loopholes that allow confidential medical information to be read by people who have no business doing so. It is unclear whether such legislation will become law. Until then, there are a few things you can do to minimize the risk:

• Any time you agree for the release of medical information, make sure you know *who* will be allowed to see it, *which information* they’ll be given access to, and *what* they need the information for.
• Never sign blanket disclosure forms (such as when you are admitted to the hospital).
• Remind your doctor that you don’t want sensitive information shared with anyone without your consent.
• Ask your doctor if you prefer something not be written in your record. You might say “If I tell you something very personal that may be relevant to my care but that I don’t want to be written in my chart, would you be willing to respect my wishes?” The doctor may or may not be willing to comply. If the doctor won’t, then maybe you need to find one who will.

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