How much do doctors need to know? With Internet-based personal health records on the rise, debate is intensifying:
“People are suddenly going to find there’s no way to compartmentalize the sensitive things in their health histories from the nonsensitive things in their health histories,” said Rothstein, a lawyer who also is director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine.“Someone who is treating you for a broken leg doesn’t need to know you had an abortion 20 years ago.”
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{ 5 comments }
Actually, a lot of past medical and psychiatric history that patients might think is unrelated can occasionally be pertinent to a new problem.
A PHR that has been edited by a patient could be worse than no record at all.
We have solved that problem in keyose.com.
The patient has 2 levels of access, so he can choose everytime which kind of information can the doctor access or not.
The patient is able also to just do not wirte some information in the keyose personal health record.
Also, keyose is a anonymous personal health record (no name, no email stored), so privacy is guaranteed.
It is true that the patient can not always know what information is relevant and may conceal what the doctor needs to know to provide optimal and safe care–but it is their risk to take and their right to take it. They have to balance that against the level of trust they have for this particular doctors with their most embarassing information. I know that my psych patients tell some of their doctor about our treatment and not others. I discuss the risk with them. In some cases the risk is extreme–like if they are are on lithium and I want to make sure that they know that since otherwise they may chose in ignorance of that fact.
If on the other hand they know that their ENT doctor is a religious zealot who thinks everyone who sees a psychiatrist is going to go to hell, but they are going to him for their periodic Flonase renewal, they may chose to not mention our care, and check with me about drug-interactions. Is that ideal? Of course not! But it is realistic.
They also may mention their visit with the shrink to their PCP but ask him not to put the fact that they are on Prozac in the chart because the PCP is part of a hospital owned practice in a small town where there are no boundaries whatsoever and the hospital is the local gossip mill. They want him to know but not put it in the record. Entirely Kosher with the best standards of medical documentation? No! But a realistic accomodation to the substance of medical ethics and best medical practice in the conditions in which they find themselves–especially if that guy on the Prozac is that ENT doctors deacon.
We haven’t even begun to count the social complications that a unitary national health database would create.
Patient created records are VERY risky as they do not have the legal or ethical protections that a doctor’s record has. Sure they have the promise of privacy–but we all have had our faith breached by American business–I would personally only use that where there is no identifying information in the record and I access it anonymously as above.
But then, if I am mentally intact enought to give the ER doctor that information–why can’t I just give him my history.
If a patient presents with records I will always request the records again from the original source if there’s any psych or controlled substance issues.
On more than one occasion I have found patients have edited their own records. They want controlled substances and they show me their record, which somehow is missing the DUI report or the psych admission or the physician dismissal for doctor-shopping, etc., which I do get when the record is requested directly from the previous doc.
I’ve also had patient requests to send edited versions of their own medical record to other docs, either to pain clinics or similar, for controlled substances, or to a medical marijuana mill. Again, the records release is highly specific for this date and that date treatment, but not these records or that time period.
At least in my state, the advice I received was you can refuse those records releases clearly designed to deceive. You can insist on all the records released or none. That may well differ elsewhere.
So yes, based on repeated experience, I would be suspicious of any patient-generated medical record unless very straightforward, no pain issues, psych, controlled substances, etc.
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