Doctors

I do a lot of enemas five or six days a week up to 4qts at a time. I have told her I do the occasional enema and suppositories for constipation. But since I just got put back on my blood pressure pills should I tell her honestly how much I do them

I do a lot of enemas five or six days a week up to 4qts at a time. I have told her I do the occasional enema and suppositories for constipation. But since I just got put back on my blood pressure pills should I tell her honestly how much I do them

NO.

Just keep doing what you have been doing and let them titrate your drug dosages to the desired BP they want you to have.

If you tell them the truth, they will write that you are a klysmo and it will be on your medical record forever for everyone-doctors, nurses, administrative people and insurance companies to see.

KEEP YOUR MOUTH SHUT.

Now what would a insurance company have to do with my enema usage

Now what would a insurance company have to do with my enema usage

Skeptical? Don't believe me? Fine. Consider yourself warned.

I’m just curious what honestly would happen. Why would admistrative and insurance companies be able to see it. I can understand drs and nurse. But my main concern is if I don’t tell her how much I do it and something does happen to me with my blood pressure and other levels enemas have the Ability to disrupt I’d have to tell her or the hospital at that point. I’m just trying to make the right decision for myself that’s all.

Even with the HIPPO laws, most of the information - medical, personal, etc. - can mange to make it to the mainstream. I agree with Susie, if it's not medically necessary to tell your doc, keep it to yourself. Docs are pretty good at permanently recording everything they hear from you: smoking, alcohol, anger, depression, spousal problems, fetishes. Some of it needs to be in your record -some not so much.

I'm not a doctor, but I don't see how enemas would affect your BP.

Even with the HIPPO laws, most of the information - medical, personal, etc. - can mange to make it to the mainstream.. . . .

It's HIPAA

Health Insurance Portability and Accountability Act

People think the "P" stands for PRIVACY--BUT IT DOESN'T

You better remember that.

I'm a doctor in real life. (Yeah, I know, it's hard to believe...)

The current push is for interoperability in electronic medical record systems. So not only is what's in your chart visible to MANY people, over the next couple years it will be visible to MANY MORE people. Going forward your doctor is going to have less and less control over the data in those records

In our practice, we use a system that is half electronic and half paper. Prescriptions have to be electronic in our state. We do not "interoperate" with any outside system, and my patient's data is on a server that lives in my building, and which we maintain in-house. That, unfortunately, is becoming a rare thing. With the big push to "cloud computing" your records are far from private.

There are regional "data exchanges", and permission for your doctor to "share data" with these exchanges, is usually part of the new patient paperwork that most patients sign but don't bother to read. When I bring up privacy concerns, my colleagues look at me funny. They've drunk the cool-aid. They don't even notice that once errors make it into these exchanges, those errors are gospel. Those exchanges are private - by state law! The same state law that can change in a heartbeat to mandate access to some organization or government agency "for the public good".

That being said, if you are seeing a physician for a real medical issue, ask about how records are kept, and if things discussed in the exam room stay in the exam room. I take care of a number of kinky people, and it's pretty amazing how vanilla their medical records look. (in other words, not everything needs to be in the patient's charts, and they trust me to keep their secrets secret)

Susie is right, be careful who you tell your secrets to. I think it's more important though to find a doctor that you can trust to keep your secrets. They're getting scarce.

About those HIPPO laws.. in our town all pet hippos need to be tagged and on a leash.

Doc

I'm not a physician, but my clients are. I've been directly involved in HIPAA regulations for 22 years (since 1996, when it passed).

The original question has been well answered, but the nature of our shared interests led me to want to offer a bit more background on rights, provider obligations and what's practical.

There is a provision in HIPAA {remember, there's no "PP" in HIPAA - that's a different kink} that obligates providers to honor patients' requests to keep specific information confidential that might otherwise become part of a general record. For example, if I am tested and diagnosed with a genetic disorder that might affect my employment, I would not want my self-insured employer to know about that unless/until I decided to disclose it, nor do I want that information in a database (more on that below) affecting my insurability in the future. I might need to talk to my doctor about managing my hypertension or diabetes in the context of suspension play or bondage (positional syncope), breath play (hypoxia), enemas (M & M, soda/sugar, wine, beer) or other medical consequences, but do not want my kinks in my medical record. HIPAA provides that we may specify certain information cannot be shared - period - and the provider is obligated to honor that and could be legally/financially liable it that confidentiality is violated.

Suppose my wife is having an affair and becomes pregnant. My vasectomy removes me as a candidate, so her abortion would be something she could require her Gyn to keep confidential, even from the staff (or limited to specific staff). In a small town, that's a biggie!

There are also a few things that a provider may not agree to keep confidential, even if you insist. HIV/STI infections require notice to the Health Department, not matter what. Spousal and child abuse must be reported. Suicidal ideation or being a threat to others are two more.

Can you totally rely on your doctor to protect your "special information" as confidential? I think docinny45 covered that really well. Yeah, kinda, we hope, maybe, but not exactly, for the reasons he cited. A few years ago I worked with a practice commencing use of an EMR. One of the doctors had some patients with "special situations" (consensual heavy SM play, for example, another with marital sexual abuse). She kept a set of private, paper files locked in her office with a note in the EMR indicating that there were separate, confidential, "eyes only" files related to that patient. Think of someone just beginning to sort out being transgender in a small, rural town in Utah.

One solution is for YOU to maintain custody of your very private records, taking them to your doctor for each visit; NOTE: s/he may or may not agree for liability reasons. Once they've been updated, as needed, you take them home That allows your doctor to have them during the visit, note that there are "external records" being maintained, but with much less chance of an accidental disclosure. Unless YOU lose them, have a nosy spouse or kid(s) or need to quickly get them to a new doctor or ER. A flash drive might solve the problem - or not.

HIPAA requires that providers supply you with a complete copy of your medical records, on demand. They're also supposed to provide you with a copy of today's visit record, every time (part of the ACA requirements related to the mythical "interoperability"). Get your records and review them. Several of mine were wrong (R kidney vs. L kidney?) and I had to fight for correction. If your confidential information shows up, deal with it on-the-spot.

EVERY health insurance claim processed by EVERY insurer has some of the claim data exported. Your name, SSN#, DOB, date of services, billing codes and diagnosis codes go to the Medical Information Bureau. Why? So when I apply for a $5M life insurance policy and swear I'm healthier than an olympic athlete, MIB will report my history of cancer, obesity, drug abuse and depression to prevent insurance fraud. NO copies of your medical records go with the data sent to MIB - just codes, but parts or all of your medical records could end up in your insurer's files if medical necessity or other claim dispute arises.

Our digital age has positives and negatives. As noted, privacy is mostly a casualty. State, area and regional data exchanges are still mostly in uncharted (and not reliable) waters. Find out if your doctor, hospital, lab, pharmacy, etc. are participating, willingly or unwillingly. You have the right to totally bar sharing your information, or define what cannot be shared, but you have to ask the question "are you?" and you have to get an honest answer. If your doctor(s) are employees of a hospital, or the practice is owned by a hospital but still uses their original name, they may not have the authority to agree to your limits - that might be the domain of the hospital's Medical Director or Privacy Officer. Ask. Verify. Ask, every time ("have your privacy policies changed?").

Don't risk your health or life by not sharing information with the people who can keep you alive, but how you share that and how they keep records - or not - matter immensely.

Excellent and very professional comments! In addition to the comments made on 'cloud based sharing' of data, many patients ARE offered consent to 'share their records' electronically - HOWEVER, as a patient (and I am also a physician) I was offered the consent verbally with just an electronic signature pad at the check in window - and no explanation other than 'this is the consent for sharing records.' My primary MD's office is owned by a hospital and has incentive to participate in the cloud based sharing for state healthcare reform dollars. When I asked for the 'consent' in writing I was given a scowl. I said "NO WAY" and was again given a hard time about my signature. The other MAJOR issue is that the 'sharing' of your records to the cloud --- sharing makes ALL your records go to the cloud information exchange. The data management systems are not able to parcel out individual visits or diagnoses or tests, although HIPAA requires such detail. For transparency, this is in NY, but many other systems are the same. In theory you then sign a release on 'the other side' - like at your GI doc's office - for specific information. But, guess what - the data base can't separate out that information from the whole of your record, so mostly that entire data base (ALL of your personal information) is shared, also.

It is a total scam on privacy. Considering that my billing data has been violated a number of times (Anthem being one), I would not share any of my records to a cloud based data share. But local office servers such as NextGen or cloud based systems like Athena are not impervious to data breaches, either.

My gyn has a paper chart he keeps at home. He knows to bring it to the office when I come in. He knows I play hard and have a Dom, but I believe it's not in my chart - just between us. And I honestly don't think he cares, as mostly it is not relevant to my care. My GI is brilliant, but I have no need to share my activities with him, at least at this point. He works in a State system on Epic, and for that reason I would likely never choose to disclose, even in the event of an emergent trauma. Besides, my recent colonoscopy was a clean bill of health!!! LOL.

Bottom line - think long and hard about WHY you want to share information. What does that information contribute to your medical care REALLY? What forms of privacy can you put into place if you choose to share? (such as ask your MD to not document in detail - there are ways of doing almost anything discretely)

I decided not to tell her about my extreme habit. She was fighting down everything I said today. If it was a older school man or women dr then I would have thinking they grew up with it and thought nothing of it. I got great advice from a lot of people on here and I appreciate it all.

If a doctor is fighting down everything you say, it might be time to get a second opinion.

Dan

My father is on blood pressure meds

He takes his meds every time he take an enema.

What he does is take the prescription meds, then wait about an hour an take any oral laxatives involved. If it's an enema instead he waits about two hours

Only one he does not take is his blood thinner.

@enemasubgirl, @bburl, and @docinny45,

Thank you all for the information you have posted and the suggestions as well. You have helped explain quite a few things and confirmed many of my suspicions regarding the various systems and entities at play here. People are being misled as to the realities of all this and many are being duped into thinking this is all in there best interests to play along. Things that pop into my head are caveat emptor and an quotation attributed to Thomas Jefferson but it seems it came from John Basil Barnhill, "Where the people fear the government you have tyranny. Where the government fears the people you have liberty." I wish many more people would act like wolves and not sheep where there health, life and liberty are concerned.

https://www.monticello.org/site/jefferson/when-government-fears-people-there-liberty-spurious-quotation

Oh.. Important privacy tip? READ THE DAMN PAPERS BEFORE YOU SIGN THEM.

New patient walks into the office today. He fills out the paperwork, and signs all of it. We hand him a new patient drug test. He pees in the cup, brings it back to the lab, and says to our office manager "I didn't agree to be drug tested". She pointed out to him "yes, you did! You signed your new patient paperwork, and initialed the consent. Can you guess his answer?

"Well, I signed them.. But I didn't READ them!"

We disposed of his test, informed him we're not accepting him as a patient, and invited him to leave.

The sad thing he is not the first one to say that to us. Read the paperwork, know what you're signing.

Docinny45

Oh.. Important privacy tip? READ THE DAMN PAPERS BEFORE YOU SIGN THEM.

Most of the doctors' offices I go to these days have an electronic signature pad, and when I ask to see what I'm signing, they tell me the name of the document, but they can't provide a copy of it for me.

So much for accountability on their part.

@docinny45 You're referring to a regular dr appointment right? Yeah, any document is important to READ people.

I have never, nor will I ever sign anything without reading it top to bottom. I know it miffs many people..receptionists, nurses, mechanics, etc....

I did once. Once in my adult life. How did that turn out? Not too good..... Going through a divorce, do not remember the circumstances, but remember distinctly sliding a rather lengthy document over to my shit head attorney. Looked him in the eye.....He knew how I operated....So far as not just signing something because he said to. Looked him in the eye and said "You've got me on this?" Something to that effect. Thumbs up, whatever.

Months later, something came up, I said no way, or of course, something, and was brought to my attention I had signed a legal document starting I would/wouldn't/did/did not......Was a nasty divorce as she wanted to get rich for putting up with my ass for three years maybe. Damn divorce took longer than we were together.

Took my infant son to a Dr.s visit for I want to say two, maybe three shots....Regardless, the nurse slides me over a clipboard full of signatures, and maybe two paragraphs worth of verbiage at the top.....She slides it over with a pen. I remove my pen from pocket and place hand on the document to sign....Off to the side so I can read whats at the top.....First, she says..."Here"...points to the next empty space on sheet. Me: "Ma'am. I'm going to read it before signing it. I'm maybe halfway through it...."All it says is, if you don't sign it, the kid doesn't get the shots."....Again, this time a little snarky, and different verbiage, I told her my signature rarely came cheap, but as it was about to be, I was going to read the fucking document. All of it. Like she was pissed off that I wanted to know what I was signing. She was pissed. Wasting her valuable time. Fucking people.

Little off topic I guess, but the convo was headed this way. Thought I would share...

Oh....All the folks with intimate HIPPA knowledge....Thank you so much. Very, very useful. I value my privacy immensely. I value my right to privacy as much as anything I suppose.

EDIT: Couple Typos

I agree with Susie and others who say do not volunteer information that is not necessary. Whether it is a talkative nurse or doctor (illegal?) or someone hacking your files, you would be surprised how things travel.

Years ago when discussing my bowel habits with a GI doctor prior to a colonoscopy I admitted that I hated laxatives and I preferred a small plain water enema if necessary for occasional constipation. But I was not going to admit I liked enemas and often gave myself an enema even when not constipated. She just smiled and said she would prefer I took something like Miralax or increase my fiber.

@Luvnurses62 : Have you been asked to sign an electronic sig pad without the document being present? If so, how did you handle it?

As you all have read, computers get hacked all the time. These electronic records or patient portals are no exception. If it is on a server or computer, it is vulnerable. I even wonder how many others have access to those files? Drug manufactures or sales reps, medical device companies ?

I am pretty sure insurance companies evaluate your health records and charge you rates based on your medical history. If you are smoker you present more risk so you pay more- at least that is my understanding. I would be curious to know exactly how they evaluate risk based on medical history. It's similar to a guy who pays a lot more for car insurance if he's wrecked his car several times.

To me this is the insidious side of how medical records are used against the patient.

Do understand that in US, there are only two types of information covered by privacy laws.

The US has weak, out of date privacy laws governing financial information, and slightly later, more up-to-date but still largely dated laws governing medical privacy.

The flaw in the medical privacy law assumes every provider is fully electronic in their records-keeping.

We are just now getting to that point!!

Medical records are not used to evaluate how much you pay for your health insurance unless you are buying an individual policy for yourself or a family.

Most group insurances, your premiums, are based on statistics of the occurrence of diseases and conditions and the number of people on medications. And remember insurance companies are out to make money.

And anytime you are not honest with your doctor with what you do or feel or practice just might hurt you in the long run.