MEDICAL MATTERS/Dr Muiris Houston: Thank you if you are one of the many chocolate lovers who responded to my St Valentine's column on the health benefits of chocolate.
Some of you asked about the exact "dosage" needed to achieve the heart benefits outlined by the American Dietetic Association study.
Unfortunately, the researchers didn't specify this. It would appear, however, that the cocoa content of the chocolate bar is more important than how much you eat.
You should choose chocolate with the highest percentage of cocoa you can find. Almost certainly this will be dark, bitter chocolate. In any event, the information on the wrapper should allow you to differentiate. And although I have no specific evidence to back up the statement, I suspect the benefits lie in regularly eating a couple of pieces of dark chocolate rather than bingeing on it every now and then.
On a more serious note, there was also considerable feedback from the column of January 27th, which dealt with the issue of disclosing medical records.
You might recall that it focused on the "private medical attendant reports" - doctor's reports - that insurance companies ask family doctors for and how aware patients are of what they consent to when they sign a blanket consent form.
Dr Brian Meade, a Dublin GP, had questioned the validity of such consent. "How can it be considered to be 'informed' consent when in many cases patients do not realise the extent, nature and consequences of the information being sought by the insurance company?" he asked.
According to a postgraduate computer student who kindly sent on a copy of a college assignment on information security in a health setting, a fundamental concern must be that patient information is disclosed only to authorised individuals. He is concerned that unprotected, unattended and logged-on workstations can lead to medical information being compromised.
His paper states: "The patient's identity must never be disclosed under any circumstances." He warns that no institution should use social-security numbers or other publicly used codes as health identifiers.
I also heard from the mother of a disabled young man whose experience of patient confidentiality was less than ideal. He lives semi-independently, with home support from a health board and with support from his family. Although he has been well settled for three years, the health board raised concerns about the severity of his epilepsy.
It contacted the young man's GP, seeking an appointment with a neurologist for a specialist opinion. The GP correctly asked the family for their view; they decided to wait for his next scheduled specialist appointment to deal with the issue.
Subsequently, they were astonished to learn that information from a hospital chart was discussed at a health-board disability-team meeting without their son's permission. Even worse, the meeting concluded that he should move out of his home and live with a group of disabled people.
"We are very concerned about the issue of doctor-patient confidentiality in general and specifically now in relation to people with disabilities," his mother said.
My suggestion in the original column that all medical assessments for insurance companies be performed by independent medical practitioners did not find favour with one Dublin GP.
"I think insurance companies are absolutely justified in seeking this information [that is, doctor's reports\]. I would like if they would explain the process more clearly to patients. This could be done by means of a simple brief explanatory leaflet issued to applicants," she said.
The British Medical Journal has just reported a Canadian study that shows patients are willing to allow information from their medical records to be used in research. Most, however, prefer to be asked for consent either verbally or in writing. Research sponsored by insurance firms generated the greatest concern.
Finally, and also in response to the column, one of the medical representative organisations is planning a workshop on the issue at its annual general meeting. I will report on the outcome in due course.
Dr Muiris Houston is at mhouston@irish-times.ie. He regrets he cannot answer individual queries