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To Your Good Health: Depression Can Play Role In Making Health Choices

Dear Dr. Roach: As a psychiatrist, please allow me to offer the benefit of my expertise regarding the 90-year-old man who refused potentially life-saving surgery for bladder cancer.

While it is certainly the patient’s decision, it was not clear from the letter whether his doctors had considered the possibility of depression having influenced his decision.

This is very common in old age and often can be addressed with a brief psychotherapeutic intervention, depending on the cause and severity.

At the least, this man should have had an evaluation to see if he was depressed about his life circumstances and if talking about it would help.

There are many non-drug alternatives for addressing the loneliness that can accompany old age as well as the sense of despair that can occur when many of the activities that make life meaningful for younger people can no longer be enjoyed.

It is certainly possible that his decision was based on a rational consideration of his values, which led him to conclude that he had enjoyed his life long enough and wanted nature to take its course, but it always behooves the doctor and family to consider the possibility that a patient’s willingness or even eagerness to die may be changed by simply talking about his reasons.

— R.S., M.D.

Answer: Thank you, doctor.

I wrote that “I believe everyone has the right to not treat their own condition, even if their doctor disagrees, if they truly understand what the consequences are.” I did not mention that mental illness such as depression might prevent a person from being able to understand the consequences of his or her actions fully.

Dear Dr. Roach: Are men less likely to wash their hands after using the bathroom (for any reason) than women?

Are there any studies providing statistics?

I “preach” hand-washing as the single greatest preventive for most illness.

— L.P.

Answer: If you can think of it, it’s probably been studied.

In 2003, a study at a university found that after using the washroom, women washed their hands with soap and water 61 percent of the time, and men 37 percent of the time.

Placing a reminder sign increased the rate to 97 percent of women, but only 35 percent of men washed their hands with the reminder, although 53 percent rinsed their hands without soap.

Keeping hands clean reduces infection transmission to yourself and to others.

Unfortunately, too often even doctors forget to wash our hands (only 65 percent of the time, in several studies).

Our nursing colleagues are better at washing their hands. Many hospitals, including mine, have policies in place to improve hand-washing compliance.

Dear Dr. Roach: About eight weeks ago, I received oral sex from an escort.

I did wear a condom. I haven’t been able to relax, thinking that I could have caught HIV or another STD.

Could you help me put my mind at ease? I know it was a stupid thing to do.

I wasn’t thinking clearly. Thanks. — L.T.

Answer: Your risk is very, very, very, very low.

Nevertheless, you might sleep better at night if you do get tested.

You can go to your local health department if you don’t want to go to your doctor.

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 ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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