As more patient records go electronic, there is debate as to how much of it a patient should see.
This is a particularly sensitive topic, which I touched upon a few months ago, and brings out some contention between patients and their doctors.
Primary care physician Rob Lamberts’ practice is introducing a patient portal, and in this blog entry, he tries to delineate what patients should see, and what they need to request. In effect, he plans to give them easy access to 99 percent of their record.
There are some patient advocates who would like to complete, unrestricted access to their chart. But there is sensitive information, such as psychiatric issues, suspected abuse, or private conversations, along with the thought process behind a doctor’s medical decisions, that perhaps need to remain private.
That right balance is like finding, in Dr. Rob’s words, the proverbial “sweet spot.” But there’s no doubt that the move towards more transparent records is inevitable, and in the future, the medical chart will be shared and collaborated with both patients and other providers.
Update:
Boston’s BI-Deaconess Hospital recently announced they are test-piloting a project where patients will have easy access to the assessment and plan section the medical chart. It’s going to be interesting to see what happens, as many doctors may be wary about the increased workload that the inevitable patient questions will bring.
And, with primary care doctors already pressed for time, is this possible consequence something the current health system can support?
Furthermore, physician Jay Parkinson also feels that the trend towards unrestricted chart access may ultimately lead to two sets of notes, one for the consumer, and another to satisfy billing requirements: “Unfortunately, most medical records exist to maximize reimbursement and are loaded with false information about a patient’s condition. And therein lies the dilemma. Do we give patients access to billing information? Or do we ask doctors to document twice? One aimed at the insurance companies and one aimed at consumers.”
Related posts:
- Poll: Is easy patient access to the medical record a good idea?
- Reader take: Patients should be allowed to access their entire medical record
- Should patients own their medical records?
- 11 electronic medical record posts you may have missed
- How will patients accept the medical home?
- Should patients lie to their doctors?
- Most hospitals still use paper records, and why money alone won’t solve the electronic medical record problem
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Medical Student,
I wonder what your thoughts would be if you ever become the patient. Your condescending attitude is exactly the reason why medical consumers should track their heath the way they track their credit.
What if you happen to need treatment and your doctor decides he doesn’t want a “back seat” provider and feels it’s best that you don’t have access to your records because it wouldn’t enhance the doctor/patient relationships. Would the records still belong to the doctor again in that case?
Patient X,
I would be a pretty strange person if I had never been the patient of a physician, and I agree that patients should track their health. Actually, I’m not sure how your comment is exactly directed at me, except that I don’t believe in complete access to medical records.
Well, there is a point at which knowing more information doesn’t benefit the patient. This is not because I think that the patient can’t understand the additional information, it applies even if the patient is himself a physician.
Think about it like this, knowing more information comes with risks and rewards. Would you want to know every thought of your spouse? There is a point at which knowing more could not possibly help you, but stands a good chance of harming you. When it comes to medical records, I’m setting the bar pretty low for patient access. All diagnoses, treatment plans, and vital statistics are good for the patient to track. Notes along the lines of “sweaty and disheveled”, or “possible drug seeker”, or anything else that does not lead to a diagnosis or treatment… Why should patients want this information? It’s like learning that your wife is attracted to the next door neighbor. If it leads to nothing, then what can you gain by knowing it? You will only become miserable.
I think someone else mentioned this before, but several different points are being conflated in this post and the comments. I have two points
1) In medical records, there is hard data and there is opinion/derived information. Data (vitals, lab results, imaging, pathology, biopsies, etc. etc.) is directly paid for by the patient, and I don’t think ANYBODY has a problem with this information being more easily available to the patient. Data is simple, and generally is value-neutral. There are no judgments in data. The rest of the record is different. To make an analogy, take the example of an ad agency. If you hire one to make a TV spot for you, you DON’T get access to all the intermediate steps, meeting notes, rejected ideas, minutes of brainstorming sessions etc. along the way. You get the end result – the finished ad. The “record” of the agency’s work may seem to belong to you, but it doesn’t. Seeing it would be confusing and potentially upsetting. Similarly, the non-objective parts of a medical record may not add much value to a patient.
2) ALL medical records are currently available to patients (at a price) under HIPAA. So what we’re arguing about here is simply easier and cheaper access. I admit it does seem ridiculous to me that it costs so much to see information that intuitively seems to belong to me (as the patient).
So: simple solution is to make all data-type information more easily and cheaply available to patients (something that will become easier with EMR). Information that is more subjective and is more like the doctor’s work-product, would still be covered under HIPAA and be accessible, but could be kept in it’s current state – i.e. not as easy to access. This should address most of the problems articulated by both patients and medical professionals in the comments above.
patients medical records are available to insurance companies, in some cases employers, or to any”legit” inquiry when a waiver has been signed by the patient.
that any one could argue that the patient shouldn’t have , or won’t understand etc. is telling . is it fear that the records contain damaging and inaccurate information? is it that the subjective remarks will be hurtful to the patient? will those doctor notes cause more litigation? of course it is. not wanting patients to see their own records and notes only says there is something to hide. no other babble can cover this fact up.
that a patient can’t see what is in their file while an insurance company can is a facist idea that as to be ended.
let the chips fall where they may and let knowledge be empowering. and get this, partners health care is considering summarizing the records for the patient; i think they meant sanitizing. reminds me of efete’ intellecutial snobs.
I still don’t see the perceived need for “private” physician musings. If you think someone is a drug seeker, and you are concerned enough about it to put it on the chart, isn’t your concern sufficiently high to discuss it with the patient? If you are concerned about abuse enough to put it on the chart, don;t you think it would be wise to discuss those concerns with the patient, especially in mandatory reporting situations? Perhaps you will get an explanation, perhaps not. For all professionals, sometimes things are not so fun with the clients. Part of getting the big bucks. Wanting your own private notes, in general, seems to me that you are chicken. This is to me, not a good trait for a doctor.
I don’t also don’t understand why doctors think that, unlike every other professional, they should be free of scrutiny and double checking by their clients and others. Yes, its unpleasant. Yes, it takes time. Get over it. If you are doing something of importance that could negatively affect someone else, someone else is going to be looking over your shoulder. Is that stressful — yes. But every other profession has learn to deal — financial advisors, attorneys, accountants, etc, etc. If you don’t like it, become a hair dresser. Oh, wait, they get second guessed too. And as someone who has had doctors “miss” things like a post-operative heart attack, which I discovered after getting my records to figure out on-going heart issues that weren’t resolving, I darn well want my records. If you can’t handle the stress, get counseling or do something else. Frankly, as a professional, I have learned to appreciate a back-stop — although I try my best, I am not perfect and I don’t know anyone who is. It took me many years not to chafe at second-looks, but I have learned better. Even the best make mistakes; I would rather my mistakes get caught early that do harm to someone else.
Third, any doctor who thinks that he or she has “private” records that can be kept from the patient or others in all circumstances is deluding him/herself. If the patient has a lawsuit, if a patient goes on disability, etc. etc., those medical records get disclosed to the patient and others. Who may make important decisions based on your baseless speculations if you put them in the records. Records are for facts. Conversations are for speculations. If you have an important speculation, discuss it with the patient.
Fourth, as to a patient being upset about a not so complete recount of an encounter, it seems to me that the medical professionals here are missing the reason for the friction. I doubt the patient was upset that the doctor said she was disheveled; I suspect that the reason for the patient’s unhappiness was that it appeared to her that the doc in question jumped to conclusions without getting all of the facts and apparently was unprepared for the visit– and that is NOT a good trait in a doctor.
As a veterinarian (and, obviously, an occasional patient of a physician), I think that patients should have access to ALL medical records upon request.
It’s true that my patients have little interest in their records, which I suppose makes my role similar to that of a pediatrician. But at the conclusion of every appointment, I present each owner with a complete copy of my notes, including clinical impressions, exam findings and plans for further diagnostics and treatment. I find that this minimizes misunderstanding and clarifies any communication glitches. And yes, I do print neatly – there’s no excuse for messy handwriting! Furthermore, I do this even in cases of neglect, abuse and poor management. It is indeed possible to be accurate, tactful and professional in one’s comments.
After several unfortunate experiences with physicians, I routinely request copies of all of my medical records. I’ve found numerous factual errors, some of which could have affected my care adversely or caused problems in my obtaining new health, disability or life insurance.
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