Dear Dr. Roach: I recently visited an ophthalmologist. Prior to the consultation, his staff member went over a form with me, including my marital status 鈥� single, married, divorced, widowed, partnered, etc. I鈥檝e gotten questions like this in a number of doctors鈥� offices, and it鈥檚 on a form I鈥檝e seen a number of times. I can understand that a gynecologist, for example, might need to know whether a patient had given birth and whether a patient is sexually active. But the question about marital status doesn鈥檛 elicit that information. And why would an ophthalmologist need that information? When I questioned the ophthalmologist鈥檚 nurse, she informed me that Medicare requires them to ask these questions.
So, here鈥檚 my question: Is there some regulation requiring docs to ask patients this kind of question? When a patient encounters questions he or she finds intrusive and irrelevant, how does the patient avoid answering them? I鈥檝e simply not answered them on the form, but then a staff member specifically questions me about my marital status. I think these intrusive questions fall into the category of curiosity, and to ask them 鈥� and, in my case, to not answer them 鈥� can affect the doctor-patient relationship. How would you suggest that patients handle this issue?
L.W.
Medicare does not require marital status in order to process claims, although the registrars I spoke to thought it was required. But to answer your larger question, the best way I can think of to avoid answering questions that seem intrusive and not relevant to your medical care would be to politely tell the doctor鈥檚 staff that you would prefer to give the information directly to the doctor. Then you and the doctor can discuss your concerns about your information and your concerns for your privacy, and the doctor can explain the reasons he or she wants to know.
In the case of marital status, I can鈥檛 think of any good reason an ophthalmologist would need to know. A compassionate doctor caring for your psyche or for you holistically might well be concerned about your relationship status, as relationships are an important part of most people鈥檚 lives. Difficulties in relationships can manifest in physical and psychological symptoms, and they even can affect the risk of heart disease. But I differentiate 鈥渞elationship status鈥� from 鈥渕arital status,鈥� because the two are not synonymous.
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Dear Dr. Roach: I have never seen anything in your column about sebaceous hyperplasia. I read that it is quite similar to acne and that a person could use an acne treatment to keep the condition in check. Could you give your thoughts on this?
R.G.
Although sebaceous hyperplasia can be mistaken for acne, sebaceous hyperplasia happens mostly to middle-age adults (or newborns). These bumps appear most commonly on the forehead and cheeks, and have an umbilicus (a small hole) in the centre. They are enlargements of the oil-producing sebaceous glands. They happen particularly in people with oily skin.
Treatment can be challenging. Reducing dietary fat and using a good-quality skin-care regimen for oily skin may help. Dermatologists can treat these when they are cosmetically important, not because they cause harm in themselves. Although they can be mistaken for basal cell cancers of the skin, they are not cancerous or pre-cancerous. They are mostly treated mechanically, and by that I mean using a surgical technique such as cauterization or excision. But these techniques can leave scars. Laser and phototherapy have good cosmetic results, but are expensive. Isotretoin, a systemic acne drug with significant side effects that I recently discussed, also has been shown in a small study to be effective.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to听 [email protected]
