When patients see their medical record

Traditionally, the patient chart stayed in the doctors office and rarely did a patient get a glimpse of anything in the record.  Photocopying the chart is expensive and no physician would let a chart leave her office because the record must be held safely for a minimum of 7 years.   Now more and more offices are doing away with clunky paper charts and electronic medical records are becoming the norm.  With electronic portals, is there any reason a patient shouldn’t have access to their own medical record?

A study published in the Annals of Internal Medicine reported that up to 97% of patients queried thought the ability to have “open visit chart notes” was a good thing.  Doctors weren’t quite so eager.

The study found that doctors worried that open visit notes would result in greater confusion and worry among patients and they anticipated more patient questions between visits.  But the patients overwhelmingly wanted to see the notes and were not worried about being confused.   They thought seeing their own record would provide information that would help them be healthier.  They could see the treatment plans and the test results directly.

One of the study authors, Dr.  Joann Elmore at University of Washington School of Medicine, said that access to records is important for indigent patients or people who move frequently for continuity of care.

It is a new world of sharing of information and there is no reason medicine shouldn’t be part of the change.  Patients have access to research studies on-line as well as multiple medical websites  to look things up. (Some  are just junk and filled with ads).   If open records helps create a dialog about good health and allows patients to understand and take ownership of their own life it can only be a good thing.

I do worry a bit about the overly obsessive patient who might misinterpret every slight lab value that is outside of normal.  They will need to understand that not everything carries the same weight in medicine and slight variations of normal can in fact be … normal.

Toni Brayer is an internal medicine physician who blogs at EverythingHealth.

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  • Anonymous

    We’ve been providing open access to charts for almost a year resulting in improved doctor/patient communication, increasing a patient’s understanding about their illness, and enhancing accountability for both the doctor and the patient.   We don’t see any reason to turn back.

    Emily Gibson M.D.

  • Denys Yeo

    In my experience it does appear that the main impediment to patients having access to their records is the reluctance of doctors to provide them. I think this is an issue of educating health professionals about how they can practice in a way that results in them being comfortable with directly sharing information with their patients and that when they do this there can be gains for “both sides “.

  • http://www.facebook.com/people/Doc-ForthePeople/100002110027011 Doc ForthePeople

    When I was in practice I gave each patient a copy of the previous office note at each and every visit. It was given to them when they were taken to the exam room so the patient had a chance to review the note and then discuss any issues with me. It was the best move I made to get information right in the medical record. I simply do not understand why doctors are so afraid of doing this, unless they may not be as accurate in their record keeping as we would hope. It really does make for a good bond between the doctor and patient and it also places a lot of responsibility for accuracy of information on the patient. If they do not agree with info they have the ability to correct it right then and there!

  • Anonymous

    I understand both views well-  as a physician, I know I will get a barrage of questions about itsy abnormalities. For some of these patients, it is extremely hard to answer the question in a brief amount of time.
    As a patient, I want access to information- to correct error, particularly those that are perpetuated in EMR, and extremely difficult to correct.

  • http://twitter.com/balts Dr Steve Balt

    I agree there are pros and cons of providing patients with open access to their medical charts.  And while the topic is certainly worth discussing, it may be much ado about nothing.  A lot of patients either don’t want their chart info, or when they get that information, it ends up being far too overwhelming.  See this recent post in the Harvard Business Review arguing this side of the issue:  http://is.gd/YYnWW3

    Oh, and one more thing:  in my experience, the adjective “clunky” applies to EMRs every bit as much as it does to paper charts. 

  • Anonymous

    When a patient has a copy of their doctor’s notes, they can  review them unhurried at home.  Sometimes my head is swimming when I leave the doctor’s office, and unless I take my own sketchy notes while there, (possibly innacurate), I don’t remember everything that was discussed.

  • http://makethislookawesome.blogspot.com/ PamC

    Shouldn’t the notes say exactly what the doctor shared in the appointment? Then what’s the problem? Call me a cynic, but how many doctors don’t want their patients to see what they’ve written because what they’ve written may not necessarily be nice?

  • http://pulse.yahoo.com/_AQGAJ4XQOZ56VG4GULIC324QCQ That really cool Sarah

    Most people with questions about lab values LOOK THEM UP and determine whether the lab value has significance,  what it might be in context of their own circumstances.  They’ll bring it up with you as warranted.

    There’s a lot more danger from doctors who just ignore or never see significant lab values – even the most common problems.    I had a doctor tell me my shakes and weakness were nothing and in no way related to my underlying spondyloarthropathy and almost angrily say I should see the primary care doc for prozac.

    Gosh but then I got my chart…the test in my chart said I had severe microcytic hypochromic anemia – a direct result of bleeding from the meds HE prescribed.   Thanks a lot, doc.

  • http://www.twitter.com/alicearobertson Alice Robertson

    A doctor can also use the EMR’s (Cleveland Clinic) to cover for a colleague that screwed up.  You should see my daughter’s EMR’s.   The original doctor regretted what he transcribed and tried to remove it himself…nope…then he filled in the proper paperwork and it couldn’t get past the Chair who threw it out and refused to approve the removal of false notes.  He finally quit for a much better job.

    Then there are the EMR’s that say a patient is allergic to a drug, or decides the patient can never have a certain classification of a drug.  No doctor in that system can override it.  This happened to a friend of our’s and they are fearful they will be in an accident and be banned from pain relief.  Another doctor tried to override it….the original doctor refused to remove the notes even though the patient was the one who originally requested it (during a weak moment.  The doctor did not warn the patient of repercussions).  Doctors have a type of private diary on the EMR’s with personal notes about patients and some of the notes are not too flattering.  Patients can never see those notes…just as they can never see if a doctor is disciplined…internal memos may not even be available via court orders.

    EMR’s have value….but ordering a copy from Cleveland Clinic is like a segment of a Monty Phython movie.  You order via Atlanta, Georgia….then you start to beg…plead….get the wrong notes….misinformation….no in person collection of notes unless you visit a satelite center.  Some feel they need to hire a bounty hunter….it would make a great reality show for the viewers….not the patient who is really disadvantaged because a pitbull mans the phone.  I have had to go through management to get the records, then you pay almost $2 per page after shipping and they send you a bill of $30 for the double of the five original pages they sent you….and forget a credit.  A collector contacts you and I believe no more records will be sent until you pay….a punishment for complaining that after 30 days your records were not even sent.  Why they refuse to let us print them ourselve is beyond me.  Their MyChart system is wonderful, but some doctors will not use it, and it’s limited….it is not really your medical record because doctor notes are missing.  Only a few doctors will engage in email.

    Ultimately, the EMR’s will go national if HHS gets their way.  Doctor shopping will be hampered, a banned legal substance on a patient’s file will follow them nationally….doctor’s second opinions will be hampered and helped….it’s a double edged sword.  Patients feel empowered by the benefits…..but the records haven’t been nationalized or around long enough to see that doctors are excellent at manipulating to protect their long term personal investment in their careers, and their employer.  Doctors still have the final say about what goes in those notes.

    I long for the day all the notes we paid for via medical payments and tax dollar incentives are available to us and a way for a patient to note their own chart with their own feedback.  Patients are no longer in the dark…we do not offer the blind obedience that once made the job easier….and doctors are regulated and strangulated….but lawsuits are down….along with the money…..and patients are demanding accountability.  I can think of no other profession that demands payment for a service then wants carte blanche.    The times they are changing……..

  • Anonymous

    As someone with a military background and ‘raised’ in the military system, I was used to carrying around my medical records. that was the first thing you got when you went for your appt and you carried them around. we read them. if you didn’t understand something, you ASKED your doctor.. how novel..

  • Anonymous

    I believe that ALL patients should have complete access to medical records and especially from so called mental health experts.  The reason is that most people do not know that if they go to a mental “health” person for a life crisis or problem in living that the expert has to give them a bogus stigma from the junk science bible of psychiatry, the DSM, with all of its labels blaming the victim or person seeking help even if it is abuse related stress/trauma or other unjust, evil, oppressive conditions in one’s environment.  Psychiatry was created to maintain the status quo for the power elite and silence, discredit, punish and disempower any critics exposing rampant social injustice and inequality.  Biological psychiatry in bed with BIG PHARMA has hijacked the entire mental health system so the only so called help you can get is a life destroying stigma and lethal drugs with lip service paid to so called therapy or counseling.  So, if patients were allowed to see all these records, the fraud would be exposed immediately so that they could escape more quickly.

    Real medical doctors can also make negative, untrue comments about patients that they should have a right to see and correct and/or dump any offending doctors who create harmful  records or fail to relay important health information which happens frequently with many test results in including pap smears, etc.

  • Anonymous

    The justifications for patients to see their medical records is a matter of the autonomy of the patient.