Forgot your password?
typodupeerror
Medicine Privacy Science Your Rights Online

Most Doctors Don't Think Patients Need Full Access To Med Records 659

Posted by samzenpus
from the for-our-eyes-only dept.
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."
This discussion has been archived. No new comments can be posted.

Most Doctors Don't Think Patients Need Full Access To Med Records

Comments Filter:
  • Conspiracy! (Score:5, Insightful)

    by mwvdlee (775178) on Friday March 08, 2013 @08:07AM (#43114667) Homepage

    What could possibly be in my medical records that they don't want me to know about?

    • by SJHillman (1966756) on Friday March 08, 2013 @08:09AM (#43114679)

      The price tag

      • The price tag isn't part of your Medical Record. However you do get a lit of Procedures which you may be able to cross reference to see what the price of them are... However you normally get the price when they send you the EOB (Explanation of Benifits)

        • Re:Conspiracy! (Score:4, Interesting)

          by filthpickle (1199927) on Friday March 08, 2013 @09:57AM (#43115691)
          Not only see what the price is, see what they told your insurance company they did. It is rampant to bill a longer office visit (the time that the Dr is actually speaking to/examining you) than what actually happened. I will generally give them the benefit of the doubt, but if they rush in/rush out and then bill my insurance a code saying they spent about 25 minutes with me....I have to call and complain. I have high deductible insurance...I have to pay it.
      • Most Patients think Doctors and Hospitals should charge less.

        There are way more patients than doctors so if we are going to get into this bullshit of setting policy by taking fucking polls, then I think the Doctors will be fucked over well and good.

    • Re:Conspiracy! (Score:5, Insightful)

      by Smallpond (221300) on Friday March 08, 2013 @08:20AM (#43114751) Homepage Journal

      The mistakes

    • Re:Conspiracy! (Score:5, Insightful)

      by Anonymous Coward on Friday March 08, 2013 @08:21AM (#43114761)

      Notes.

      For example:

      "Patient responds well to placebos"

      "Patient is a looney hypochondriac, but has lots of money. Recommend all possible expensive tests."

      "Patient is an addict, faking symptoms in order to get painkillers."

      etc.

      • by PopeRatzo (965947) on Friday March 08, 2013 @08:41AM (#43114913) Homepage Journal

        Or,

        "I'm not going to do test X because the lab I own doesn't sell that service, but I'll send him for an extra MRI because I've got a boat payment to make".

      • by mikael_j (106439)

        "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.

        • Re:Conspiracy! (Score:5, Interesting)

          by Rob the Bold (788862) on Friday March 08, 2013 @09:05AM (#43115125)

          "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:5, Insightful)

            by Anonymous Coward on Friday March 08, 2013 @09:30AM (#43115367)

            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.

            Posting as AC for obvious reasons but... Yes I would agree that a lot of addicts get their drugs directly from a doctor. It just takes one injury that causes chronic pain and you're often left with two choices in the end: Try and live with the pain, or become an addict. I don't necessarily mean mental addiction, but there is no way to avoid the physical addiction. I was hurt, and was on narcotics for years. They finally were able to perform a procedure that didn't remove the pain, but got it down to the bearable level it was at when I was medicated. I was virtually pain free, even at the lowest dose of my medication. I asked the doctor to take me off completely and we spent months and months weening me off. Within 3 days of taking that last dose, I thought I was dying. It was the most miserable experience in the world. At least, I thought so at the time. It's been almost a year since I've touched the stuff, but the first few weeks were the only time in my life where I ever thought I needed a drug to live. I had to flush my stockpile of medication down the toilet for fear that I would, in my weakness, use it.

            Unfortunately for me, the procedure was only a temporary fix. It will help me for 6-24 months. I've also discovered that I still have bad days. Days where I can't get out of bed in the morning due to pain. So, now I find that I am going to have to ask my doctor for a limited supply of meds anyway, just to deal with this occasional issue. I could have gone on long term disability years ago, but I prefer to work. I can't keep a job if I can't get out of bed, however. It's a terrible situation to be in, and I would never wish it upon my greatest enemy. I wouldn't even subject the man who did this to me to this kind of life.

        • by MightyYar (622222)

          Disclosure: I'm married to a doctor. A pain doctor, no less.

          Doctors go to jail for prescribing painkillers that are later abused, so they err on the side of caution. Your friend is a victim of the drug war. My wife has "fired" many a patient - most of them quite deservedly. But people are very good at saying what they need to say, so she has to be over-cautious.

      • Re:Conspiracy! (Score:5, Informative)

        by Sarten-X (1102295) on Friday March 08, 2013 @08:55AM (#43115045) Homepage

        I worked in the medical industry, handling medical data. This is exactly what they don't want you to see.

        Patient records are riddled with notes intended only for internal use. To a doctor, it's nothing special that you suffered explosive diarrhea in the middle of the hospital elevator - that happens once a week, and it could be medically important. To a patient, that's a terribly embarrassing episode that shouldn't be in records, and even considering storing such a thing is grounds for a lawsuit. That lawsuit would be argued in front of people outside a hospital setting, who would be biased in favor of the patient. In front of a hospital ethics board, tthe incident is just another bad day for the janitor.

        To use the traditional car analogy, hospitals are much like body shops. You really don't need to know every point that was inspected, every noise source that was considered, or the internal notes from the mechanic about how you question every repair so he should make sure to only finish work on days the manager's available. Most of the information is obvious to someone knowledgable, useless to someone who knows nothing, and ammunition for someone who knows just enough to be dangerous.

        On the other hand, what does the patient need to see? Doctors know that old records are unreliable, so history beyond a few years old doesn't really matter if it's slightly inaccurate. Current treatment is usually handled by a single primary doctor, who knows what makes sense for a particular patient, so inaccuracies there don't matter either.

        Sure, it's information about the patient, but giving out all the details just causes more trouble than good.

        • To use the traditional car analogy, hospitals are much like body shops. You really don't need to know every point that was inspected, every noise source that was considered, or the internal notes from the mechanic about how you question every repair so he should make sure to only finish work on days the manager's available.

          True, but I'd expect to get that information if I ask for it. Same with medical records.

        • Re:Conspiracy! (Score:5, Insightful)

          by bl968 (190792) on Friday March 08, 2013 @10:11AM (#43115847) Journal

          I observe every single thing done to my car. I am there in the shop as they do them; not in the waiting room. I have seen belts put on backwards, i have seen a mechanic raise my hood into the ceiling. I also come out with a full understanding of what needed to be done on my vehicle and why. Healthcare is the same. You should have full access to YOUR records.

        • by crakbone (860662)
          I've been to the hospital a number of times with friends. I've seen a number of screw ups from sexual assault ( male nurse found I was watching the girl and disappeared) to the wrong armband being put on a patient after she had been there for three days. I want to have my records, because if anything is wrong in there I will be pay for it with my life. Not the doctor that goes home at the end of the day, not the nurse that is wondering if her makeup is good enough, not the hospital administrator that
        • by MightyYar (622222)

          Sure, it's information about the patient, but giving out all the details just causes more trouble than good.

          You miss the point... it's ALL discoverable in a lawsuit. And not just the patient's internal records - everything the hospital did anywhere near the case. Emails, internal mail, policies, meeting notes, texts, call records... you name it. Discovery alone can cost the hospital a small fortune. People in general - not just doctors - are under the impression that secrecy prevents problems, but making a patient feel like there are secrets to be discovered only leads to more trouble. Even if the hospital makes

          • Re:Conspiracy! (Score:5, Interesting)

            by Sarten-X (1102295) on Friday March 08, 2013 @01:03PM (#43118013) Homepage

            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.

        • Patient records are riddled with notes intended only for internal use...could be medically important.

          Not all of those notes are. Friend of mine got access to her medical records. One of the notes was, "pleasant young female."

          Wtf?

          • by kaliann (1316559)

            I've read notes on me that said the same, but I'm also in a health profession, so I read the importance a little differently.

            "Pleasant" indicates that the patient is not showing undue signs of stress, depression, altered mentation, or hostility. A "pleasant" person is more likely to follow medical advice (i.e. comply), and therefor more likely to actually get the treatment as prescribed by the doctor. Depression, altered mentation, or hostility indicate more care needs to be taken, or might indicate pain,

      • Re:Conspiracy! (Score:5, Informative)

        by v1 (525388) on Friday March 08, 2013 @09:04AM (#43115115) Homepage Journal

        "Patient responds well to placebos"
        "Patient is a looney hypochondriac, but has lots of money. Recommend all possible expensive tests."
        "Patient is an addict, faking symptoms in order to get painkillers."

        My knee-jerk reaction to this is of course "there's NO good reason to withhold my medical information from me!", which was only made worse by the surprising statistics of doctors that wanted to keep it hidden from my view. But you raise some very good points.

        Perhaps what's needed here is a two-section medical record. Things that should be shared with the patient, (which should be the default behavior) and things that should NOT be shared with them, for their own benefit. The patient should not be able to determine if the "not to share" section contains information or not.

        But as for the 2nd of your examples, yes a hidden feature is abusable. But this is your DOCTOR we're talking about. They are in a position of trust. If you don't trust your doctor, you need to find a new one. If you're a doctor and you've proven yourself untrustworthy, you need to be delicensed. It should be safe to assume you can trust your doctor. Given that, they should be allowed to selectively hide information from you for your benefit.

        Like the old saying goes, there are two people in life you should never lie to: your doctor, and your lawyer. Because it's their exclusive job to represent and protect your best interest. And you need to be able to completely trust them both, because your health and your freedom are on the line, and they're the ones you're relying on to protect that.

        • Re:Conspiracy! (Score:5, Informative)

          by aethelrick (926305) on Friday March 08, 2013 @09:11AM (#43115187)
          I found that here in the UK, doctors tend to develop shorthand just in case anyone (like a nosy relative) looks at the patients notes in hospital... a nice one that stands out in my mind is "NFN" which is taken to mean that the patient is mentally impaired and thus requires extra care/attention when being spoken to. When I asked a doctor friend of mine what "NFN" stood for he chuckled and said... "Normal for Norfolk".
    • Re:Conspiracy! (Score:5, Interesting)

      by Anonymous Coward on Friday March 08, 2013 @08:23AM (#43114773)

      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.

      • 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.

        Doctors do make mistakes just like any human. The human body is a complicated thing and doctors are nearly always working with incomplete information. Mistakes are unfortunate but also inevitable. The most you can and should ask for is that the doctor treated you with the appropriate standard of care [wikipedia.org].

        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.

        It is terrifying that some people think that 5 minutes on google somehow will make them more informed than 10 years of medical training plus years of actual medical practice. Self diagnosis via google is a

        • by IndustrialComplex (975015) on Friday March 08, 2013 @09:48AM (#43115587)

          5 minutes on google will tell me that the self-protecting asshole doctor prescribed a relative of mine a drug containing paracetamol, which google helped me learn was a synonym for acetaminophen.

          What's the big deal? Well the relative had knee replacement surgery, so painkillers were necessary. The asshole doctor ignored the fact that he was explicitly told not to administer anything containing acetaminophen because the patient had liver disease and explicitly stated such on multiple occassions. The doctor didn't want to go through the hassle/overhead of dealing with a schedule 2 drug, and just prescribed the drug containing acetaminophen.

          Even after explaining to him that 'No, this person really needs to not take acetaminophen/paracetamol/tylenol/etc' we still discovered that they kept 'resetting' and going back to giving him the drug.

          So you will have to forgive me for not trusting 10+ years of experience vs google when the asshole kept giving tylenol to a guy with liver disease.

          • by sjbe (173966) on Friday March 08, 2013 @10:14AM (#43115893)

            So you will have to forgive me for not trusting 10+ years of experience vs google when the asshole kept giving tylenol to a guy with liver disease.

            It's appropriate to check on what is being prescribed and be involved in your care when you have the ability. Even well intentioned doctors (and pharmacists) make mistakes. Odds are that there was a problem with communication and that it was an honest mistake. Doctor's that would intentionally or negligently harm a patient are quite rare.

            That said, if you felt the patient was being intentionally mis-treated or incompetently treated then one has to ask why you continued to let this doctor treat the patient? If this guy was such an "asshole" then you can and should demand a different doctor be involved. You always have that right and you should exercise it if needed. What you are describing is grounds for a lawsuit. Did you bring one or are you just trying to bash doctors in general based on one anecdote?

            • That said, if you felt the patient was being intentionally mis-treated or incompetently treated then one has to ask why you continued to let this doctor treat the patient? If this guy was such an "asshole" then you can and should demand a different doctor be involved. You always have that right and you should exercise it if needed. What you are describing is grounds for a lawsuit. Did you bring one or are you just trying to bash doctors in general based on one anecdote?

              It was the non-surgical doctors/staff

      • Re: (Score:3, Insightful)

        by fractoid (1076465)
        Ayep. I can't find the link right now but there was a news article a while ago about a bunch of doctors complaining about people researching their own symptoms online.

        Admittedly, it's bad when some looney googles a list of every single illness that initially presents with "headache, fever, sore throat" and insists they have meningitis or chlorine poisoning when they obviously just have a cold. There's also the flip side, though, that if a doctor isn't very good, they're going to be easy to catch out with
    • Re: (Score:3, Insightful)

      by Anonymous Coward

      Agreed. Whatever their reasoning is, you can bet that it isn't for your benefit.

      Doctors are human beings just like the rest of us, and driven by self-interest just like the rest of us. I've always found it strage that people are so willing to put their undivided trust in doctors -- when those doctors are ultimately driven by self-interest and theferore should be regarded as no more or less trustworthy than any other human being.

      In fact, I've noticed that doctors are every bit as susceptible to "material dri

    • Re:Conspiracy! (Score:5, Interesting)

      by SternisheFan (2529412) on Friday March 08, 2013 @08:35AM (#43114865)

      What could possibly be in my medical records that they don't want me to know about?

      20 years ago my 35 year old friend died from stomach cancer. 8 years prior a radioligist failed to do his/her job correctly by not noticing a tiny white dot, so for 8 years the cancer grew until any swallowed food was blocked from continuing on into his body. Coincidentally, my friend's wife happened to work in the records room of his HMO (it's name rhymes with 'gyp'), and snuck his medical records out. The widow received a large wrongful death settlement only because of her having physical possession of his records, else no one would have known the true cause of his provider's negligence.

      That's one reason why you would want full access to your own records.

    • by Tsingi (870990)
      It's a God complex thing. Doctors don't like to be questioned. If you don't have the info, you can't question them.
    • I type medical transcription. Doctors can and do insert personal opinion into their notes, make mistakes, misstate facts, and other things that might lead to malpractice suits and other legal problems. This is called ass coverage.

  • by kdataman (1687444) on Friday March 08, 2013 @08:10AM (#43114691)

    I was surprised that in the article and in the linked survey article there was no mention of WHY a doc would want to restrict information.

    • Because you don't need it; now stop acting like a 3 year old with all this 'why' nonsense!

  • I develop an EHR (Score:4, Interesting)

    by Anonymous Coward on Friday March 08, 2013 @08:12AM (#43114697)

    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)

    by geekmux (1040042) on Friday March 08, 2013 @08:15AM (#43114723)

    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.

  • by Tx (96709) on Friday March 08, 2013 @08:21AM (#43114753) Journal

    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.

    • by Hatta (162192) on Friday March 08, 2013 @08:58AM (#43115079) Journal

      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.

    • by ledow (319597) on Friday March 08, 2013 @09:05AM (#43115131) Homepage

      With my ex-wife, we only managed to get a (now-multiply-confirrmed) diagnosis of her inherent genetic condition after 30 years of misdiagnosis by dozens of doctors. With the help of Google. Yes, I'm sure lots of people waste their time and it's a haven for hypochondriacs but it's also an invaluable resource when doctors are as overworked/lazy as they are.

      Her condition is JHS - joint hypermobility syndrome (also called HMS) that can come from over-extending joints (e.g. ballet dancers, gymnasts) or - in her case - from a genetic predisposition to a collagen deficiency. It was almost unheard of until a decade of so ago (and I've since seen another diagnosis of it in the school I work for) and there is little research on it - it's one UK doctor's pet research project, but by all accounts he's a bit of an arsehole.

      It's misdiagnosed by most doctors as arthritis because the chronic joint pain associated with it is easier to write off as that than anything else (even in 20-30 year olds). In fact, it's the exact opposite - sufferers can do the splits and bend over backwards to rival the best contortionists but have chronic pain, whereas arthritis LIMITS joints movement and have chronic pain.

      There's a simple ten-point test that's taken as official diagnosis, one point if you can place your hands flat on the floor without bending your knees, for example. Everyone in the world scores about 2-3. Flexible people can score 3-5. JHS sufferers score 8-10. My ex- scored 10 and always will, even when she's 80. It's the prime diagnostic for it, as they don't even have isolated genetic tests for it yet.

      The process to find out what the condition was (from just 30 years of constant arthritis diagnoses and treatments to help loosen joints, etc.) was:

      a) I had to explain to her that normal people AREN'T in pain 24 hours a day (when you live with it all day, every day, you just assume everyone else does but keeps quiet and soldiers on) and that your shoulder/hip shouldn't just "fall out of the socket" once a week or so (I became expert at putting them back in).

      b) I collected her symptoms, went on Google, found this (rare, genetic) condition that matched. There was precisely one doctor actively researching it, but it was in all the medical textbooks. Arthritis wasn't even close to matching the symptoms, but it was listed under the arthritis departments and diagnoses every time because it's SO often mis-diagnosed (which makes you wonder how 20+ doctors missed it).

      For instance, one of the symptoms is a reduced effectiveness of anaesthetics, and my ex- had a chronic fear of dentists because - even when anaesthetised - it hurt her too much. That's too simple to be a diagnostic on its own, but after 20+ such odd foibles of her health explained within 10 minutes of reading, things started to click (and not just her joints!).

      c) We took it to our doctor. He was overjoyed and keen. He had a diagnosis that he'd never seen before, it fitted the symptoms he had recorded in her notes perfectly, it was commonly mistaken for the arthritis that doctors before him had diagnosed. He was able to say that 20+ doctors before him were wrong, that "he'd" spotted the problem, and prove it. He ran off, researched it himself, and said he thought we were right.

      d) He sent us to a specialist (ironically, an arthritis consultant). They confirmed the diagnosis in seconds, and said they would have been able to in seconds for the previous few decades as it was well-known to them even if there was little they (or anyone else) could do to treat it.

      e) She received treatment (physio, painkillers, etc.), an official diagnosis, found support groups, was made aware of the chances of passing it on to our daughter (who has a much milder form, that isn't pain-associated, which probably means she'll be good at ballet and gymnastics and not suffer like her mother, but she'll still carry the gene and needs to know that when she gets older), got on with her life, and hasn't been back to a doctor for anyth

  • by Overzeetop (214511) on Friday March 08, 2013 @08:22AM (#43114767) Journal

    Some doctors will argue that by allowing the patient full access to the notes in the system, a doctor may be less frank about the mental condition of the patient or be reluctant to place information in the record which reflects poorly on the patient's demeanor, such as cooperativeness, a tenancy toward hypochondria, or just plan belligerence. In their defense, this honesty could lead to lawsuits (in the worst cases). Even in the instance where it's a simple difference of opinion, some patients are going to be fairly vocal about having the records changed or modified to suit their version of reality (correctly or not), resulting in more time spent by the doctor and administrative staff on uncompensated work.

    Now, the best way to combat this is to allow comments on the records by patients. It will keep some of the sillyness out of records (http://www.smithsonianmag.com/arts-culture/The-Last-Page-UBI-in-the-Knife-and-Gun-Club.html) and will allow legitimate differences of opinions. A chart which is riddled with patient comments contradicting past providers will be just as valuable to a future provider as a note that the patient is difficult or uncooperative in treatment decisions.

    Another item of concern is from the insurer's side. There will be people who attempt to expunge their records of items which decrease their insurability or increase their rates (and this will only get worse with mandatory insurance without cost caps or guaranteed rates). The way the questions were worded wasn't mentioned in the fine article, so if write/erase access was included in "full access," then continuity of care may be jeopardized by those seeking to minimize the impact of previous conditions on current health care rates - or simple embarrassment.

    • by clam666 (1178429)

      Some doctors will argue that by allowing the patient full access to the notes in the system, a doctor may be less frank about the mental condition of the patient or be reluctant to place information in the record which reflects poorly on the patient's demeanor, such as cooperativeness, a tenancy toward hypochondria, or just plan belligerence. In their defense, this honesty could lead to lawsuits (in the worst cases).

      If they are less frank, then doctors are adding opinions and personal biases, not facts.

  • Arrogance (Score:3, Interesting)

    by notaspy (457709) <imnotaspy@@@yahoo...com> on Friday March 08, 2013 @08:29AM (#43114819)

    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.

  • by ledow (319597) on Friday March 08, 2013 @08:30AM (#43114829) Homepage

    I have seen my entire medical records. Everything that a doctor has access to about myself. They were handed to me while I was at my doctors once and left alone in the room for several minutes while they arranged something. This was pre-computerisation, and they were my damn records, so I sat and read through them all.

    Most of them were boring. Most of them related to childhood reports that were ultimately no-diagnosis because it was a cold or sniffles or whatever. One of them relating to my birth describes sub-conjuctival haemorrhaging (bleeding behind the eye) - today my birth would have resulted in compensation and investigations as they damaged my eyes pulling me out.

    Apart from that, it was not interesting. Hell, they didn't even have my blood type, because they don't test for it unless they need to. And I haven't been to the doctors in YEARS except to register with a new one. I'm in the UK so there's no "cost" involved in treating me that I shouldn't know, as such.

    That said, why would you not want me to see them. If I have a condition, can you really hide it from myself? Seems like nothing more than an arse-covering exercise and - if that's so - why do you have to cover your arse? Why should you care that a previous doctor might have to cover their arse?

    Don't let me delete them or modify them, but I should at least be able to view them on demand and provide notes/comments as necessary if there's a dispute. How else can I be assured that the data you have is accurate? I can even query my entire criminal record and have it corrected if necessary (e.g. if someone falsely used my identity to commit a crime, which is quite a common thing), so why can't I do the same for medical records?

    In the UK, the PNC has an access and appeals process because there are recorded instances of someone being refused a job only to discover that the things on their record WEREN'T THEIRS - computer error, deliberate fraud, etc. is quite common - enough that there's a procedure to identify you with fingerprints in that case and modify criminal records accordingly, and have an appeals process.

    You're not telling me that medical records can't have exactly the same problem and solution, especially in countries where that person's insurance is going to be paying for that medical treatment?

    Hell, in the UK, even the Data Protection Act can be brought in here - you're storing data concerning my personal details on a computer system - that's automatic right to query, appeal, correction, etc. before you even start whether that's your image on CCTV (yes, under the UK DPA you can ask for all 'personal data' about yourself, including CCTV of you, from anyone who records it and stores it - there's even an official FAQ about it and they have 40 days to respond, so long as you provide enough details to isolate the data you require), the details your employer holds, or what a certain website holds on you in terms of cookies and stored data on their systems.

    It's entirely a malpractice cover, from what I can see. And if you're scared of someone potentially discovering malpractice, then maybe you should deal with your patients more carefully, not try to hide your tracks. And, honestly, that would be #1, top-of-my-list reason for records TO be opened, if that's the case.

  • by Patrick May (305709) on Friday March 08, 2013 @08:30AM (#43114833)
    God doesn't think he's a doctor.
  • by mbaGeek (1219224) on Friday March 08, 2013 @08:38AM (#43114887) Homepage

    Brokers don't think you should have full access to your investment account (after all THEY are professionals and you are too stupid to understand what they are doing).

    Mechanics don't think you should have full access to your car's maintenance record (see above).

    file this under ruductio ad absurdum [wikipedia.org] - I can understand the physicians point of view. I simply disagree...

    "sed quis custodiet ipsos custodes"

  • by Millennium (2451) on Friday March 08, 2013 @08:38AM (#43114895) Homepage

    Split the record into a "data" section and a private "remarks" section. Patients get unrestricted access to their own data sections, but require a court order to see the remarks. Establish clear rules for what can go in the remarks section: everything else must go into data, and inappropriate use of the remarks section itself counts as a minor form of malpractice.

    This should strike an appropriate balance. Patients can still get at the significant stuff, and they have recourse to get the rest if it's truly necessary. Doctors can continue to comment frankly about patients-from-Hell, without having to worry about being embarrassed unless they already have much bigger problems.

  • by Cigarra (652458) on Friday March 08, 2013 @08:41AM (#43114925)
    Maybe Dr. Van Nostrum [youtube.com] can help
  • Psych patients (Score:4, Interesting)

    by symes (835608) on Friday March 08, 2013 @08:52AM (#43115015) Journal

    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.

  • Foolishness (Score:5, Informative)

    by Charliemopps (1157495) on Friday March 08, 2013 @09:08AM (#43115153)

    My mother has worked in the medical industry her whole life on the administrative side. Since I was a kid, she would always go on and on about "always get your full medical record, check it for errors. Always ask for an itemized bill and check it as well." Then, a few years ago she got cancer, and thankfully survived and is cancer free after several surgeries and radiation treatment. And guess what... her persistence paid off. She again asked for an itemized bill, something that, over the years they've gotten more and more reluctant to give us... and the hospital had literally double charged her for everything. 2 pillows, 2 blankets, 2 room stays. They tried to argue this with her, but she had experience in the medical field and pointed out to them that if she had received the dosage of general anesthetic listed on the bill she'd be dead. The insurance company hadn't even caught it. She saved them hundreds of thousands of dollars, and they sent her a letter thanking her for her diligence. She only saved herself a few hundred dollars in co-pays, but she was proud none-the-less. Your medical record is yours, not the doctors. You should have full access to everything in it, and should be able to remove anything that you feel is inaccurate at will.

  • by realsilly (186931) on Friday March 08, 2013 @09:12AM (#43115197)

    .... proof of that service rendered.

    It is absolutely important for a doctor to understand the medical history of a patient and it is very beneficial to the patient, because frankly, every patient is different. I also believe it is important for a patient who is seeking medical services to be fully informed of what doctors prescribed and the reasons for those prescriptions. I feel that if you don't like the relationship with your doctor, don't go back to that doctor again. Let that doctor keep the information records that you provided for that visit, but you as the patient are the original owner of that info, not the doctor, not the hospital, not the insurance company. As a standard of practice, I feel it is vital for a patient to make sure he/she review their own medical records from all their physicians every 2 years or so.

    Our government recommends that we review our credit history every year, so why not your medical records? I also believe that a patient should be responsible for all of their own records. This information is about you and you have a right to understand if say an eye doctor is noting down psychological opinions about you and your mental state where he/she is not an expert. They have a right to an opinion, but it observations should be as non-biased in nature as possible, the information they write down should be factual, not conjecture, and if your copy of the medical records is not exactly the same as the physician's copy, then this should be an issue for everyone.

    When a patient volunteers information such as "I've just lost my job and I'm struggling to get out of bed, because I feel so deflated", that can and should be reported. If the doctor responds with the following, "It sounds like you're experiencing depression." I feel the patient/doctor should both have to initial this discussion. Unfortunately, this will open up a can of worms on a legal front should the mental capacity of the patient come into question.

    What happens when a doctor has his own medical issues such as a drug and alcohol addiction and is treating a patient, and the above statement is made, who is still scrutinized worse the patient or the doctor?

    Sadly, I have met many doctors in my life, some are excellent and will take time to talk to a patient and are happy to share all medical records, while some (that I've met) believe that since you're not a doctor, you're too stupid to understand your issues and that's why you came to me complex. These are people who believe that they are more intelligent than their patients and that patients have no right to look at medical records that they cannot possibly comprehend. (to that I say Horse-shit)

    I'm a voluptuous blonde haired woman who has had many doctors think that I couldn't possibly understand anything, and then when I actually ask intelligent questions, they are condescending in their response..."that's a difficult question my dear.../patknee" and that's the only response I've received. Those doctors never see me again, and if anyone inquires as to their abilities, I state that they refused to answer my questions and I won't see them again.

    I've been lucky also to have doctors ask questions of me about my medical conditions and are forthwith in their lack of knowledge in a particular area, and these are the ones who will also state that they need to perform a little research to familiarize themselves with my conditions before they are willing to discuss them or call those conditions into the current diagnosis.

    No one doctor knows everything, they need history, they need the knowledgeable patient to work with them. Let us not forget, long before medical degrees existed, people were pretty capable of diagnosing their own ailments.

  • Doctor's POV (Score:5, Interesting)

    by Just Some Guy (3352) <kirk+slashdot@strauser.com> on Friday March 08, 2013 @12:49PM (#43117831) Homepage Journal

    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

    SOAP NOTE FOR PATIENT X

    SUBJECTIVE: PATIENT DENIES EXCESSIVE DRINKING, TOBACCO, AND DRUG USE.

    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.

  • by Misanthropy (31291) on Friday March 08, 2013 @03:39PM (#43120065)

    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?"

"Consistency requires you to be as ignorant today as you were a year ago." -- Bernard Berenson

Working...