Can I ask my doc to remove a Dx from my chart?
September 22, 2007 11:48 AM   Subscribe

Is it reasonable or necessary for me to ask my doctor to remove the recent "Tobacco Use Disorder" diagnosis as a "current health condition" from my medical record?

I went to the doc last week for 2 things: 1) knee pain, 2) to get an Rx for Chantix, the new quit-smoking drug.

This is the same doctor who prescribed me Zyban several years ago for smoking, as well, and while it worked for that for a while, I have stayed on it for depression. When she prescribed the Zyban, no special note was made in my record about any "disorders", depression- or smoking-related.

She could NOT give me the Chantix this time, as it is not yet in the HMO's formulary. Fine. I got the usual brochure about the HMO's smoking cessation program and off I went. I believe I've told her my smoking history in the past, although she didn't ask me this time, just how much I'm currently smoking.

I looked at my medical info online yesterday, and under the listing for a chronic condition I've had all my life, is this new entry "Tobacco Use Disorder". I would prefer not to have this official diagnosis for insurance reasons in the future (thank god I have great insurance now), and wonder if, because she didn't actually prescribe me anything for smoking that would necessitate this official diagnosis, if I could ask her to remove this from my record?

Is that even possible? Had she given me the Chantix I would obviously have no problem with this - it'd be pretty clear what the drug was for. But, no drug, no need to make this so glaring for the insurance assholes of the future, right? I won't even bother to ask if this is something that doctors just simply do NOT/cannot do, but I just don't know.

Email if you'd like, and thanks.
posted by anonymous to Health & Fitness (11 answers total)
Your doctor may have noted that diagnosis for billing purposes -- perhaps knee pain would not have covered the time she spent with you regarding smoking, or she expected followup visits about Chantix.

IANAD, but getting an accurate diagnosis off your chart seems like a futile form of denial. Future insurers can (a) ask you if you smoked or (b) check the same chart you're concerned about and see that you've been prescribed Zyban and have discussed your smoking with your doctor. Unless she's incompetent, your doctor is not going to change your chart to remove all mention of your smoking habit.
posted by backupjesus at 12:01 PM on September 22, 2007

Unfortunately, it's highly unlikely and at this point, may qualify as fraud. Welcome to the trainwreck that is our current US healthcare system, where even the insured and their healthcare providers must now consider hiding their ailments to avoid future bankruptcy. I urge you to share your circumstances with others in a political context so that we might ultimately find a legislative solution to our problems that overcomes the influence of nefarious, deep-pocketed special interests.
posted by drpynchon at 12:30 PM on September 22, 2007

Are you positive that insurance companies are even allowed access to your medical history?
posted by Brocktoon at 12:46 PM on September 22, 2007

because she didn't actually prescribe me anything for smoking that would necessitate this official diagnosis

Treating is not a requirement for a diagnosis. I've had patients who meet diagnostic criteria for 'heart attack' and who decide to leave the hospital anyway.

Backupjesus may be right, that it was added for billing purposes--or your doctor may have forgotten to add it in previous years. Ask all you want, but it puts your doctor in an unfair situation--if she removes it, it makes it look like she didn't recognize that you're a smoker, and that smoking greatly increases your morbidity and mortality. But I do have an idea for how to get it removed, if you're concerned about it:

Quit smoking.
posted by gramcracker at 12:50 PM on September 22, 2007

(And technically talking to you about smoking cessation and offering your smoking cessation classes is a form of treatment.)
posted by gramcracker at 12:52 PM on September 22, 2007

But I do have an idea for how to get it removed, if you're concerned about it:
Quit smoking.

They would remove the diagnosis if the disorder was "cured"? That doesn't make sense.
posted by tristeza at 1:29 PM on September 22, 2007

You're likely stuck with it. I know this will hurt your insurance rates in the future, but unfortunately you'll have to live with it. Otherwise, in the future, you may find yourself looking for insurance, whether health or life. They're going to ask you if you smoke. Either you answer "yes" and take the rate hit... or you answer "no," and in the future chances are your insurer will find out that you do indeed smoke, very possibly while you're in a hospital bed. That can lead to a) cancellation, b) rate hike, or c) refusal to pay out a claim due to misrepresentation on your application.

But, IANAL, and this is something that you would want to discuss with someone knowledgeable in the insurance industry if the answer doesn't come here. The reason I mention that is because insurers are aggressively pursuing smoking cessation programs, and I don't know how they look upon past smoking history if you do quit. (Our insurance last year instituted a $600 per year smoker surcharge, and also now offers a smoking cessation program that has gotten good reviews from my co-workers that have used it.)
posted by azpenguin at 1:39 PM on September 22, 2007

They would remove the diagnosis if the disorder was "cured"?

I computerize medical records for a hospital. If you quit, it changes to 'Hx of TOBACCO USE' and I put a quit date and your pack/year information, if I have it, into the comment section.

When they do breathing function tests and certain other diagnostics they like to know if you were previously a light or heavy smoker, and how long it's been. If, for instance, you have breathing impairment later on, it's one thing if you've been a smoker, or worked in an asbestos mill, or were a bird breeder, and it's another thing if you don't have external risk factors for lung impairment - the same outward symptoms can (but doesn't always) mean different diseases.

For the record, I also put in 'ENVIRONMENTAL EXPOSURE to XYZ' if that's in their written record. That you're a smoker is a part of your medical history, just like I need to jog more is part of mine.

As for insurance purposes, yes, that's probably fraud, but I don't deal with insurance. All I do is hospital records, and I rarely send things off for review. If I do, it doesn't matter - that you smoke is somewhere part of your record, but when you quit, that will also be part of it.
posted by cobaltnine at 2:34 PM on September 22, 2007 [3 favorites]

that you smoke is somewhere part of your record, but when you quit, that will also be part of it.

Exactly right. Even if you have the diagnosis removed from your "problem list," the fact that you're a smoker is all over your medical record. Part of the doctor's note is the "social history," which includes things like alcohol, tobacco, drug use, living situation, sexual history, etc.
posted by gramcracker at 3:08 PM on September 22, 2007

IANAD and IANAAmerican, but it does seem unreasonable to request that this be removed from your record, but for the simple fact that it's true. You are a smoker. My feelings about the shittiness about the way your system works are separate. It would seem unethical to me for a doctor to lie or withhold information knowingly.

That being said I wouldn't personally think it unacceptable to talk to your doctor about your feelings simply in the aim of having open communication. There's something entirely relevant about discussing your medical record and its implications on your life with your doctor. Not to make a request, again, but just to talk about your worries and what you can do to make positive, healthy changes in your life that will reflect positively on not just your medical record but your longevity and quality of life.
posted by loiseau at 7:52 PM on September 22, 2007 [1 favorite]

As a physician, I'd be happy to discuss with any of my patients what diagnoses and history I record about them -- because lord knows, mistakes make it into charts here and there -- but I can't imagine a time when I'd remove a properly-made diagnosis or a properly-recorded bit of history from a patient's medical record. For one thing, it's engaging in a flat-out lie, as if I never made the diagnosis or elicited the history; for another, if the patient ever developed a complication related to that bit of information, and I didn't have a way to demonstrate that I knew about it and was engaging in the right treatment or counseling or whatever to deal with it, I'd be opening myself up to a hell of a hard time explaining how I hadn't done my job. All in all, it's a lose-lose for the physician, all surrounding an actual bit of truth that a patient doesn't want to face.

I'd also have to say that your concern about removing it from your chart "for future insurance reasons" is superbly concerning to me -- there's no reason why insurance companies should be denied the information that you are a smoker, or have smoked in the past, given that smokers of all varieties cost insurance companies and the health care system far, far more than nonsmokers. When you join an insurance plan, you're asking all the other members of that insurance plan to share financially in the risk of you becoming ill, and if I were a member of the same plan, I'd hope that our common insurance company did a great job of figuring out all the various behaviors that lead to increased risk of illness or injury; that way, they can ask those people who engage in high-risk behavior to pay more into the shared pot to cover us all, so that the rest of us don't have to.
posted by delfuego at 8:59 AM on September 23, 2007

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