• Doctors, not Obamacare, will ask you about your sex life

    When I was a medical student, my teachers explained that – as physicians – we would be privy to people’s most private information. They would tell us things about themselves that they might tell no other human being. It was stressed that this was an honor, something to be noted and respected. We would keep those things secret, both by law and by social contract.

    Sometimes, we would have to ask them questions about awkward things. During my month of adolescent training, we spend a large amount of time learning how to talk to kids about drugs, depression, eating disorders,violence,  and – yes – sex. We learn to do it because it’s our job. We’re trying to keep people healthy, and all of these things are inherently risky. If they are occuring, we want to talk to adolescents about how to protect themselves and take care of themselves.

    As an adult, when I go to a checkup, my doctors still ask me about my sexual health. They ask if I’m sexually active. The best among them have the courage to ask if I’m sexually active with anyone other than my wife. Why? Not because they’re prying busybodies; they ask because having multiple sexual partners greatly increases your risk of sexually transmitted infections. They’re looking out for my health, and want to advise me best on how to manage it.

    Understand, please, that I can refuse to answer these questions. I can also lie. How would they know? But lying about my sexual activity to my physician would be akin to lying about my aches and pains. If I don’t tell the physician what’s going on, it’s hard for him or her to help me.

    This is the way it’s always been.

    So take this piece by Betsy McCaughey with a grain of salt:

    Are you sexually active? If so, with one partner, multiple partners or same-sex partners?”

    Be ready to answer those questions and more the next time you go to the doctor, whether it’s the dermatologist or the cardiologist and no matter if the questions are unrelated to why you’re seeking medical help. And you can thank the Obama health law.

    “This is nasty business,” says New York cardiologist Dr. Adam Budzikowski. He called the sex questions “insensitive, stupid and very intrusive.” He couldn’t think of an occasion when a cardiologist would need such information — but he knows he’ll be pushed to ask for it.

    The president’s “reforms” aim to turn doctors into government agents, pressuring them financially to ask questions they consider inappropriate and unnecessary, and to violate their Hippocratic Oath to keep patients’ records confidential.

    Evidently Ms. McCaughey knows some pretty crappy doctors, because if you consider it “inappropriate and unnecessary” to talk to your patients about their sex lives, then you really shouldn’t be in the business. I agree that it’s not necessary to ask these questions at every visit for every complaint. But seriously, a cardiologist is saying he can’t imagine a single occasion when he might ask a patient about his sex life? Really? I’m speechless.

    But it gets worse. Ms. McCaughey further misrepresents what the law does:

    Embarrassing though it may be, you confide things to a doctor you wouldn’t tell anyone else. But this is entirely different.

    Doctors and hospitals who don’t comply with the federal government’s electronic-health-records requirements forgo incentive payments now; starting in 2015, they’ll face financial penalties from Medicare and Medicaid. The Department of Health and Human Services has already paid out over $12.7 billion for these incentives.

    There are federal EHR requirements. But those are part of the HITECH Act (which was part of ARRA), not Obamacare. What Obamacare introduces is that insurance must now reimburse physicians for preventive services. These include things like STI counseling (which is why more docs may ask about sex). They also include lots of other stuff, especially for women and children. I’m fine with this, because these things work. They have evidence behind them. That’s why they’re in there. For years, we’ve paid for tons of things that don’t work, while not paying for things that do. This tries to right that balance.

    But, hey, if you don’t do those things as a doctor, you won’t be “penalized”. You won’t get paid for them, and your patients might suffer, but no Obamacare thugs will come to get you. Moreover, there’s nothing in the law that mandates that the answers to your questions be sent anywhere or to the government. They’re part of your medical record, as they always have been, and they’re protected by the same laws that have always protected your data.

    There are legitimate reasons to dislike Obamacare. It amazes me how opponents of the law keep needing to invent ones that aren’t accurate in order to rail against it.

    @aaronecarroll

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