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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."
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.
The easy way around this is to treat a medical records system like an accounting system. You can't delete any record you can only add corrections. Anyone reading the record would be able to see the "erroneous" entries as well as the justification for correcting them.
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.
Notes.
For example:
"Patient responds well to placebos"
"Patient is a looney hypochondriac, but has lots of money. Recommend all possible expensive tests."
"Patient is an addict, faking symptoms in order to get painkillers."
etc.
Well... what they did :-)
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. 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.
In Romania we have a law, that they "forget" to change every year, stating that the dead guy (and only him) must personally ask in writing for the medical records. In case someone dies from malpraxis no-one has access to that anymore so basically you can't argue malpraxis for people who died (therefore we have a statistically excellent medical system).
So yes, I'd go with conspiracy.
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."
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.
I worked in the medical industry, handling medical data. This is exactly what they don't want you to see.
Patient records are riddled with notes intended only for internal use. To a doctor, it's nothing special that you suffered explosive diarrhea in the middle of the hospital elevator - that happens once a week, and it could be medically important. To a patient, that's a terribly embarrassing episode that shouldn't be in records, and even considering storing such a thing is grounds for a lawsuit. That lawsuit would be argued in front of people outside a hospital setting, who would be biased in favor of the patient. In front of a hospital ethics board, tthe incident is just another bad day for the janitor.
To use the traditional car analogy, hospitals are much like body shops. You really don't need to know every point that was inspected, every noise source that was considered, or the internal notes from the mechanic about how you question every repair so he should make sure to only finish work on days the manager's available. Most of the information is obvious to someone knowledgable, useless to someone who knows nothing, and ammunition for someone who knows just enough to be dangerous.
On the other hand, what does the patient need to see? Doctors know that old records are unreliable, so history beyond a few years old doesn't really matter if it's slightly inaccurate. Current treatment is usually handled by a single primary doctor, who knows what makes sense for a particular patient, so inaccuracies there don't matter either.
Sure, it's information about the patient, but giving out all the details just causes more trouble than good.
You do not have a moral or legal right to do absolutely anything you want.
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.
I found that here in the UK, doctors tend to develop shorthand just in case anyone (like a nosy relative) looks at the patients notes in hospital... a nice one that stands out in my mind is "NFN" which is taken to mean that the patient is mentally impaired and thus requires extra care/attention when being spoken to. When I asked a doctor friend of mine what "NFN" stood for he chuckled and said... "Normal for Norfolk".
http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita
Unfortunately, doctors are generally woefully unequipped to treat pain, particularly long-term pain. Plenty of addicts are made by the medical profession, something they don't like to admit.
Posting as AC for obvious reasons but... Yes I would agree that a lot of addicts get their drugs directly from a doctor. It just takes one injury that causes chronic pain and you're often left with two choices in the end: Try and live with the pain, or become an addict. I don't necessarily mean mental addiction, but there is no way to avoid the physical addiction. I was hurt, and was on narcotics for years. They finally were able to perform a procedure that didn't remove the pain, but got it down to the bearable level it was at when I was medicated. I was virtually pain free, even at the lowest dose of my medication. I asked the doctor to take me off completely and we spent months and months weening me off. Within 3 days of taking that last dose, I thought I was dying. It was the most miserable experience in the world. At least, I thought so at the time. It's been almost a year since I've touched the stuff, but the first few weeks were the only time in my life where I ever thought I needed a drug to live. I had to flush my stockpile of medication down the toilet for fear that I would, in my weakness, use it.
Unfortunately for me, the procedure was only a temporary fix. It will help me for 6-24 months. I've also discovered that I still have bad days. Days where I can't get out of bed in the morning due to pain. So, now I find that I am going to have to ask my doctor for a limited supply of meds anyway, just to deal with this occasional issue. I could have gone on long term disability years ago, but I prefer to work. I can't keep a job if I can't get out of bed, however. It's a terrible situation to be in, and I would never wish it upon my greatest enemy. I wouldn't even subject the man who did this to me to this kind of life.
I'm saying expensive cancer drugs are banned because they would increase healthcare costs to US levels:
This is the key point. The American health care system is expensive because we demand expensive health care.
For those of us with insurance, we pick the best treatments, not the most economical. For those of us that can afford to choose what hospitals we get non-emergency treatment at, we pick the ones that have the experts, and the robot surgery facilities, and the fancy new MRI and PET scanners. Prices are set by contract with the insurance company, so why wouldn't we pick the one with the best marketing/facilities?
When we have bad outcomes, we sue the doctors, the hospital, the equipment manufacturers. We (via our lawyers) say things like, "they should have done more." This encourages them to practice medicine defensively: use the more expensive drugs, book more time on the expensive imaging devices, pay out settlements as a cost of doing business. And so, as time goes on, consumption of expensive health care rises as expensive health care options proliferate. In some ways this is good (sometimes the expensive options actually are better), but usually it's just wasteful.
It's easy to blame "free riders" and EMTLA, but this is a small fraction of healthcare expenses in the US.