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Health information: What does your doctor share?
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DEAR DR. ROACH: If I share confidential information with my doctor, how much of that information is reported to my insurance company? I am required to sign the HIPAA form that allows information to be shared in order to provide treatment. What are the limits and boundaries of insurance companies’ knowledge? Your answer determines how honest I can be with a doctor. -- S.F.L.

ANSWER: Your insurance company has access to your medical records. It receives the billing information from your doctor and can review the medical records to ensure appropriate billing and quality. It may not disclose this information except as provided for in the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

It happens occasionally to me that a patient asks me not to put some personal facts about him- or herself into the medical record, and I always agree not to do so, with the caveat that there are a very few situations in which I, as a physician, am required to divulge privileged information. The most important is if a patient tells me he or she has a plan to injure a particular person.

In my experience, the most common situations in which a person doesn’t want something in his or her record relates to a psychiatric diagnosis, a history of assault and illegal activities, especially drug use. These all are important for your doctor to know, so I hope you will be honest with your doctor about whatever situation you are concerned about, but I would encourage you to discuss privacy, including your desire for the information not to be entered into the medical record.

DEAR DR. ROACH: Plastic pill crushers and a mortar and pestle are very painful for my arthritic hands. The pharmacist offered me no better option for crushing pills. Then my aging brain had a moment of lucidity -- an electric coffee grinder! It works perfectly and can handle several different pills at the same time. Please let your readers know. -- S.L.P.

ANSWER: I think it’s brilliant; however, do make sure the machine is clean, and I would use it only for medicine. Use a brush (also, used just for this task) to remove all the powdered medicine after each use. Finally, check with the pharmacist to make sure the pills can be safely crushed. Some cannot be, especially those with an extended-release formulation.

  DEAR DR. ROACH: Can you tell me about the safety of urethane? Is it a safe material for shoes to be made with? I have allergies to many things and don’t want to order something that might cause feet problems. So many things are man-made these days instead of using natural and proven materials. -- F.L.G.

  ANSWER: I think you are talking about polyurethane, a useful plastic polymer that is used in many applications, including hard plastics and foam plastics. The short answer is that while a man-made product, polyurethane in shoes and inserts are very likely safe.

  Some foam mattresses and other products made before 2005 contain fire-retardant chemicals called PBDEs, which can accumulate in the environment and may cause toxicity. However, shoes bought now using polyurethane should be safe.