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."
Conspiracy! (Score:5, Insightful)
What could possibly be in my medical records that they don't want me to know about?
But no mention of why (Score:5, Insightful)
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.
File a US disability claim (Score:1, Insightful)
File a US disability claim, and find out how much fun it is to get all those records, and then get your doctor to contradict the governments doctors in court.
Re:I develop an EHR (Score:5, Insightful)
Re:Conspiracy! (Score:5, Insightful)
The mistakes
Re:Conspiracy! (Score:5, Insightful)
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.
Not really surprising (Score:5, Insightful)
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.
Re:Necessary for MD's to do their job (Score:5, Insightful)
Re:doctors are overpaid (Score:4, Insightful)
Are you kidding? To become that pediatrician that doctor went to 4 years of undergraduate college, then 4 years of medical school (which has an average cost of >100,000), then completed 3 years of residency (making around 45k/yr). So now they are in their mid 30's, have a mortgage payment due every month, and all so they can work 120 hours a week so they can see enough patients to keep the doors to the practice open and pay their insurance company the ludicrous amount needed for malpractice protection from the sea of parasitic attorneys looking for a quick settlement.
Get real, the waste in the healthcare sector is not in doctor's earnings. If anything, they deserve more for all the crap they have to deal with day in and day out.
Re:Conspiracy! (Score:3, Insightful)
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 drive" as those who are normally stereotyped as such -- lawyers, stock traders, corporate ladder-climbers. The fact that one is willing to spend $100,000 on an automobile and $1 million on a house really paints the picture. There's nothing wrong or immoral about that, but it certainly does stand in stark contrast to the common perspective that doctors are driven by altruism and deserve automatic trust.
Re:Obvious reason (Score:4, Insightful)
John Edwards and his kind are the reason. Many malpractice suits don't have any scientific basis, it's just a matter of running a sympathetic "victim" in front of a jury.
http://www.washingtontimes.com/news/2004/aug/16/20040816-011234-1949r/?page=all [washingtontimes.com]
In related story ... (Score:4, Insightful)
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"
Possible compromise? (Score:5, Insightful)
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.
5 min on google 10 years medical training (Score:3, Insightful)
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 HUGE problem because disease processes are complicated and there are a lot of subtle distinctions the lay-person will not know anything about. Yes, sometimes the doctor might miss something but the vast majority of the time you will observe the doctor having a better batting average on the diagnosis than the patient.
Re:Conspiracy! (Score:3, Insightful)
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 some basic cross checking of their diagnosis. A lot of doctors seem to have this idea that just because they studied medical science instead of some other kind of science, that they're beyond question and somehow better than non-medical specialists. They hate getting caught out.
I'm paying for a service, and my records are (Score:4, Insightful)
.... 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.
Re:Conspiracy! (Score:3, Insightful)
Re:Conspiracy! (Score:5, Insightful)
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.
Re:Arrogance (Score:2, Insightful)
This is an absurd position to take. In any field, people who are overconfident of their abilities have a far greater likelihood of making mistakes than those who are cautious and believe that they have more to learn. Doctors, regardless of whatever delusions of grandeur they may possess, are still just people.
I'd much rather have a doctor with a cautious, inquiring attitude than an arrogant, patronising one with a god complex who has become incapable of listening to a patient or learning anything new as a result. Quite frankly, many doctors have an attitude and respond in a way that in any other profession would be considered to be a serious mental health problem.
Re:Conspiracy! (Score:4, Insightful)
If someone is sueing a hospital because their medical records contain an episode of explosive diarreha in a hospital elevator and winning, you should maybe find a lawyer worth a lick of salt.
So let's suppose the patient sees the note about the incident, and takes offense. They sue the hospital for libel, claiming that the incident was recorded for the amusement of doctors at the patient's expense. One defense would be to show a medical reason making the note necessary - but if it was isolated with no known cause, that may not be possible. Another defense is to point out how common messy incidents are in a hospital, but that'll skewer the PR department's campaign saying how clean the hospital is (which it was again an hour after the incident). Regardless of how skilled the hospital's lawyers are, an offended patient with a grudge will be expensive to deal with.
Because of this, we wouldn't leave a remark like "Patient questions everything, be sure to only see patient when management is available" because that sounds absurd, and yeah if that comes out during a case where say, the patient wasn't seen quickly in an emergency situation resulting in injury or death, well, too bad.
One comment I saw in actual records: "Patient has dementia and insists on seeing Dr. Johnson, who retired in 1985. Dr. Williams looks similar enough that he can tell her that whoever's on call is 'a good doctor'."
Sure, it's sneaky and underhanded, and a skilled lawyer can turn it into a case where the hospital was intentionally deceiving a patient to mislead them into trusting someone... but it's ultimately what's necessary to get anything done.
Inacuracies dont matter? I'd love to know where you work, so I can avoid whatever idiots you work with.
I worked with data from one of the largest hospital networks in the United States. Good luck avoiding them. The problem is that they've switched record systems a half-dozen times in the last two decades, and some records are known to be wrong. Whe processing their data, I was explicitly told to ignore anything older than 6 years, because anything prior to that was from the last system, and would likely have invalid data. I did still encounter some things like an ingrown toenail on someone's face (wrong ICD9 codes), a patient over 200 years old (invalid dates being sent by a third-party system), and one patient with a hundred different names (but the same social security number: 000-00-0000).
I think a patient has a right to understand everything regarding their treatment. Just dumping raw medical records on them won't do that, though.
Re:Conspiracy! (Score:5, Insightful)
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.
Mistakes and anecdotes (Score:4, Insightful)
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?
Re:Conspiracy! (Score:0, Insightful)
"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.
The medical profession did not make them addicts, the person themselves made themself an addict.
Look at the millions each year they are exposed to narcotics alone in a hospital that never become addicts, if it were really the medical professions fault then every single one of them would become an addict but that isnt the case. They make themselves addicts because they have an addictice personality which has nothing to do with the medical industry.
Re:Patients (Score:2, Insightful)
The Doctors have been colluding with government to fuck over patients well and good for a long time. There'd be some justice in seeing them take the shaft in their turn, but I'd rather just end the power of their guild to control may access to health care services and treatments.
Re:Conspiracy! (Score:4, Insightful)
Look at the millions each year they are exposed to narcotics alone in a hospital that never become addicts, if it were really the medical professions fault then every single one of them would become an addict but that isnt the case. They make themselves addicts because they have an addictice personality which has nothing to do with the medical industry.
This is, sadly, the attitude of many physicians. A tendency to get addicted to narcotics is a moral failure on the part of the patient, whereas, e.g., an allergy to penicillin is a legitimate, organic, condition that should be addressed in considering treatment.
Re:Conspiracy! (Score:3, Insightful)
Price gouging...
Private hospital in tiny town: $18,000 for 36 hours in a womens health room with a straight saline drip, half of that bill was for the saline drip (billed as "IV therapy", it had no meds in it and was only there so they had a line open if needed)
Closest hospital equipped to deal with a 7 week preemie: $17,000 for 10 days stay total. Lifeflight, 3 days high risk pregnancy observation and blood pressure treatment, c-section, 7 days of recovery, and emergency hemorrhage treatment 2 days after the c-section
Even couple hour ER trips on the weekends where they just tell us "Sorry you're in blinding pain but I don't feel like doing anything, have some tylenol" result in multiple $5,000-10,000 bills from the hospital, doctor, nurses, oncall surgeon/anesthesia/radiology who wasn't even there and did noting.
Re:Conspiracy! (Score:5, Insightful)
Both of my two children were born around 31 weeks. The first was in a ICU for 3 weeks, and humidicrib for about 4 weeks.
My second was healthier (wife managed to get steriods to improve the baby's lungs before birth), but was still in hospital for around 5 weeks.
My wife was admitted to hospital during both pregnancies multiple times due to excessive vomiting.
We calculated the total cost to us for both pregnancies - it was around $200. Thankfully we live in Australia were there is a proper health care system.
Re:Patients (Score:4, Insightful)