How much access should patients have to their medical record?

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.”

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  • http://tarl.net/tarl Tarl Neustaedter

    ” Do we give patients access to billing information? ”

    There are a number of things that occur to me to say about this, none of them particularly polite.

    As the patient, I’m responsible for payment. I might have insurance which might pay part of the fees, but *I’m* the one held responsible by the debt-collectors. The idea that as a patient, I’m not allowed to see what my doctor is billing for is preposterous.

    I understand that doctors need a place to keep notes on observations about the patient that s/he doesn’t care to share with the patient, but restricting billing information isn’t germane to that issue.

    On the general issue of sharing information with the patient – I currently am under treatment by four specialists and a GP. I have *often* been given conflicting orders and prescriptions – sometimes I get them to talk to each other to sort them out, sometimes I have to push back myself.

    My doctors may be world-class experts in their fields, but there is only one person who has the time or motivation to become a world class expert on this particular patient’s intersecting maladies. So restricting information to that one central point (which seems instinctive) is the wrong answer.

  • http://www.unnecesarean.com Jill–Unnecesarean

    “the thought process behind a doctor’s medical decisions, that perhaps need to remain private.”

    Really? Why would anyone argue that the thought process should remain out of the patient’s reach? What are some examples?

  • E.

    Sorry, my body, my records – whatever you have to say about me is mine. If there’s something you don’t want me to see don’t write it down. You have an assessment of me and my personality – it’s mine. You have an opinion about me as a person – after spending 5 minutes with me – it’s mine. You want to be my doctor – my records are mine – Power to the patient – We can boycott any doctor that won’t share openly all his/her records of us. I give some quarter to mental health records in some circumstances. But that’s it. Anything else is mine, mine, mine, mine – anytime I say.

  • skepticus

    HIPAA requires access to the entire record, except a few exceptions involving psychiatric notes or info that the doctor has firm reason to believe will hurt the paper.

    The question, therefore, is why healthcare providers won’t make it easy for patients to see all the records.

    Patients pay for the records’ production–they should have unlimited access.

    BTW, google health e-records give patients that control. Patients should demand google records!

  • twaw

    I can see it now…Social Hx: etoh use, drug use, number of sexual partners, firearms in household. Yeppers, we will get real accurate information from our teens, unfaithful spouses, and ex cons. How long before the DEA, BATF or an overzealous prosecutor can subpoena a record (not from us but from the patient) just as they do financial records now? I can see the divorce/defense/prosecution lawyers salivating. Another fine example of lawyers “fixing” a medical problem when no problem exists.

  • Caroline the NP

    I am of two minds about this. One particular event sticks in my mind. A patient who worked hard to lose 70+ lbs though portion control and according to BMI could still stand to lose another 30lbs, recently received a copy of their records. After the most recent check up a “overweight” notion was made, along with her observations about her appearance. (Disheveled and sweaty). The patient had ridden her bike on a hot day ten miles and I was really upset about the notes in her chart written by a physician who had never seen her before and hadn’t bothered to read her chart before examining her.

    I hadn’t had the time to go over the records with her and unfortunately the specialist she had seen decided to disclose information from her chart. It was really a mess.

    Bad idea.

    Despite how important it is to patients to actively engaged in their own care, I don’t know what can be gained in terms of fostering strong provider/patient relationship if reading things in their charts without context would prove upsetting.

  • http://www.aintchicken.com Carol

    I’m just floored by the whole conversation. At my family practice doctor’s office, I am physically handed my entire chart to carry from the exam room to the check out. I always take a seat by the desk and read whatever is new since my last visit. There is nothing to hide – it’s my medical record!

    At specialists, I’ve asked a couple of times to see the charts. One specialist kept paper records – the nurse handed me the chart and just asked me to read it in the exam room, returning it to her when I was ready to leave. No big deal. Another specialist keeps and EMR. I always always ask for a printout and there are always always big mistakes. Whole paragraphs get copied and pasted without being updated… med changes aren’t documented… Funny thing though. The paper charts are always right.

    It’s just foreign to me to even think that I wouldn’t have the right to read my own medical record. It had never even entered my mind that there are people who aren’t allowed to. How very strange and disturbing.

  • twaw

    On second thought, you’re right. Take em, they’re all yours. Bring them home and leave them in your sock drawer. Bring them to the county fair in your purse or forget about them in the glove compartment. Just don’t come crying to me when that nosey, suspicious spouse, parent, PI, or a neighbor rummaging in your garbage finds them and puts the information in the public domain (like a divorce proceding for example) or on their facebook page (just for humiliation) as your spouse doesnt have to follow HIPPA. Have at it in the name of consumer advocacy. It keeps me from having to worry about HIPPA. All I have to do is document that the records were released to you, and my responsibility for confidentiality is just about over.

  • http://psychcentral.com/blog/ John M. Grohol, PsyD

    One thought too, is that if docs are writing things they’d rather not have patients see, then maybe they need a refresher course in how to write objective and useful notes. From the comments, “disheveled and sweaty,” isn’t exactly a useful notation in a medical record unless it’s put in context (“disheveled and sweaty from biking 20 miles into her appointment today; patient is doing very well with weight loss routine”). Docs who actually take the extra 20 seconds to write a proper note for each patient have nothing to fear or hide.

    Those docs who’ve been using the medical record as their own personal little notepad to make attributions about the patient that have little to do with the patient’s health, or fails to put them into proper life context, should rightfully be afraid — and ashamed. Maybe this exercise will eventually change the status quo.

    And how this entry could not mention the HealthDataRights.org movement is beyond me. Dr. Kevin, are you there?

    http://www.healthdatarights.org/

    • http://www.kevinmd.com Kevin

      Posts on the blog are generally written 2-3 weeks in advance. In this case, this post was written almost 2 weeks ago, before the press release of HeathDataRights.org. Thanks for mentioning it.

      Kevin

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  • http://www.unnecesarean.com Jill–Unnecesarean

    twaw, if you’re a physician, you would be exactly the kind of doc whose notes I would love to read. I bet they’re pure comedy since you seem to think your patients (sorry… “consumers”) are bumbling idiots who are too careless and stupid to manage their own affairs and records.

    Sorry it makes you so upset that patients would like access to their health information? Is this like a mystique preserving thing or just fear of liability?

  • Peon

    Patient records should be available for the patient to review and to send updated information. Patients meds change from one visit to the next. Patient may see another physician. Patient may have stopped a med because of side effects. All test results should be available to the patient, after all, the patient paid for the tests. There should not be two sets of notes! If a physician is billing an insurance company, then he should be billing correctly. If the insurance company does not pay, the patient should be sent a bill. It is not proper for a physician to be sending false information to an insurance company…that is fraud. I know the physician is trying to help the patient and feels that the insurance company should be paying for the tests he requests. However, it is not in the best interest of the physician to be sending false information or the patient. If there is a problem with an insurance company paying, then that problem should be passed along to the patient. Those insurance companies that do not pay for tests, where you feel they should, will be losing customers.

  • Mike

    All I want to know is, if a patient can’t read my writing or if a patient has questions about what I wrote, do I have to spend time explaining it, even though I went through it all at the visit. Also, if a patient doesn’t agree with my assessment, do I have to change my notes? And if I wrote that they use marijuana, or that their father had colon cancer, and they ask me to erase or amend the chart because they don’t want it getting out and/or they are afraid an insurance company won’t insure them in the future, do I have to comply?

    There is more to the story, I’m sorry to all the patient-empowerment folks.

    Part of the problem, is that non-physicians have no idea how to chart in such a way that the chart is useful, both to the physician when he reads the chart later, and other physicians. And as EMR gains traction and cut-and-paste garbage becomes standard, the charts will be even less useful. I suspect most patients do NOT want their charts/notes AND trust their physician to write the correct things. It really is a non issue, or at least a dopey one. This is par for the course for health care “debates” these days… focus on the trivial.

  • http://survivethejourney.blogspot.com Robin

    Rob and I have had many “conversations” (twitter, blog, and otherwise) about this. I’ve learned a lot from him. In a discussion the other day via the aformentioned post and on twitter, we came to one concensus: If something is placed in a patients medical record and will be seen by another doctor, then it needs to be available to the patient.

    In an effort to decrease redundancy, I’ll leave our dialog on the respective blogs, but I would like to say I not only want my health records/data, but I want to be able to amend and/or notate them if I feel they are wrong or misleading. And I want to do obtain and amend electronically. I know the arguments about security, etc. But if we can do this in our banking system, we can do this with our medical records. Instead of fussing about it, I hope we can work together to do it. As I said in a recent blog post, it really is not a matter of “IF”, but a matter of “WHEN”. It will happen. I am hopeful we can make it happen sooner but with quality. Let’s do it right.

    As a sidenote, when one reads “Patients Often Not Told About Abnormal Test Results” and then reads of a patient losing his insurance (and subsequently dying) due pre-existing conditions unknown to the patient (Health insurers refuse to limit rescission of coverage), I know I need my records.

    I hate to say I see “both sides” of the issue. I think there should never be sides on this issue, but only the best interests of the patient at heart, and all of us working together to make this so. Dialog and disagreement help us learn as long as we keep that common goal in mind.

  • http://tarl.net/tarl Tarl Neustaedter

    The argument over “sweaty and disheveled” is precisely the nub of the issue.

    It was an accurate observation. It is potentially useful information for long-term tracking – how the patient appears at appointments is relevant data (does patient show a pattern of deteriorating hygiene, for example?). It would have undoubtedly been better to have the cause stated (rode bicycle in warm weather), always assuming the physician even knew it, but the observation as entered was accurate.

    The fact that a patient found it offensive is precisely what doctors fear – they can’t make germane observations without being at risk of patients finding it offensive – and actionable.

    As a society, we have a problem with how we’d like the world to be (and legislate it to be that way), as opposed to how it actually is. By law, all sorts of things are not allowed to be important or mentioned – but for medical treatment, they may actually be relevant. Prime example – sexual partner choice. Several laws state that no distinctions may be made about such choices, but medically, distinctions may be relevant.

    So, I can see doctors wanting to be able to record stuff that they won’t have to fight with the patient about. But the vast majority of what is recorded doesn’t fall in that category. In particular, billing information doesn’t fall into that category.

  • twaw

    Jill,
    The issue for me is not if the patient wishes to READ their record. Read YOUR record all you want. As mentioned above, there should be nothing in the record that is not objective or pertinent to the patient’s stated complaint. The issue I have is when there is a demand to possess the record (electronically or paper). That is when confidentiality is lost. Local/State/National law enforcement can simply obtain a search warrant (for something else) and take the record from your home as “potential evidence” . For example; let’s say you tell me at an office visit that you are feeling anxious because you are concerned that your 23 year old live at home son may be taking drugs (he is not my patient). I state that information in the record, as it pertains to your care (anxiety due to a social situation ). You now have that record sitting in your file cabinet. Two years later, your son is accused of a drug related crime. Your house gets searched and they find “evidence” stating your concern. Do you want to go on a witness stand and have to explain “your concern?” If that record is only in my office it is not accessible.
    The other examples above although extreme are not uncommon. Insecure spouses do pry. People lose credit cards daily. If parental approval is not required for an abortion, do parents have a right to know if their teens are engaging in sex, drugs, and rock and roll? Would YOU tell me the most intimate details of your life, if you knew that someone (maybe your POA for health care or parent) could take it home with them, and do what they wish with it and you would never know how secure it is? It is hard enough getting abused spouses/children to speak up as it is.

    As I stated, have at it. Giving the record to you takes me off the hook if it ever becomes public. I just do not think it is in your interest to potentially have your personal information public. I also do not think you would be honest with me in the office if you knew your information could become public.
    Be careful what you wish for on this one.
    Oh, and btw, that you would admit in a public forum “you would be exactly the kind of doc whose notes I would love to read. I bet they’re pure comedy…” pretty much confirms the problem.

  • Anonymous

    I know from personal experience that the clinic I go to makes a distinction between “the chart” (which the patient can see, and copy for a small price) and “business records” (billing data, Patient Relations communications, etc.; no idea if a doctor’s personal notes would be included but I can’t see how that would be practical). SInce we’re talking about a 300-doctor medical center, it doesn’t surprise me that there would be overlapping records. That in itself is probably a good reason for allowing patients access to help keep it all straight.
    But a previous post made a very good point that you need someone to help interpret. I’ve seen my chart; it’s filled with unfamiliar abbreviations (“PRN”, for example) that need to be defined. Plus, much of the handwiriting is illegible, with notes being taken quickly and sometimes garbled or even scratched out…alarming if you’re already concerned about the quality of your care.
    I can’t think of any other solution than communication. Allow access, warn the patient that the notes are written for medical professionals, and have someone available in the records office to take questions and, if necessary, forward any concerns that s/he can’t answer to the physician’s office. In many ways it would be a good thing for everyone.

  • http://www.unnecesarean.com Jill–Unnecesarean

    Like Mike said, it’s trivial. Patients can benefit from having their records (I have some in arm’s reach that have been immensely helpful to me and I am very grateful to have) and no, doctors do not need to bash patients by assuming that they are incapable of managing private information.

    twaw, I suppose it could be said that the fact that you would come out “on a public forum” to complain about the incompetence of patients who need to be protected from the possession of their own helath information is… interesting. That’s why I think I’d get a kick out of your notes about me if I were your patient. It’s a funny attitude to me that someone would be wanting to protect me from prying and insecure spouse and parents.

    Regardless, I was glad my records were available to me in their entirety and that I was able to get a copy of them.

    Enlightening topic, Kevin. Thank you for the post.

  • http://survivethejourney.blogspot.com Robin

    twaw: Re: “The other examples above although extreme are not uncommon. Insecure spouses do pry. People lose credit cards daily. If parental approval is not required for an abortion, do parents have a right to know if their teens are engaging in sex, drugs, and rock and roll? Would YOU tell me the most intimate details of your life, if you knew that someone (maybe your POA for health care or parent) could take it home with them, and do what they wish with it and you would never know how secure it is? It is hard enough getting abused spouses/children to speak up as it is.”

    What is the law on supoenaing medical records now? No matter who possesses them, the law should stand. Secondly, whether paper or digital copies, the laws about obtaining the records of a minor shouldn’t change.

    Anonymous: re: “But a previous post made a very good point that you need someone to help interpret. I’ve seen my chart; it’s filled with unfamiliar abbreviations (”PRN”, for example) that need to be defined. Plus, much of the handwiriting is illegible, with notes being taken quickly and sometimes garbled or even scratched out…alarming if you’re already concerned about the quality of your care.”

    Patients who want their records are totally willing and able to learn. If you or anyone else can learn what “PRN” means, I certainly can. I certainly know I know more about my disease than most doctors. I’ve proven it over and over.

    One of my favorite quotes comes from a cyber-friend on a support message board. She has learned all she can about her daughter’s disease, and gets every record in self-defense. Here is what she said: “Until this all began I was a hairstylist/soccer mom with a high school education. It’s been a learning curve. I am done with doctors who speak to me as if they know all; I know better now.”

  • Medical Student

    It seems like there are a few issues being conflated here. Most of the medical record should be fine for patients to have, take home, put under their pillow, or whatever. Other parts of the medical record should not be given to the patient.

    For instance, what if you suspect your patient of drug-seeking? That needs to be annotated, and future physicians need to consider it, but it would likely be hurtful to the patient if they read it. Your patient may be disheveled and have poor hygiene, which can reflect the onset of a mental disorder and should be annotated, but may hurt the patients feelings as well.

    If the physician feels that their writing a pertinent and relevant note will cause conflict when the patient reads it, they may neglect to write the note and the patient’s care will suffer.

    It’s one thing to know that you have depression and should take prozac, but it’s another thing to know that your physician partly came to this diagnosis by noticing your persistent decline in personal hygiene, increase in body odor, and that your personality was irritable and unpleasant. Important observations that lead to a correct diagnosis, but unnecessary and harmful for the patient to read.

  • Peon

    Patients should have some access to their records. Just how much access is debateable. As the Medical Student said, a physician writing a note that he believes a patient is drug seeking, would not be something that the patient needs to know. I am against any legislation requiring docs to provide patient medical records online. HIPPA is a mess. We don’t need more regulations in healthcare.

  • http://survivethejourney.blogspot.com Robin

    Medical Student and Peon:

    If anything a doctor (or other medical personnel) writes about me is shared with another person for any reason, then I want to see it, too. If it is for personal notes only, I have no problem with that.

    Doctors are people, too, and are mistaken or have wrong impressions sometimes. Once passed on to someone else, they can be detrimental to the patient’s care and treatment.

    I’ve had this happen in my life. I’ve had many stories shared with me from other patients who have, too.

    Bottom line, everything shared by a physician with anyone else about me, I need to know. S/he could be very wrong or the information could be misleading. And it can have a horrible impact on my care.

  • deleted

    <>

    I was fairly clear that I support access, but I also appreciate the wariness that’s coming from the medical side. I’ll illustrate with an embarrassing personal anecdote. Seven years ago I went through eight outpatient procedures for the one problem that left me with some doubts about the surgeon involved. Coming out of sedation from #8 was a bit rough, and I decided at that point — when I was probably least emotionally prepared to do so — to examine my record. There was a blank on the chart for the recovery room nurse to fill in her opinion of my status upon discharge. It read “Stable”, but she’d been a bit overeager with the cross-mark on the “T” so that it almost looked like the word had been crossed out. That was all I needed to start wasting a lot of good peoples’ time…over a silly piece of sloppy penmanship. I was perfectly fine, and as it turned out, surgery #8 resolved the problem once and for all. I really regret the fuss I raised over that.
    My point is that while many patients probably can and do view their records calmly and intelligently, there are bound to be some whose motivation is based on emotion and distrust of their doctor, not personal enlightenment — and that subset is primed and ready to see problems that may not exist. And I think those of us in the patient population have to be sensitive to that, and not simply demand unlimited access without considering what steps may be necessary to make such access manageable from the medical point of view. Thanks for your comment.

  • Medical Student

    Robin,
    I understand your concerns about medical errors, but I don’t think that complete patient access to medical records will have the effect that you want. In fact, I think it will have the opposite effect.

    Not everything that your doctor writes in you record is something that you want to hear, but it is all relevant to your care. If you read an observation of your physician in your medical record and get upset about it, you may begin to view him as your enemy, which will be uncomfortable for both of you. The only way around this is for your doctor not to make the note, but in that case it is only your care that suffers.

    Doctors are certainly people and can have mistaken impressions, but I’m not suggesting that things like your diagnosis, vital stats, or treatment plan should be confidential. Those are the mistakes that you need to watch out for. If your doctor’s notes include the fact that you are very sweaty, you may be upset, but this observation is relevant for a number of conditions and absolutely should be annotated. If you are sweaty every time, it may help with a diagnosis. If you aren’t, then that observation will lead to nothing. But what purpose is served by you reading it? It only obstructs the doctor-patient relationship.

    In the end, you may get your wish that all medical records will be open to you, but it will not be in the best interests of your medical care. If this trade-off is worth it to you, then that is fine, but constantly having to defend one’s legitimate observations from the patient is not a pleasant lifestyle for a physician.

  • http://survivethejourney.blogspot.com Robin

    Thanks for the reply, Medical Student. Before I comment, I want to say one thing: I am thankful for all of you who go into medicine. It is not my desire to be antagonistic. I realize your job is a tough one, as are many jobs.

    Since we are on the topic of sweating/being sweaty, perhaps if I (the patient) knew that might be important, I could keep a record of when that happens and under what conditions. Did I just eat? Is everyone hot and sweaty around me? Am I alone in that? What is my BP? My blood sugar level? Etc…etc….

    One of the things I and others who are testing for Cushing’s have learned to do is chart signs/symptoms. Anyone can do it. Technology challenged patients can do it via a calendar. I do it via a database I set up for myself. I can then chart my test results along with those and see if they are related. A Cushing’s patient realized her blood sugar had an inappropriate response to eating when her cortisol was high. Others noticed how being sweaty or cold correlated with cortisol levels. I could go on. My point is, those things you may think we don’t need to know might actually be very valuable to us both. We could collaborate on this.

    Regards….

  • Peon

    When I read the the post by Dr. Kevin, I quickly assumed that it would be best for patients to have full access to “their” medical records. However, after reading the comments by Medical Student, I have changed my mind. I have come to the conclusion that the medical records belong to the physician, not the patient. And, for any records to be given to the patient, it must be by permission of the doc and he can release some or all at his discretion. There are going to be a number of patients that a physician examines that have conditions or behavior, which the physician may note, that should not be read by the patient. A drug seeker is one example. A mentally disturbed person is another example. A rude and obnoxious patient is another example. I have concluded that the trend toward “patients rights” have gone too far. HIPPA is the biggest example I know. It is a mess and I believe it does more harm than good.

  • Patient X

    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?

  • Medical Student

    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.

  • Texas med student

    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.

  • http://richiedonahue@msn.com boston bound and tied

    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.

  • kathy

    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.

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  • outrider

    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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