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Most Doctors Don't Think Patients Need Full Access To Med Records
Lucas123 writes "While electronic medical records (EMR) may contain your health information, most physicians think you should only be able to add information to them, not get access to all of the contents. A survey released this week of 3,700 physicians in eight countries found that only 31% of them believe patients should have full access to their medical record; 65% believe patients should have only limited access. Four percent said patients should have no access at all. The findings were consistent among doctors surveyed in eight countries: Australia, Canada, England, France, Germany, Singapore, Spain and the United States."
What could possibly be in my medical records that they don't want me to know about?
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I hope you get herpes, chlamydia, genital warts and crabs, and then they refuse to give you your medical records afterwards.
... wait, what?
Physicians are scared of malpractise suits.
And also, of patients getting to know what they really think of them...
Maybe, there should be two sets of data... the doctor's and the patients... The doctor's remarks can go into their dataset.
Of course they want to hide the medical records, so they can hide their malpractice better. Don't know about the rest of the world, but in a 3rd world country where I live, doctors mess up on a regular basis. My grandpa got diagnosed with sleep disorder which he didn't even have, so the prescribed some pills whose side effect had something to do with the ability to walk. So he almost did.
I was surprised that in the article and in the linked survey article there was no mention of WHY a doc would want to restrict information.
File a US disability claim, and find out how much fun it is to get all those records, and then get your doctor to contradict the governments doctors in court.
C|N>K
We had to take out a feature that let patients update their medical history online (which is a great feature because then the patient isn't be forced to memorydump in the clinic, there's a reason they tell you to write all this down and bring it a notebook when you see the doctor) because they were trying to removing items from the medical history in order to get claims paid that were rejecting for pre-existing conditions.
Now that obamacare is putting an end to the pre-existing condition thing, we may put it back, we'll see if the docs want it though. I believe the 65 percent is right though. On the other extreme, my boss believes that the patient should own their own medical record as a file they carry with them everywhere on a thumbdrive, I see that as a recipe for lost records and forgotten passwords. The alternative to having it on your person being Microsoft HealthVault still doesn't exactly make me tremble with joy.
I'd say switch to a different insecticide, Mr. Burroughs.
You see a simple folder full of your medical history.
Your doctor sees it as a book of half-truths that can be twisted to create liability in a multitude of ways.
Remove the liability here, and these results would change.
Information != Knowledge. It's already a big problem for doctors that patients come in demanding this or that treatment that they've read about on the internet, often with no real understanding of whether it's appropriate for them, or whether it's actually an effective treatment at all. I would imaging this is what is behind the doctors attitude in this study; full access to medical records will probably only increase that trend, with people trying to interpret their own records, and saying why did I not get such and such a treatment that I found on Google. That's not to say I agree with the doctors stance, but I can see where they're coming from.
Oh no... it's the future.
Some doctors will argue that by allowing the patient full access to the notes in the system, a doctor may be less frank about the mental condition of the patient or be reluctant to place information in the record which reflects poorly on the patient's demeanor, such as cooperativeness, a tenancy toward hypochondria, or just plan belligerence. In their defense, this honesty could lead to lawsuits (in the worst cases). Even in the instance where it's a simple difference of opinion, some patients are going to be fairly vocal about having the records changed or modified to suit their version of reality (correctly or not), resulting in more time spent by the doctor and administrative staff on uncompensated work.
Now, the best way to combat this is to allow comments on the records by patients. It will keep some of the sillyness out of records (http://www.smithsonianmag.com/arts-culture/The-Last-Page-UBI-in-the-Knife-and-Gun-Club.html) and will allow legitimate differences of opinions. A chart which is riddled with patient comments contradicting past providers will be just as valuable to a future provider as a note that the patient is difficult or uncooperative in treatment decisions.
Another item of concern is from the insurer's side. There will be people who attempt to expunge their records of items which decrease their insurability or increase their rates (and this will only get worse with mandatory insurance without cost caps or guaranteed rates). The way the questions were worded wasn't mentioned in the fine article, so if write/erase access was included in "full access," then continuity of care may be jeopardized by those seeking to minimize the impact of previous conditions on current health care rates - or simple embarrassment.
Is it just my observation, or are there way too many stupid people in the world?
The problem with limited access and the record keepers determining what is/isn't available is that it creates a strong pressure to hide things that should normally be available for less-than-honest reasons. Just look at all the information our government classifies and the types of things we've seen declassified years later. It's as likely as not that information is being hidden not to protect the patient, but rather to protect the doctor.
"They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety."
Are you kidding? To become that pediatrician that doctor went to 4 years of undergraduate college, then 4 years of medical school (which has an average cost of >100,000), then completed 3 years of residency (making around 45k/yr). So now they are in their mid 30's, have a mortgage payment due every month, and all so they can work 120 hours a week so they can see enough patients to keep the doors to the practice open and pay their insurance company the ludicrous amount needed for malpractice protection from the sea of parasitic attorneys looking for a quick settlement.
Get real, the waste in the healthcare sector is not in doctor's earnings. If anything, they deserve more for all the crap they have to deal with day in and day out.
How is this news for nerds? Taco is really starting to let this site go downhill.....
I guess you haven't noticed what's happened to every other type of data over the last 20 years.
This is data that you (possibly though an agent) have paid for, and in any reasonable world you own it and should be able to control it's disposition. In other words, they should have to ask for permission to use this data, not the other way around.
Because you don't need it; now stop acting like a 3 year old with all this 'why' nonsense!
Years ago (HS/college), my old doctor wouldn't let my have my records, after I decided to switch. He had asked for a prostate exam. So I waited till an hour before the appointment and slammed a pound of apple sauce.
.
He never spoke to me again after that.
.
I felt his business was going downhill fast and I was right he went to prison a year later.
C|N>K
Your average HR lackey doesn't have people's lives in their hands.
Doctors do. So it's an entirely different kind of situation.
The idea that the process should be open to auditing shouldn't even be in question. Nor should the idea that doctors would be exposed to "code review" and examination by their peers.
A Pirate and a Puritan look the same on a balance sheet.
I'm an attorney, so I know a little bit about arrogance, but we're patzers compared with doctors. Many truly have, if not God, then Emperor complexes, with their wisdom received without question by their subjects.
But that's probably not the real reason they don't want patients to have access to their complete medical records. It's all about avoiding medical malpractice claims (and annoying phone calls from patients asking questions).
So blame the lawyers.
hi!
I have seen my entire medical records. Everything that a doctor has access to about myself. They were handed to me while I was at my doctors once and left alone in the room for several minutes while they arranged something. This was pre-computerisation, and they were my damn records, so I sat and read through them all.
Most of them were boring. Most of them related to childhood reports that were ultimately no-diagnosis because it was a cold or sniffles or whatever. One of them relating to my birth describes sub-conjuctival haemorrhaging (bleeding behind the eye) - today my birth would have resulted in compensation and investigations as they damaged my eyes pulling me out.
Apart from that, it was not interesting. Hell, they didn't even have my blood type, because they don't test for it unless they need to. And I haven't been to the doctors in YEARS except to register with a new one. I'm in the UK so there's no "cost" involved in treating me that I shouldn't know, as such.
That said, why would you not want me to see them. If I have a condition, can you really hide it from myself? Seems like nothing more than an arse-covering exercise and - if that's so - why do you have to cover your arse? Why should you care that a previous doctor might have to cover their arse?
Don't let me delete them or modify them, but I should at least be able to view them on demand and provide notes/comments as necessary if there's a dispute. How else can I be assured that the data you have is accurate? I can even query my entire criminal record and have it corrected if necessary (e.g. if someone falsely used my identity to commit a crime, which is quite a common thing), so why can't I do the same for medical records?
In the UK, the PNC has an access and appeals process because there are recorded instances of someone being refused a job only to discover that the things on their record WEREN'T THEIRS - computer error, deliberate fraud, etc. is quite common - enough that there's a procedure to identify you with fingerprints in that case and modify criminal records accordingly, and have an appeals process.
You're not telling me that medical records can't have exactly the same problem and solution, especially in countries where that person's insurance is going to be paying for that medical treatment?
Hell, in the UK, even the Data Protection Act can be brought in here - you're storing data concerning my personal details on a computer system - that's automatic right to query, appeal, correction, etc. before you even start whether that's your image on CCTV (yes, under the UK DPA you can ask for all 'personal data' about yourself, including CCTV of you, from anyone who records it and stores it - there's even an official FAQ about it and they have 40 days to respond, so long as you provide enough details to isolate the data you require), the details your employer holds, or what a certain website holds on you in terms of cookies and stored data on their systems.
It's entirely a malpractice cover, from what I can see. And if you're scared of someone potentially discovering malpractice, then maybe you should deal with your patients more carefully, not try to hide your tracks. And, honestly, that would be #1, top-of-my-list reason for records TO be opened, if that's the case.
God doesn't think he's a doctor.
The funny thing in the UK is if you are a transgender woman doctors seem to work under the idea that they can share you medical records with colleagues for a laugh like you're some sort of curiosity or gimmick for their amusement. UK doctors specialising in transgender healthcare also insist on having complete access to everything in your medical record even when one of the not infrequently abusive doctors has made a complete hash of diagnosis to the point where their comments in your medical record are prejudicial to your healthcare. Some people may think this is bad enough but the Gender Governance Group have stated in their minutes revealed by a Freedom of Information request that they actually believe human rights and equality law does not apply to them because they are doctors and transgenders are a medical issue. Indeed, this goes further. It is only under the duress of appearing in court than some doctors with prejudicial attitudes towards improving transgender healthcare options and funding show how behind the times and neglectful their medical judgement is. As far as some people are concerned transgenders are the lowest of the low and in often male dominated healthcare organisation one wonders if they don't just see us fucktoys or freaks. With an already huge power imbalance between us and a medical profession that operates like a closed shop you really have to begin questioning their motives when they believe patients should be forbidden from seeing their own medical records because secrecy of that level can only allow incompetent and abusive doctors to get away with more crimes of neglect or worse.
It has been proven over and over again that the mere visit to the doctor and the placebo effect has a significant effect on the reconvalescens. It basically hinges on the fact that you feel better, understood and taken care of. It totally destroys the effect if you learn that half of the medication or treatment you get is actually just feel good or placebo medication.
Brokers don't think you should have full access to your investment account (after all THEY are professionals and you are too stupid to understand what they are doing).
Mechanics don't think you should have full access to your car's maintenance record (see above).
file this under ruductio ad absurdum - I can understand the physicians point of view. I simply disagree...
"sed quis custodiet ipsos custodes"
It ain't what they call you. It's what you answer to. http://mylyceum.us/
Whether the doctor wants you to be allowed to see them or not, it is not appropriate that they can hide them.
One place you listed was England, where I am. I wonder if doctors in the rest of the country (UK) feel the same. Whether they do or not, it does not matter. We have rules about this and the law generally allows people to see their medical records. This has ended those cryptic comments allegedly once found in patient notes -
TTFO - Told to f*** *ff
PP - Pumpkin Positive
BB - Big B****
GA - Great *ss
and even more obvious comments like
hypochondriac
smells
gorgeous
and so on
All that should be in patient notes are a record of events, examinations, results and so on. They do not need some juvinile comments about what the patient looks like or stupid personal remarks. I would be interested to hear someone try and justify not letting anyone see their records. I am sure that there will be valid reasons for individuals, mental health comes to mind, but they have to be the rare exception.
I'll see your Constitution and raise you a Queen.
Split the record into a "data" section and a private "remarks" section. Patients get unrestricted access to their own data sections, but require a court order to see the remarks. Establish clear rules for what can go in the remarks section: everything else must go into data, and inappropriate use of the remarks section itself counts as a minor form of malpractice.
This should strike an appropriate balance. Patients can still get at the significant stuff, and they have recourse to get the rest if it's truly necessary. Doctors can continue to comment frankly about patients-from-Hell, without having to worry about being embarrassed unless they already have much bigger problems.
Doctors and Nurses are sometimes brutally honest in their documentation. If you've been a difficult or non-compliant patient you can expect that it was documented. Some people get quite irate about that when they see it in their records, especially if insurance is refusing to cover something because they were non-compliant with treatment. Some people even get upset with the description of morbidly obese, even though for these purposes it's a strictly defined medical term.
I imagine most doctors could identify some patients that would benefit from full access to their records and some patients that they'd rather not even tell them their blood pressure because they'd insist that the nurse did it wrong because their BP is never that high.
That's not the lowest salary for the lowest paid doctors. That's a list of specialists. General practicioners don't make much money at all compared to spedialists.
There's this meme going around that anyone making more than the median salary (or, sometimes, anyone making more than minimum wage) is overpaid.
The best part about racing to the bottom is the sickening crunch when you get there.
Maybe Dr. Van Nostrum can help
I don't have a sig.
Well at least you seem totally mentally balanced now...
http://blog.nexusuk.org
In 2008 I took a peek at an old amber computer screen in a clinic I was getting treated for bronchitis in. What did I see?
I saw text dated from 1981 which referred to me as "NASTY CHILD, IMPOSSIBLE TO CONTROL"
I guess doctors make wrong or let's say suboptimal decisions all the time, it's just that rarely people get so bad or die because of it so you actually get into malpraxis discussions.
Doctors do make mistakes just like any human. The human body is a complicated thing and doctors are nearly always working with incomplete information. Mistakes are unfortunate but also inevitable. The most you can and should ask for is that the doctor treated you with the appropriate standard of care.
They want no patient oversight of what they are doing because a 5 minutes google search might convince you they are not doing a stellar job after all.
It is terrifying that some people think that 5 minutes on google somehow will make them more informed than 10 years of medical training plus years of actual medical practice. Self diagnosis via google is a HUGE problem because disease processes are complicated and there are a lot of subtle distinctions the lay-person will not know anything about. Yes, sometimes the doctor might miss something but the vast majority of the time you will observe the doctor having a better batting average on the diagnosis than the patient.
If patients had free access to this, it would be very difficult for the physician to document their true findings and impressions for fear of "offending" their patient. This would also jeopardize the relationship between the doctor and patient, which is necessary in any setting.
But witholding this data offends me more than anything that could be inside it, and damages the relationship between me and my doctor. If my doctor cannot be completely honest with me, how can I be completely honest with her?
Give me Classic Slashdot or give me death!
you misspelled like
Cheap storage VM.
I think one reason why medics might have a problem sharing is that there are issues if there are suspected psychiatric issues. Imagine a situation that a patient is prone to aggression and the doc thinks this might be related to schizophrenia or something along those lines. In my experience, anyone dealing with patients like this really try hard to keep themselves distant from the patient, in case they turn up on their doorstep... and this does happen. So I would look closely at how the question was worded in this survey. I would imagine most medics can think of at least one person who they would prefer didn't see their notes and for very good reasons. So if the question was along the lines of "should all patients" have access then the answer must be no.
And your solution is?
[FUCK BETA]
Sounds like a pretty good return on investment to me. You should easily be able to service a $100k student loan debt on a low six figure salary. That residency pay may look low to Doc's, but it is a high starting wage for many professions. The time commitment may be high, but the money still rolls in for docs. It took me almost 8 years to break $40k with an AS.
Cheap storage VM.
Doctors develop a big EGO; having a form of "code review" is going to bruise their egos.
The public expects too much of doctors and believes in them too much the doctors enjoy it despite the fears of liability.
Doctors are human biological mechanics. The machine may be more complex but dealing with both auto mechanics and doctors for me has been surprisingly similar with their cycle of educated guess -> routine maintenance procedures -> bill -> success/failure -> repeat.
Democracy Now! - uncensored, anti-establishment news
"most physicians think you should only be able to add information to them, not get access to all of the contents. "
Nope. What it said was that most of them believed you should not be able to UPDATE your medical records. The first paragraph also says 'access', but look at the questions that were asked and the graph. It's about updates, not reading them.
http://newsroom.accenture.com/news/most-us-doctors-believe-patients-should-update-electronic-health-record-but-not-have-full-access-to-it-according-to-accenture-eight-country-survey.htm
http://en.wikipedia.org/wiki/The_Package_(Seinfeld)
Democracy Now! - uncensored, anti-establishment news
My mother has worked in the medical industry her whole life on the administrative side. Since I was a kid, she would always go on and on about "always get your full medical record, check it for errors. Always ask for an itemized bill and check it as well." Then, a few years ago she got cancer, and thankfully survived and is cancer free after several surgeries and radiation treatment. And guess what... her persistence paid off. She again asked for an itemized bill, something that, over the years they've gotten more and more reluctant to give us... and the hospital had literally double charged her for everything. 2 pillows, 2 blankets, 2 room stays. They tried to argue this with her, but she had experience in the medical field and pointed out to them that if she had received the dosage of general anesthetic listed on the bill she'd be dead. The insurance company hadn't even caught it. She saved them hundreds of thousands of dollars, and they sent her a letter thanking her for her diligence. She only saved herself a few hundred dollars in co-pays, but she was proud none-the-less. Your medical record is yours, not the doctors. You should have full access to everything in it, and should be able to remove anything that you feel is inaccurate at will.
[citation needed]
And I can provide you with plenty of citations referencing articles where doctors aren't making any money and/or going out of business. Their billing rates are getting hammered on the Medicare/HMO side.
.... proof of that service rendered.
It is absolutely important for a doctor to understand the medical history of a patient and it is very beneficial to the patient, because frankly, every patient is different. I also believe it is important for a patient who is seeking medical services to be fully informed of what doctors prescribed and the reasons for those prescriptions. I feel that if you don't like the relationship with your doctor, don't go back to that doctor again. Let that doctor keep the information records that you provided for that visit, but you as the patient are the original owner of that info, not the doctor, not the hospital, not the insurance company. As a standard of practice, I feel it is vital for a patient to make sure he/she review their own medical records from all their physicians every 2 years or so.
Our government recommends that we review our credit history every year, so why not your medical records? I also believe that a patient should be responsible for all of their own records. This information is about you and you have a right to understand if say an eye doctor is noting down psychological opinions about you and your mental state where he/she is not an expert. They have a right to an opinion, but it observations should be as non-biased in nature as possible, the information they write down should be factual, not conjecture, and if your copy of the medical records is not exactly the same as the physician's copy, then this should be an issue for everyone.
When a patient volunteers information such as "I've just lost my job and I'm struggling to get out of bed, because I feel so deflated", that can and should be reported. If the doctor responds with the following, "It sounds like you're experiencing depression." I feel the patient/doctor should both have to initial this discussion. Unfortunately, this will open up a can of worms on a legal front should the mental capacity of the patient come into question.
What happens when a doctor has his own medical issues such as a drug and alcohol addiction and is treating a patient, and the above statement is made, who is still scrutinized worse the patient or the doctor?
Sadly, I have met many doctors in my life, some are excellent and will take time to talk to a patient and are happy to share all medical records, while some (that I've met) believe that since you're not a doctor, you're too stupid to understand your issues and that's why you came to me complex. These are people who believe that they are more intelligent than their patients and that patients have no right to look at medical records that they cannot possibly comprehend. (to that I say Horse-shit)
I'm a voluptuous blonde haired woman who has had many doctors think that I couldn't possibly understand anything, and then when I actually ask intelligent questions, they are condescending in their response..."that's a difficult question my dear.../patknee" and that's the only response I've received. Those doctors never see me again, and if anyone inquires as to their abilities, I state that they refused to answer my questions and I won't see them again.
I've been lucky also to have doctors ask questions of me about my medical conditions and are forthwith in their lack of knowledge in a particular area, and these are the ones who will also state that they need to perform a little research to familiarize themselves with my conditions before they are willing to discuss them or call those conditions into the current diagnosis.
No one doctor knows everything, they need history, they need the knowledgeable patient to work with them. Let us not forget, long before medical degrees existed, people were pretty capable of diagnosing their own ailments.
Life takes interesting turns, but the most interest is when you're off the beaten path.
The law in most places in the U.S. (Virginia in my case) is the patient owns the content, the doc owns the paper its recorded on, and the doc may exclude only certain pieces (mostly psychiatric observations). The principle issue is the cost of having the doc's office reproduce the records. It doesn't matter what the docs think--it's settled law.
In Canada, I've read that doctors who are retiring often 'sell' the records they've kept over the years to the new doctor who takes over the practice - no wonder they'd prefer not to give patience full access. Years ago the values I'd heard mentioned was in the hundreds of thousands of dollars for these records.. in a way not too different from estimating the value for intangible 'goodwill' when selling a business.
Arguing on the "positive" side of preventing access: personally, I document things differently if it's customer facing vs. internal notes. Selling the records does give the older doctors a little more financial security in their retirement. Giving people full access will probably cause a few headaches for the doctors - imagine if someone wrote "5th visit, all tests came back negative, issue may be psychosomatic.. patient however became almost when this was listed as a possibility."
While transparency doesn't fix all problems, I'd prefer if the records were open: if we're avoiding the hard talks/arguments because 4% flip out when a reference is made to a mental condition or unpopular diagnosis is made, if doctors are relying on selling records to supplement retirement income because they don't have enough (really??)... I think these are problems to try and fix; not sweep under the rug. These medical records are literally life and death: I'd say open them up. Maybe if everyone had more access, we could possibly find the level of care improving in different ways. It's certainly worth a trial somewhere.
I wonder what hidden gems are in his medical notes.
SJW n. One who posts facts.
Any cool start-ups selling medical diagnosis software?
I can see the need for my lawyer and second doctor to have access to them, but I don't see how I will be able to do anything useful with them.
I predict medical malpractice will disintegrate. Too often we non-experts are expected to make expert level decisions. With the records there will be less of an excuse.
20 characters max for the password? How will I use my favorite poems as passwords?
It totally destroys the effect if you learn that half of the medication or treatment you get is actually just feel good or placebo medication.
Actually, the placebo effect may actually still work even if the patient knows the treatment is fake.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015591
upon the advice of my lawyer, i have no sig at this time
But witholding this data offends me more than anything that could be inside it, and damages the relationship between me and my doctor. If my doctor cannot be completely honest with me, how can I be completely honest with her?
When you do see them, it can be pretty ugly. (I've seen mine as a result of making an injury claim.) I'm not trying to contradict anything you're saying, either. Your model of an ideal relationship with your doctor does sound like it would be beneficial, but physician training teaches them to write notes with the assumption that the patient never sees them. Therefore, the idea of being open about them with the patient is burned into their brains as a bad thing. It'd be a challenge to find a doctor with a more open philosophy, who's on your health plan, and close enough to visit when you need them, etc.
I am not a crackpot.
To say the patient shouldn't have access to their medical records would be like saying a person shouldn't have access to their credit report. It's a given that incorrect, incomplete, or misleading information will be found from time to time. That bad info could affect future care, or possibly even other things in the future. Who knows who besides the patient may end up being able to view this information that the patient would have no way of viewing or correcting. For instance, could insurance companies be allowed to view it before deternining if they should write a policy for an individual? Another example would be if the DOT or FAA could view it and decide not to issue a medical certificate based on what they see. Someone could loose their livelyhood without being able to even see the evidence used against them.
I'm sorry, but it's MASSIVELY different. In your job, you are genuinely subordinate to the higher ups. They tell you to do stuff and you have to do it (or find a different job). There are things about the health and wellness of your company that are quite rightly none of your business. For example, selling off your division and laying you off might be the right thing to do. Telling you that they're contemplating that is harmful to the company (you and others may leave), especially if they decide not to.
Doctors, for all their arrogance, are the hired help. I'm sure I've angered every doctor who reads this, but it's true. I hire a guy to cut my lawn. I hire you to practice medicine upon my body. Yes, there's a vast leap in skill and knowledge required to do those jobs, but *I* am paying *you* to do something *for* me. Period. The simple solution to your claims is honesty and impartiality. Don't write that the patient is an obstinate jerk. Write that the patient failed to comply with your recommendations (not orders!) and cite examples. If the patient reads your notes and doesn't like it, the patient can find another doctor.
Sometimes the notes are important. If you're genuinely suffering from pain and the doctor thinks you're simply narcotic seeking, that's important. Even doctors have biases, and if you're a victim of one of your doctor's biases, you need to know that (and find another doctor).
If doctors think they are vulnerable to malpractice suits then clearly they are aware that their house needs to be cleaned.
It has nothing to do with how competently they practice or how high their professional standards are. The practice of medicine is an imperfect practice. We do not know everything about the human body and even with the best available medicine and exceeding standard of care doctors are going to be wrong a significant percentage of time and patients are going to sometimes have bad outcomes. All a doctor can do is provide the appropriate standard of care when treating a patient. We should not expect less than standard of care but more cannot reasonably be expected of them.
I'm not arguing for or against patient access to medical records but there are several problems with patients having free access to their medical records. First, most patients do not actually understand a great deal of the information contained in the medical records and often will not react appropriately. It is common for people to think 5 minutes on google somehow will provide more insight than 20 years of medical training and practice. Second, it is very easy for a lawyer to twist the story told by even very meticulous records that meet standard of care into a story indicating that the doctor was somehow negligent even when that is not actually the case.
Of course doctors don't want their misdeeds and incompetence on display for all to see.
Ok, how comfortable are you with detailed records of your workplace performance being handed to the public? If you say it's fine I'll call you a liar. Are your professional standards as high as those required of doctors? (for the record I'm rather confident that they are not) It's easy to throw stones. Doctors are held to very high standards and rightly so. It's unfortunate that the same is not required of everyone else.
The process is subjected to continuous auditing that would probably make your HR lackey quit. But the auditing is done by professionals who know what they're doing, rather than patients and their families who have a strong emotional involvement.
There are arguments in favour of open medical records, but "auditing" isn't one of them.
5 minutes on google will tell me that the self-protecting asshole doctor prescribed a relative of mine a drug containing paracetamol, which google helped me learn was a synonym for acetaminophen.
What's the big deal? Well the relative had knee replacement surgery, so painkillers were necessary. The asshole doctor ignored the fact that he was explicitly told not to administer anything containing acetaminophen because the patient had liver disease and explicitly stated such on multiple occassions. The doctor didn't want to go through the hassle/overhead of dealing with a schedule 2 drug, and just prescribed the drug containing acetaminophen.
Even after explaining to him that 'No, this person really needs to not take acetaminophen/paracetamol/tylenol/etc' we still discovered that they kept 'resetting' and going back to giving him the drug.
So you will have to forgive me for not trusting 10+ years of experience vs google when the asshole kept giving tylenol to a guy with liver disease.
Out of modpoints but really liked a post? 1BDkF6TtmmeZ3yqXbz9yhdYVqRYnwFoXDj
Seems like nothing more than an arse-covering exercise and - if that's so - why do you have to cover your arse?
The same reason the "if you have nothing to hide you have nothing to fear" argument is a fallacy. Doctors are sued all the time for various reasons, most of them rather frivolous but expensive and time consuming nonetheless. It isn't hard to twist medical records against you even if there is nothing actually improper contained within them.
And why should I? From the results of this poll, they clearly don't care what I think. Many seem to be under the impression that I can't read as well. While it may shock many doctors, some of their patients are as smart as they are, or smarter, and have owned a Tabers Merck manual since college, and used it more or less like they would use an encyclopedia or a dictionary. While this is not substitute for a medical education, we're not all idiots either.
Bottom line? My records are *mine* to do with as I wish. If it shows medical mistakes, than that's just too damn bad. I don't get to hide my mistakes. Suck it up and deal with it.
Please do not read this sig. Thank you.
if a doctor comes across someone who genuinely has a rare condition they're almost certain to misdiagnose it.
And a patient is even more likely to do so. A doctor is supposed to look to the highest probability diagnosis first. Rare diagnosis are hard and it's pretty rare for doctors to have perfect information. Almost every diagnosis is an educated guess and some percentage WILL be wrong. In fact sometimes getting a percentage wrong is considered appropriate care. Doctors are expected to take out a small percentage of appendixes that are not actually wrong. There is no way to know with 100% certainty whether it needs to come out until they actually do the operation and some symptoms can be mimicked by other conditions.
doctors are often too sure they have a deeper understanding than they really do.
This does happen but having a doctor that not confident is rather useless. It's a fine line to tread and most do it reasonably well.
When I write, "drug seeking behaviour" in the notes I don't want to show it to the patient, because I know all that is going to happen is I'm going to have to sit there whilst they scream at me until I finally give them the damn Diazepam just to get them out of my hair.
Legalize it so they don't have to lie to you. Problem solved.
Give me Classic Slashdot or give me death!
I don't give a fuck what THEY believe.
MY RECORDS == MY PROPERTY
So you will have to forgive me for not trusting 10+ years of experience vs google when the asshole kept giving tylenol to a guy with liver disease.
It's appropriate to check on what is being prescribed and be involved in your care when you have the ability. Even well intentioned doctors (and pharmacists) make mistakes. Odds are that there was a problem with communication and that it was an honest mistake. Doctor's that would intentionally or negligently harm a patient are quite rare.
That said, if you felt the patient was being intentionally mis-treated or incompetently treated then one has to ask why you continued to let this doctor treat the patient? If this guy was such an "asshole" then you can and should demand a different doctor be involved. You always have that right and you should exercise it if needed. What you are describing is grounds for a lawsuit. Did you bring one or are you just trying to bash doctors in general based on one anecdote?
Most Patients think Doctors and Hospitals should charge less.
There are way more patients than doctors so if we are going to get into this bullshit of setting policy by taking fucking polls, then I think the Doctors will be fucked over well and good.
When Fascism comes to America, it will call itself Anti-Fascism, and tell you to give up your guns.
Coincidentally, 31% is how much I'd like to pay for my medical services, relative to my cost today.
Let's draw an analogy. "I want full access to all my computer repair records and service calls!"
"Ok (hands over records)."
"PEBKAC?!?!? What the hell does that mean? 'Stupidly clicks on download links, leading to infections'?!?!? 'Doesn't carry his weight in raids, not counting the dent in his seat cushion'!?!?!"
(-1: Post disagrees with my already-settled worldview) is not a valid mod option.
Too many doctors simply believe that either we are not capable of understanding our own records, or that doctors should be free of the burden of of discussing those records.
pre existing conditions
http://www.slate.com/articles/news_and_politics/prescriptions/2009/09/lets_pay_doctor.html
I call BS. Median salaries for family care are under 150k. Median for even highly specialized fields like anesthesiology are around 250k. That starts in your mid 30s, and comes with a large amount of debt (unless your family dropped half a million on your education). Meanwhile, a good software engineer can clear 200k by the time they hit 30 without much trouble, and they'll have been making over 100k for nearly 10 years by that point rather than going further into debt. If you're smart with your investments, there's no reason you can't do just about as well as the average doctor in the long term.
Now, there are people who use their earning power to go deep into debt to afford all the fancy things you mentioned, but that's not exclusive to doctors except maybe the "old money" wanabe contingent who feel entitled to live that way (which I suspect may be slightly more attracted to that field). But going into more debt to support a lavish lifestyle isn't "rich". And there are the outliers... physical therapists to nationally known sports franchises, etc. who make millions of dollars, but you also have outliers like early employees at Facebook and Google on the other side.
Short answer, I just don't see where doctors are significantly overpaid on average. It doesn't fit the facts.
Slashdot needs a "-1, Wrong" moderation option.
The Urban Hippie
These are the same people who think you should not have access to their malpractice and disciplinary records.
"To those who are overly cautious, everything is impossible. "
So have a little comment section for the medical records. Those comments are for that office only. Those comments do not get transferred to another doctor. Only the official diagnoses and medical records get transferred to other offices. If a doctor wants to write down details for himself and suspects that you have mental instability, that's fine. That's for their eyes only. But if they want to communicate that to other doctors, they should use proper terminology, they should explain why they think that the patient has mental issues, and all of that should be in the medical records in a proper form.
If we're making the argument that doctors want privacy because they write stuff that they don't want the patient to know which may be offensive to the patient, then I will make the argument that professionals should not be in the business of gossiping about their patients to other professionals. A doctor should have confidence in their own diagnosis, thus there should not be any embarrassment on the part of the doctor about what they diagnose. If they need to communicate that diagnosis to another office, it should be done professionally. "Patient probably fucked up from drugs" is not a professional diagnosis that should be transferred to another professional.
You're not alone in this battle. I think every recovering alcoholic on the planet winces at the idea of "having to" take a drink on any random morning and having the will not to take a second one if it isn't needed. Knowing a fair few, I doubt half of them could pull it off, and fewer than that would assume they could.
I had one friend who had some success rotating through a diverse set of painkillers, each with it's various different side effects. He strictly enforced this rotation, and got enough relief to function, but apparently curbed some of the longing because (as I understood it) since he had only a 2 month old memory of the next drug he would take, it didn't trigger as strong a feeling of longing as the drug he took last week.
I'd like to say this was a happily ever after tale, but moving to a new state made the doctor that was willing to try the above plan inaccessible, the new doctors wanted to run the gamut of single drug remedies, and that ended poorly. My friend was not in the sturdier half of the addiction resisters.
Best of luck.
They save the new doc needing to take the entire medical history of the patients, so it makes it more likely that the new doc buying the existing practice will keep the existing patients.
On the other hand, the new doc is actually doing the old doc a favour because by accepting responsibility for those records it means the old doc doesn't need to ensure that they are safely destroyed.
At this time you can request your full medical records from your doctor or hospital. The law is that they must be provided to you, end of discussion.
Let's draw an analogy. "I want full access to all my computer repair records and service calls!"
"Ok (hands over records)."
It actually works like that with Sasktel. The Freedom of Information and Protection of Privacy Act applies to Crowns, so you can send in an application and get copy of all your service tickets. I think you could also get the call recordings, though I believe they only keep those for a few months.
upon the advice of my lawyer, i have no sig at this time
Fuck you.
Records that concern *my* body are my property. This is a more sacred right than any copyright or patent, no matter what the laws or any pill pushers say.
The Internet King? I wonder if he could provide faster nudity.
This is a failure of the doctor, not the patient. It means the doctor isn't explaining to the patient what the information means, why it should be interpreted a certain way, what other interpretations there are and why they're wrong, and why a certain course is the best one. I've dealt with too many doctors who get offended at having to explain those "why"s, resulting in me finding another doctor who's a bit more open to keeping me informed. Yes you'll find some idiots who won't listen, but you'll also find a larger number of non-idiots who've decided that your intransigence and refusal to give them information means you don't really know anything and they need to start looking elsewhere.
I've had a couple of GPs who were very clearly not capable of critical thinking. After an argument with one where I was quite sure I'd had fifth's disease (because I was exposed to it) and he was sure I'd had rheumatic fever, he actually got out his book because I kept asking him if he'd tested for fifths. He tried to show me how there was no need for him to actually figure out what happened, because "indications" told him all he needed to know. Now of course this would have meant the difference between me having a round of antibiotics every tooth cleaning for the rest of my life, or just getting over a childhood disease I'd never had as a child.
~10 years later, I obviously never had rheumatic fever, so he was wrong and I was right.
Oh, and I had another doctor prescribe me an antibiotic after telling me I had a virus. I never filled the prescription and I never returned to his office.
Point being, I don't care what letters you have after your name. If you can't make your case to me I'm not going to accept your opinion, and I don't give a fuck how much you spent on your degree. I've seen the proof that sometimes, my doctor is either stupid, lazy, or sloppy. And I deserve to know what it is they're writing in my record. Period. Otherwise, what did I pay for?
One day I feel I'm ahead of the wheel / the next it's rolling over me / I can get back on / I can get back on
If someone cut decades off my life I might just have to cut decades off his. Not like there would be a shortage of suspects.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
Let me give you a real-life example of what doctors are bracing themselves for. My wife saw a patient, and that patient later requested a copy of her medical records. No problem; my wife's office gave them to her. I personally witnessed this exchange afterward while I was picking up my wife from work:
Patient, storming into office: I WANT TO SEE DR. MRS. JUST SOME GUY!
My wife: Hi! What's wrong?
Patient: You slandered me and you're going to Fix. It. Right. Now!
Wife: What... what did I say?
Patient: You called me a drug abuser!
Wife: No, I did not!
Patient: It's right here! shows everyone who will look a highlighted section from her chart
Wife: Right...
Patient: I told you I didn't do that, and you said I'm in denial about it! If you don't fix that, I'll sue.
Wife: But that's not what we mean by "deny".
Patient: FIX IT OR I'LL SUE!
I swear that's not an exaggeration or misrepresentation. The patient was threatening to sue for defamation of character because my wife wrote "patient denies excessive drinking, tobacco, and drug use." That's medical jargon for "I asked the patient if she did this stuff and she said no" and is the industry standard way of documenting a "no" answer to a question.
Of course patients deserve complete access to their records, but I fully understand doctors who'd just as soon disarm a hand grenade as to hand over records to people who aren't trained in their interpretation.
Dewey, what part of this looks like authorities should be involved?
Mod parent up.
I would also say that most Doctors are trained to be pretty good at following an ethical code to prevent conflicts of interest from clouding their judgement. When you self-diagnose based on your symptoms, you can certainly begin looking for more symptoms in yourself that match your desired diagnosis, which might not be the correct one and lead them to miss the actual problem.
Good doctors understand that this is a huge issue, and will go so far as to avoid diagnosing and treating themselves or their immediate family.
5 minutes on google will tell me that.....
Will tell you what? Not as much as you think, apparently.Thank you for illustrating this. ~2 grams/day (some say more, but 2 is solid) of acetaminophen/paracetamol/tylenol/etc have been studied and accepted as safe in chronic liver disease. 500 mg PO QID if you are so inclined.
The therapeutic use of acetaminophen in patients with liver disease.
Alcoholic liver disease: Is acetaminophen safe?
Acetaminophen, When Taken as Directed, is Safe for Patients with Liver Disease
etc......
Argh. The laws of science be a harsh mistress.
But that is completely irrelevant. Any private entitty that maintains detailed information about an individual US citizen should be required to disclose those records to the individual in question under any circumstances. That goes for my doctor, Facebook, whatever. There may be any number of reasonable exceptions to this, but disclosure should be the default expectation. In the case of healthcare I believe that any cases of disclosure that are actually harmful to patient care are rare exceptions that prove the rule.
So to the 69% of physicians who prefer restricting patient access: Fuck off.
I work in the US healthcare industry
So do I, and I actually think your argument is irrelevant. What you are describing in a nutshell is the 80/20 rule. In essence, a majority of the customer interaction problems any business faces come from a minority of customers. Your organization's inability to manage the nutjob 20% effectively is not a justification to deny access to the other 80%. Your leadership needs to do the following:
1. Drink the kool-aid on that fact that patient access to their EMR is an overall net benefit to the quality of care they receive. (aka, the "carrot")
2. Accept that even if you can't get your head wrapped around #1, HIPAA doesn't care and mandates it anyway. (aka, the "stick")
3. Establish reasonable and consistent processes to deliver that access in a manner that is cost effective to your organization.
This is why the common defense in a malpractice lawsuit is "Medicine is a practice, not a science"
"When life gives you lemons, don't make lemonade. Make life take the lemons back!" -- Cave Johnson
There are a few spots where I hurt myself BAD and needed something for pain (Breaking my pinky toe to where it is purple and just hanging there, to a visually dislocated thumb). I tell the doc "Hey, I take excedrine 600mg 4 times a day due to headaches, documented for 30 years. Aleve does't work, ever. I can't take anymore NSAIDS". ALWAYS I get the "Well make sure you are taken care of. Here is a prescription"... for Naproxen Sodium
"When life gives you lemons, don't make lemonade. Make life take the lemons back!" -- Cave Johnson
The patient can't see the records, but the doctor has no qualms about showing an insurance company everything, every false diagnosis, every suspicion, every disease you've ever had, every medicine you've ever been prescribed. Insurance companies will then use this (mis)information to deny coverage, increase rates, or refuse payment after-the-fact.
Contribute to civilization: ari.aynrand.org/donate
My wife works with medico-legal cases, and she thinks its because of how shocking the records are. Illegible and scribbled, content free, clearly done in a rush, or ages afterwards when the doctor doesn't remember the exact details.
And thank you for illustrating the fact that when people assume they know what is best for the patient and don't involve them in health decisions, you can make some really deadly mistakes.
For example, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3112029/
In this case, my relative was going in for a SECOND knee surgery because the first replacement resulted in a MRSA infection which required a second removal surgery to remove the replacement, treatment period to elminate the MRSA, and a third surgery to put in the replacement again.
The doctor screwed up bigtime.
1. He ignored what the patient said
2. He prescribed a drug which was unnecessary because non-acetaminophen containing versions were available but required more oversight (schedule 2 vs schedule 1)
3. He did NOT inform the patient that he was ignoring the other doctor's recommendation against Acetaminophen.
The only reason we caught it was because I explicity told my relative to get confirmation of exactly what pills they gave him or tried to inject into his IV. At the time, I wasn't sure what Paracetamol was, and was able to use google to discover that they were trying to give him something that likely would have killed him.
From first surgery to this incident, due to the MRSA infection he had lost over 60lbs. By any measure he exhibited many risk factors for liver failure, and should never have been given acetaminophen.
The doctor, like you did right now, assumed that he knew more than the patient, and the results were almost deadly.
(If you want to get into the risk of getting surgery so soon after getting over an infection, welcome to the world of working for a living and your disability insurance getting maxed out months earlier. So, surgery and get back to work, or go homeless AND have a leg with no knee, remember the first one was removed to treat the infection)
Moral of the story: Don't tell the doctor you have been advised to not take Acetaminophen, tell them you are allergic so they put a bright pink wristband on you. (isn't that great, we have to lie to the doctor just so they won't ignore your other doctor's directives)
Out of modpoints but really liked a post? 1BDkF6TtmmeZ3yqXbz9yhdYVqRYnwFoXDj
It is terrifying that some people think that 5 minutes on google somehow will make them more informed than 10 years of medical training plus years of actual medical practice. Self diagnosis via google is a HUGE problem because disease processes are complicated and there are a lot of subtle distinctions the lay-person will not know anything about. Yes, sometimes the doctor might miss something but the vast majority of the time you will observe the doctor having a better batting average on the diagnosis than the patient.
It is terrifying that some people think the doctor can do a better job of diagnosing me as he jogs past my room to the next patient, barely taking the time to notice I exist, than I can with a careful reading of multiple informative and reliable websites. Data is data, after all. The disease may be complex. It may be obvious. But the doctor won't necessarily know with the three minutes he's willing to spend in the room.
BTW, for my money, I prefer nurse practioners (I'm American). They are not under the tight time constraints of a doctor, but have nearly as much training, and plenty enough to know when they are looking at something they don't know about.
Aah, change is good. -- Rafiki
Yeah, but it ain't easy. -- Simba
They want no patient oversight of what they are doing because a 5 minutes google search might convince you they are not doing a stellar job after all.
It is terrifying that some people think that 5 minutes on google somehow will make them more informed than 10 years of medical training plus years of actual medical practice. Self diagnosis via google is a HUGE problem because disease processes are complicated and there are a lot of subtle distinctions the lay-person will not know anything about.
I write some of those things that you will find in a 5-minute Google search about your disease, and you are exactly right.
If you read for example Wikipedia or Huffington Post, you'll see that many or most people don't appreciate the difference between a human study and a mouse study, association and causality, progression-free survival and overall survival, an abstract and a journal publication, etc.
The more I learn about medicine, the more I realize how little I know and how easy it is to misunderstand a journal article. If you get one word wrong, you can completely misunderstand the article.
When my own friends ask me for information about their conditions, I don't give them my own articles, I give them usually-paywalled articles from the New England Journal of Medicine, Lancet, JAMA, and the peer-reviewed journals. That's where I get my information from.
When I have a medical problem, I do look up as much as I can on Google and the peer-reviewed journals, but I don't make my own medical decisions. I find a doctor that I can trust (admittedly not easy).
It's true that there are some common conditions that come up over and over again, and you can get a good idea about how to manage them with a Google search. What you can't know is whether you're in one of those common situations or whether you're in one of the common exceptions.
I encourage people to educate themselves about medicine. I think it's fascinating and empowering. However, the first step in education is realizing how little you know. In medicine, you have to realize how complicated it is, how much there is to know, and how easy it is for you to make a mistake.
5 minutes on google will tell me that...
...it's cancer. Anytime you look up something medical on the internet, it's always cancer.
Placebos work for way more then just insane people.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
Of course patients who are ill informed or not knowledgeable about their own conditions will make those errors. That is why we need to open up, let patients gain as much knowledge as they can about their own conditions so that there isn't a knowledge imbalance between patient and doctor and the patient and doctor can actually discuss the pros and cons of different treatments in accordance to their specific medical records. Computers and artificial intelligence will solve the knowledge problem and make it so doctors and patients can rely on the artificial intelligence to handle stuff like drug interactions, allergies, and risk/benefit analysis type stuff. At that point the computer and AI may recommend certain treatments to the patient and the doctor and then they can discuss it with their doctor.
Doctors don't know everything. They're trained to spot the most common problems, but it's really, really easy to stump a doctor. My GF has been having dizzy spells. She went to her GP, who sent her to an ENT, who sent her to an audiologist. None had any ideas.
So she spends some time on Google, and finds out that dizziness can be a side effect of gall bladder attacks(through over stimulation of the vagus nerve which causes a sudden drop of blood pressure). And she had seen the same GP a year earlier about her gall bladder problems. Why didn't the GP pick this up?
No, patients should be encouraged to do as much research as they can. You as a patient care more about your issue than anyone else. You know more about your body than anyone else. You should be a partner with your doctor in your own health care.
The main problem is patients don't have access to knowledge about themselves. If a patient has their medical records, their genome and DNA information, all of this, and if there are AI running on super computers which a patient can consult with, which can tell the patient about the latest research that pertains to or involves their conditions, this would be great. A doctor is still needed but the role of a doctor is going to have to change over time as technology can diagnose, and as patients can monitor a lot of things from home using electronics. The problem is dealing with Big Data and transforming it into something relevant to the patient.
Why didn't the GP pick this up?
Probably because (a) he has more than one patient to manage and may have forgotten about the gall bladder incident (especially if it was a single acute incident that went away, as opposed to something needing surgery), (b) he may not have had time to review her chart for the past year, given the number of patients he had to see, how far his office was backed up, etc., and (c) the actual number of patients who manifest dizziness as a symptom as a result of a gall bladder attack may well be very small.
I doubt that you expected an actual answer, but these seem to be most likely. None of these, by the way, are unexpected or unusual or even get close to a notion of malpractice. In the end, you are correct in your last statement.
That is why we have computers and AI. Doctors don't have to pick everything up. Patients should be able to pick certain things up on their own to make a doctors life easier. Also with big data and the ability to analyze it, a lot of doctors will be able to take advantage of technology to empower themselves to deal with the big data problem and so should patients. Personalized or individualized medicine requires the patient to be empowered and involved.
It is expensive because of extreme corruption. Here is a good summary: Bitter Pill: Why Medical Bills Are Killing Us. As the article says, health care organizations often charge 10 or 100 times what things cost.
I actually think this is if not the thing physicians are concerned about WRT records it's definitely a huge part of it. And they're perhaps right to groan about it ... I'm sure they get real tired of being the second opinion for WebMD. But you know what? I don't care.
It's a good thing if an obnoxious patient is asking 'why do you think that about my condition?'
If the patient/family member has a point, listen to them. That way, you won't be the one asshole who told me my wife was terminal and there wasn't anything to be done, then when I asked about a treatment I read about in The Lancet tell me smugly that "there's no support for that treatment in the literature." I had a copy of the journal with me. It shut him up. I also had the phone number for an academic medical center a couple of towns over. When she got there, the first thing they did was the treatment that this doctor said was bogus. She's fine now. I think that doctor may have actually had more than 10 years of medical training. Too bad he didn't spend a few minutes learning to Google.
If the patient is a total idiot, learn how to slip him or her a print out from Up-to-Date on your way out the door. And if you're bothered by patients asking questions -- then go into research, 'cuz you shouldn't treat patients. If you're bothered because those questions are stupid, you should have become a veterinarian, because people are stupid and that'll never change.
I'm a doctor in the US, and I'm stepping into the line of fire here as there is some serious doctor hate going on in this thread, but here goes...
First of all (in the US at least) most of these arguments are moot because patients by law have the right to their medical record. So, regardless of what your doctor thinks, by federal law you have the right to request and get access to your medical record.
In regards to the attitudes about IF patients should have this access I would be willing to bet that older physicians would be more against it than younger physicians. Doctors above a certain age tend to be more paternalistic towards patients than younger doctors.
My personal opinion is that any individual should be able to obtain access to their own medical notes.
However, most people are not familiar with the diagnostic process and jargon used in medical records. This could definitely lead to misinterpretation or confusion by a patient or the feeling that information was withheld when that is not the case at all. For instance I may write in a chart "left lung cavitary mass - malignancy vs TB vs fungal infection" indicating that I'm not yet sure what it is and more workup is needed. Do I tell the patient every possible differential diagnosis? No, because that tends to freak patients out, I say "I don't know what it is yet, we need to do some more tests."
If the patient read my note without understanding how to interpret it they may feel that information was withheld or the doctor has no clue what's going on.
I think that is more what is behind the results of this survey than doctors "covering their ass", because if a patient wants to sue they will sue, and every single piece of information about that patient will be subpoenaed and scrutinized by lawyers. You cover your ass by putting complete and accurate information into the medical record, and not trying to cover up mistakes if they happen.
Personally I would not care if any of my patients read their chart. I will even show it to them "See, last time I wrote that this was going on, is that still a problem?"
In my experience, drug use information and review of systems symptoms are the things patients most often want to remove later, for legal and insurance reasons, and it is those bits that (in our system and many others) they put in directly themselves. Curious.
sentence carries a clear implication that the Dr. considers it likely that the patient is a drug/alcohol abuser.
Yes, but the records aren't in English: they're in jargon. There's a world of difference. Consider a common IT phrase "click the OK button". Although the words appear to be standard English, the sentence most certainly is not. There is no "small disk or knob" sewn to the computer screen. You are not causing the "button" to "make a short, sharp sound". Instead, you're moving a mouse (not a mammal) to reposition a cursor (not a piece of a slide rule) on the screen (not a room-dividing partition) until it's over an icon (not religious) that reads "OK". Think of how much fun we'd have if non-geeks interpreted every single word we say at work in the literal sense. "You're writing on pythons? Like, with a Sharpie?"
"Patient denies" has a well established legal meaning in the context of medical records. The patient's interpretation of that phrase as plain English is irrelevant, because it's not plain English.
Dewey, what part of this looks like authorities should be involved?
It's already law in the US that patients can have access (and copies) to their own records. The survey was about electronic access to electronic records. There would be a legitimate concern if you allow patients to add information into the doctor's record without any supervision or oversight. There are services that allow individuals to compile and maintain their own records already. And only 4% said no access... 96% said access of some type.. probably with need for explanation of how this would work in practice.
So, physician's don't want patients entering data, altering data, deleting data from the physician's electronic record.. yea that's newsworthy.
Medical records are already evidence in cases like that. Whether or not a patient gets to see their records doesn't change that juries are sympathetic to some victims regardless of facts. That's human nature and fact of jury driven justice systems. There is no easy solution. Tort reform with damage limits hurts real victims. Outrageous lawsuit damages awards hurt doctor premiums. Trial by plaintiff peers favors the plaintiff, trial by doctor peers favor doctors. The only solution that looks promising is having standards, which in medicine, is logistically difficult. However this is only made more difficult if people don't have access to their own records. Ultimately standardized EMRs should also be available in aggregate with personal info removed for study.
Also, nice pointless John Edwards insult. Partisan dumbass.
And if the patient involved has multiple liver studies showing that 2 grams is still enough to cause them problems? If they have ER records showing jaundice or other obvious signs after having taken less than that? Sure, for most patients it is still a safe dose. But most isn't all, and some people have instructions from their specialists (you know, the guys that the PCP and ER refer to for their expert opinions?) to avoid APAP.
There are pro and cons with patients accessing ALL their records (i'm on EMR) PRO: -it's your record and you know best if there is a mistake in my profile of you (meds, family history, past history) -it puts you in the driver seat for your own health (knowing your own cholesterol profile, cardiac /cancer risk factor, obesity , smoking , alcohol etc...)
-you can see my perspective of you as a patient (warning: can be painful, and if you understand all the medical terms and jargon)
-it actually takes away some of my responsibility (advised you take such meds/immunization/lifestyle changes/screening procedure/lab/xray...and you did not do it)
-shows you how little I make per visit compared to my US conterparts
-shows you how much you wasted the system for some of your useless visits (esp. to urgent care: eg. sniffle that started this morning)
-hopefully you realize that medicine diagnosis and treatment is not black and white but a very wide shade of grey, and certain diagnosis and treatment takes several visits and referrals before you get it right (what version of Chrome am I using now?)
CONS:
-you might be hurt if there some truth that hurts (eg: you're an unionized worker who cannot return to work because of small booboo while I'm sitting in front of you with a bigger boobooo, the differential diagnosis of your real back pain is malingering, if I think you're anxious and depressed and you think you're not, if I test you for a sexually transmitted disease because I know you're partner has not been faithful and you don't know, etc...)
-you might think my notes are not complete because I can't type in fast enough or I did not type in what you were thinking
-you might come back to clarify jargon/terms you do not understand, and it's going to take me for ever to explain to you that it was 'within normal limits' and there only so many hours in a day to see patients, and you're not a priority when there are sick people who would benefit from the time wasted on you.
-when you are used to a free medicare system , are you ready to pay to have access to your record?
-when I refer to you as SOB it stands for 'shortness of breath', however FOS really means constipated. This actually happens to me!
As for lawsuits: I'm not worried about it, because in a law suit your lawyer will have access to the whole chart anyway
As for hiding how much I make: it's public knowledge how much I make per visit (at least here in Canada), just multiply that by the number of visits, and I don't write that in your chart
I'm sure there are lots of other point, but those are the ones I can think of in 5 min.
I think they're afraid of http://en.wikipedia.org/wiki/Second_opinion
Casteism
Oh............Except for that laptop that some doctor took home and accidentally released everyone's records.
Or when some insurance company wants to sift through for "pre-existing conditions".
Or if an employer wants to see if you've ever been treated for bad stuff.
The shepherds did so well protecting the flock that the sheep no longer believed that wolves existed.
I happen to be a doctor. I think that patients should be allowed to have their records. Will it do them any good? Doubt it. Just because you can look your condition up on the Internet does not make you qualified to read and understand your medical records. Heck, more than half the time I can't even read what my colleagues write. But, welcome to them, I say. And if you bring your records around to my clinic after my residency, I will cheerfully meet with you and charge a level 4 visit to pore over them and do my best to try and decipher the writing. Then I will actually need to do a complete history and physical the first time I meet you and record all that data over again because that's what a good doctor does. Then I will give you information about what I think will help you - give you the data you need, and the alternatives, so that you can hopefully make an informed decision. So, sure, Have your records. I don't really see why not.
Current medical school curriculum teaches us that documentation should be objective, complete and should include an impression and plan. Never did any of my professors or attendings teach me that I should document as if no patient will see the record. Perhaps this was the case in the old days, but the old days are over.
If I shouldn't have access to my medical records, then who owns my medical records?
After going to MD Anderson for 18 months for treatment, I really appreciate their policy of posting your records online so you can read them. I really think the patient should have complete access. Those that want to deny access probably have something to hide,
That's the problem. Our medical system is great at treating "average" patients, and horrible at treating any individual one. It doesn't do a good job of learning from individual experiences. It also tends to ignore those who do have knowledge of such things.
If somebody who has been healthy all their life is driven to the ER with a heart attack you have no choice but to treat them as an "average" patient - that's going to give them the best results based on your limited knowledge. However, when somebody who has been managing type 2 diabetes with insulin for a decade tells you that they think that the dose of insulin you're about to give them doesn't seem right, you should probably should at least engage in a conversation and weigh their words carefully. I know a diabetic who has had experiences varying from nurses who are very deferential to them with regard to sugar management to those who refuse to listen and they woke up in the ICU in a cold sweat fumbling for the call button in a state of delirium (their blood sugar was around the 40s I think, and their body temperature was in the 80s). This was actually when they were starting to get better (hence not being on IV insulin with frequent checks). The most you can do as a visitor is try to talk to as many nurses as you can and get the night shift one before you leave, but that is pretty grueling when a relative is in the hospital for a week.
There are arguments in favour of open medical records, but "auditing" isn't one of them.
I want to be able to take my records to another doctor without my current doctor's knowledge. Just because I don't have the knowledge to personally audit medical records doesn't mean I don't have a legitimate interest.
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Your full work log isn't about my very personal and important issues.
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Part of my frustration with the situation, is that there is very little true culpability for non-obvious mistakes. When I say 'non-obvious' I'm not talking about mistakes which are easy to make, but consequences which are not easily traced back to actual blatant mistakes.
Here's a little secret. You don't actually want every mistake to be easily found and punished. Really, you don't. Even ignoring for a moment that humans are imperfect and that we all make mistakes sometimes. Here's the reason why. The ONLY way to learn medicine is to practice it on real, live humans. Aspiring doctors are very smart and study hard but you cannot really learn medicine until you do it on actual people. Like every other activity, when you are learning it you will make a lot of mistakes. Most if not all doctors have probably unintentionally killed and certainly hurt someone with one of their mistakes. All of them. Wrong diagnosis, wrong prescription, wrong or incorrectly performed procedure, etc. Why do we allow all these mistakes? Because on the whole they get far more right than wrong and medicine is unambiguously beneficial to society.
Doctors are often working with incomplete and/or misleading information. A lot of "mistakes" are only revealed as such after the fact even for the most experienced of doctors. If doctors were punished for every mistake they make, it would be impossible to practice medicine. The risk would simply be too high. Naturally there needs to be standards (high ones) and there is no excuse for not putting forth every effort to achieve the appropriate standard of care. But you can take it too far and punish errors so much that we hurt our ability to treat patients. Let me give you an example. In at least one state I'm aware of, OB/GYNs are potentially liable for any illness a child develops until the time they are 18 years old, including for things that there is no demonstrable connection possible between the actions of the doctor and the patient's outcome. As a result, lots of doctors have gotten out of the specialty because the cost and personal risk has become too high.
I'm married to a doctor. She's the most diligent and conscientiousness person I know and she's damn good at her job. But she would be the first to tell you that she isn't perfect and even if she was perfect and made the best possible call on every patient she STILL would get a significant number of diagnosis wrong because we simply do not know enough about the human body and we do not have perfect information.
Bear in mind as well that every doctor is, at best, delaying the inevitable. You WILL die sooner or later. All a doctor can do is maybe delay it a while and hopefully make you a bit more comfortable along the way. Be demanding of your doctor (they can handle it) but also be a little forgiving as well. They really are trying to help you.