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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 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.
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.
Because you don't need it; now stop acting like a 3 year old with all this 'why' nonsense!
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.
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/
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.
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
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.
probably had to drive everywhere he was used to walking...
Cheap storage VM.
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?
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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.
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.
.... 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.
I wonder what hidden gems are in his medical notes.
SJW n. One who posts facts.
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
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!
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.
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.
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?
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'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?"
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?