Most Doctors Don't Think Patients Need Full Access To Med Records 659
Lucas123 writes "While electronic medical records (EMR) may contain your health information, most physicians think you should only be able to add information to them, not get access to all of the contents. A survey released this week of 3,700 physicians in eight countries found that only 31% of them believe patients should have full access to their medical record; 65% believe patients should have only limited access. Four percent said patients should have no access at all. The findings were consistent among doctors surveyed in eight countries: Australia, Canada, England, France, Germany, Singapore, Spain and the United States."
I develop an EHR (Score:4, Interesting)
We had to take out a feature that let patients update their medical history online (which is a great feature because then the patient isn't be forced to memorydump in the clinic, there's a reason they tell you to write all this down and bring it a notebook when you see the doctor) because they were trying to removing items from the medical history in order to get claims paid that were rejecting for pre-existing conditions.
Now that obamacare is putting an end to the pre-existing condition thing, we may put it back, we'll see if the docs want it though. I believe the 65 percent is right though. On the other extreme, my boss believes that the patient should own their own medical record as a file they carry with them everywhere on a thumbdrive, I see that as a recipe for lost records and forgotten passwords. The alternative to having it on your person being Microsoft HealthVault still doesn't exactly make me tremble with joy.
Obvious reason (Score:5, Interesting)
You see a simple folder full of your medical history.
Your doctor sees it as a book of half-truths that can be twisted to create liability in a multitude of ways.
Remove the liability here, and these results would change.
Information != Knowledge (Score:5, Interesting)
Information != Knowledge. It's already a big problem for doctors that patients come in demanding this or that treatment that they've read about on the internet, often with no real understanding of whether it's appropriate for them, or whether it's actually an effective treatment at all. I would imaging this is what is behind the doctors attitude in this study; full access to medical records will probably only increase that trend, with people trying to interpret their own records, and saying why did I not get such and such a treatment that I found on Google. That's not to say I agree with the doctors stance, but I can see where they're coming from.
Re:Conspiracy! (Score:5, Interesting)
Well... what they did :-)
I guess doctors make wrong or let's say suboptimal decisions all the time, it's just that rarely people get so bad or die because of it so you actually get into malpraxis discussions. They want no patient oversight of what they are doing because a 5 minutes google search might convince you they are not doing a stellar job after all.
In Romania we have a law, that they "forget" to change every year, stating that the dead guy (and only him) must personally ask in writing for the medical records. In case someone dies from malpraxis no-one has access to that anymore so basically you can't argue malpraxis for people who died (therefore we have a statistically excellent medical system).
So yes, I'd go with conspiracy.
Arrogance (Score:3, Interesting)
I'm an attorney, so I know a little bit about arrogance, but we're patzers compared with doctors. Many truly have, if not God, then Emperor complexes, with their wisdom received without question by their subjects.
But that's probably not the real reason they don't want patients to have access to their complete medical records. It's all about avoiding medical malpractice claims (and annoying phone calls from patients asking questions).
So blame the lawyers.
Comment removed (Score:5, Interesting)
Psych patients (Score:4, Interesting)
I think one reason why medics might have a problem sharing is that there are issues if there are suspected psychiatric issues. Imagine a situation that a patient is prone to aggression and the doc thinks this might be related to schizophrenia or something along those lines. In my experience, anyone dealing with patients like this really try hard to keep themselves distant from the patient, in case they turn up on their doorstep... and this does happen. So I would look closely at how the question was worded in this survey. I would imagine most medics can think of at least one person who they would prefer didn't see their notes and for very good reasons. So if the question was along the lines of "should all patients" have access then the answer must be no.
Re:Information != Knowledge (Score:5, Interesting)
Doctors don't know everything. They're trained to spot the most common problems, but it's really, really easy to stump a doctor. My GF has been having dizzy spells. She went to her GP, who sent her to an ENT, who sent her to an audiologist. None had any ideas.
So she spends some time on Google, and finds out that dizziness can be a side effect of gall bladder attacks(through over stimulation of the vagus nerve which causes a sudden drop of blood pressure). And she had seen the same GP a year earlier about her gall bladder problems. Why didn't the GP pick this up?
No, patients should be encouraged to do as much research as they can. You as a patient care more about your issue than anyone else. You know more about your body than anyone else. You should be a partner with your doctor in your own health care.
Re:Conspiracy! (Score:5, Interesting)
"Patient is an addict, faking symptoms in order to get painkillers."
This one actually happened to an old friend of mine. He had in the past had issues with substance abuse and it had made its way into his medical records. Fast forward a couple of years and shows up at the ER with a pretty nasty injury after chopping wood and they outright refuse to give him any painkillers except ibuprofen...
Took 24+ hours before he and several others were able to convince the doctors that he needed real pain relief.
A number of states now have databases of patients that doctors label as such for other doctors and pharmacies to watch out for.
Unfortunately, doctors are generally woefully unequipped to treat pain, particularly long-term pain. Plenty of addicts are made by the medical profession, something they don't like to admit.
Re:Conspiracy! (Score:2, Interesting)
In the US, psychotherapy notes (i.e. the writing on the notepad) are not subject to discovery or disclosure as part of the medical record. It's not a conspiracy, it's a way for a therapist to make personal observations that will help them with your treatment. Your diagnosis, treatment plan, and everything discussed in your sessions should be in the record and must be made available for you. As for the insecure part, you can always just ask what they're doing to comply with security regulations. Most likely (unless it's a small private practice) they're doing a lot more than you think.
Your paranoia is a bit concerning, you should consider seeking treatment for that.
Re:Conspiracy! (Score:1, Interesting)
Re:Conspiracy! (Score:2, Interesting)
That's a problem with the legal system, not the medical system.
Unless the "tiny white dot" is more than a few millimeters in diameter, it could just be a dust speck or processing error on the x-ray film, which can usually be safely ignored. Of course, in hindsight it's much easier to see that the dot is cancerous. With that liitle detail out of the way, it's easy to blame the doctors, and it's easy to parade the evidence in front of a jury who know nothing about photography or medicine, and it's easy to get a huge judgement out of a judge who wants to be "tough on big corporations" and "sympathetic the the innocent widow". Regardless of the case's merit, paying out a "large wrongful death settlement" is just statistically the cheaper option.
Your friend didn't need full access to records to prevent his death. He needed a second opinion, which he probably should have gotten before eating became impossible. His second doctor could request the records, and get them, and see the mysterious error that happens twice.
Re:Conspiracy! (Score:4, Interesting)
Doctors are still better than patients at rare (Score:4, Interesting)
if a doctor comes across someone who genuinely has a rare condition they're almost certain to misdiagnose it.
And a patient is even more likely to do so. A doctor is supposed to look to the highest probability diagnosis first. Rare diagnosis are hard and it's pretty rare for doctors to have perfect information. Almost every diagnosis is an educated guess and some percentage WILL be wrong. In fact sometimes getting a percentage wrong is considered appropriate care. Doctors are expected to take out a small percentage of appendixes that are not actually wrong. There is no way to know with 100% certainty whether it needs to come out until they actually do the operation and some symptoms can be mimicked by other conditions.
doctors are often too sure they have a deeper understanding than they really do.
This does happen but having a doctor that not confident is rather useless. It's a fine line to tread and most do it reasonably well.
Re:But no mention of why (Score:4, Interesting)
In fact, if you think about it for two seconds, you realize that a system where doctors are people who are selling a service is the worst possible way to set up the system: the incentive for doctors is to get people to come to them and get them to perform expensive tests. All of the financial incentives, then, are to inflate the actual cost of medical treatment, to claim medical treatments are necessary when they really aren't, and to provide treatments that don't actually fix the problem so that the people come back again later.
Fortunately, most doctors are neither cruel nor narcissistic enough to engage in this knowingly, but even the most virtuous of doctor is going to be rather disinclined to realize they are wrong when they are profiting from being wrong. The result of this is high medical costs and crappy medical treatment. Nations that do not structure their medical system like a market have much better outcomes and much lower costs.
Re:Conspiracy! (Score:5, Interesting)
No, the reason why American health care is so expensive is a lack of preventative care and free riding. In other nations, because everybody is in the system, everybody pays into it. The only people who don't have no money and are a significant minority. The US, that minority has been about 40m people out of a population of about 310m and those people aren't opting out completely, either they wind up in Medicare eventually or they get their services through the ER at the local hospital.
Regulations are not a part of the problem to the extent that it's worth worrying about until we get those other things fixed. Then we might need to fix the regulatory environment.
Doctor's POV (Score:5, Interesting)
Let me give you a real-life example of what doctors are bracing themselves for. My wife saw a patient, and that patient later requested a copy of her medical records. No problem; my wife's office gave them to her. I personally witnessed this exchange afterward while I was picking up my wife from work:
Patient, storming into office: I WANT TO SEE DR. MRS. JUST SOME GUY!
My wife: Hi! What's wrong?
Patient: You slandered me and you're going to Fix. It. Right. Now!
Wife: What... what did I say?
Patient: You called me a drug abuser!
Wife: No, I did not!
Patient: It's right here! shows everyone who will look a highlighted section from her chart
Wife: Right...
Patient: I told you I didn't do that, and you said I'm in denial about it! If you don't fix that, I'll sue.
Wife: But that's not what we mean by "deny".
Patient: FIX IT OR I'LL SUE!
I swear that's not an exaggeration or misrepresentation. The patient was threatening to sue for defamation of character because my wife wrote "patient denies excessive drinking, tobacco, and drug use." That's medical jargon for "I asked the patient if she did this stuff and she said no" and is the industry standard way of documenting a "no" answer to a question.
Of course patients deserve complete access to their records, but I fully understand doctors who'd just as soon disarm a hand grenade as to hand over records to people who aren't trained in their interpretation.
Re:Conspiracy! (Score:5, Interesting)
In a lawsuit, the trouble's already arrived, and the records can do more good than harm.
The real problem isn't really patients knowing their records, but rather patients taking their records out of context, without understanding what each note means. Ten minutes on the Internet, and patients get a huge list of questions about every trivial detail in their records, and they'll be sure to waste the doctor's time with them at the next appointment. They'll think that a noted tiny chance of a problem is a major issue, They'll see every mistake is a gamble with their life.
Not every patient, of course... but just enough to make medicine even harder than it is.
An interesting anecdote: About two decades ago, my father developed cancer. He had surgery, which went well and led to a complete recovery. At one of his follow-up appointments, his doctor told him something from his record, that he'd kept secret. As it turns out, my father had actually died on the table. He's always known he was allergic to all seafood (and that was noted in the record), but it's actually a particular iodine compound that's the culprit. That compound was used in the normal surgical antiseptic, and was never before thought to be an allergen. During surgery, he had a severe reaction and had a severe heart attack.
The surgeons of course noticed immediately, treated the heart attack, then finished the cancer surgery, then the doctors included treatment afterward to clean up the mess. It was all detailed in the record, and any inquiry (or future surgical plans) would have clearly seen it, but it wasn't something my father needed to know in the months after surgery. After such an ordeal, the extra stress of knowlege would have only hindered recovery. Ignorance can indeed be bliss.
Physician perspective (Score:4, Interesting)
I'm a doctor in the US, and I'm stepping into the line of fire here as there is some serious doctor hate going on in this thread, but here goes...
First of all (in the US at least) most of these arguments are moot because patients by law have the right to their medical record. So, regardless of what your doctor thinks, by federal law you have the right to request and get access to your medical record.
In regards to the attitudes about IF patients should have this access I would be willing to bet that older physicians would be more against it than younger physicians. Doctors above a certain age tend to be more paternalistic towards patients than younger doctors.
My personal opinion is that any individual should be able to obtain access to their own medical notes.
However, most people are not familiar with the diagnostic process and jargon used in medical records. This could definitely lead to misinterpretation or confusion by a patient or the feeling that information was withheld when that is not the case at all. For instance I may write in a chart "left lung cavitary mass - malignancy vs TB vs fungal infection" indicating that I'm not yet sure what it is and more workup is needed. Do I tell the patient every possible differential diagnosis? No, because that tends to freak patients out, I say "I don't know what it is yet, we need to do some more tests."
If the patient read my note without understanding how to interpret it they may feel that information was withheld or the doctor has no clue what's going on.
I think that is more what is behind the results of this survey than doctors "covering their ass", because if a patient wants to sue they will sue, and every single piece of information about that patient will be subpoenaed and scrutinized by lawyers. You cover your ass by putting complete and accurate information into the medical record, and not trying to cover up mistakes if they happen.
Personally I would not care if any of my patients read their chart. I will even show it to them "See, last time I wrote that this was going on, is that still a problem?"