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.

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.

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.

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 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?

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….