4.11.2009

Do You Own Your Medical Record?

It seems like a simple question. Certainly policy wonks and advocacy groups make it seem so. Before I tell you what I think, I'd like to know your thoughts, as well as why you feel that way. In about a month there will be a round table of researchers in data management and structures in Washington D.C. discussing long term approaches to medical information flow and management. Who owns the record will be one of the factors that will influence the direction taken.

5 comments:

Stacy S. said...

I have personal reasons for this answer - but I think 'YES' I should be the owner of my own medical record.

Other than the fact that you are your own best advocate for medical issues .. it's a major pain in the a** to get your records to a new doctor, specialist, etc.

Harvey said...

Pliny;
During most of my medical career I have been given the impression by administrators of various medical establishments (hospitals, clinics) that the medical record "belongs" to the patient, but that they were not permitted access to it, except through written permission for it to be transferred to some other facility. Once it had been forwarded or transferred ("legally"), it was up to the medical professional or facility who had received it whether or not all or part of it might be "given" to the patient. This was certainly true when I was in the military. When I was finally discharged, the paper copy of my personal medical records where sent to me, without my request. To my knowledge, the Navy no longer has any copies of this record.
In my capacity as an "expert" witness (more often than I wish had been necessary) and once as a defendant, it was made clear to me by the lawyers I was dealing with that this doctrine of "owned" by the patient, but not to be made available except to another valid professional (or a lawyer by subpoena) was the most widely accepted doctrine.
In recent years, partly as a result of The Freedom of Information laws that have been passed by our government and even moreso the result of the growth of "paperless", electronic record keeping, this doctrine has seemingly finally required more specific and better delineated parameters, under which patients can have direct access to their records. Along with this, of course, has come much more "control" of access to electronic records by anyone other than the patient. As you probably know better than I do, anyone who accesses a patient's electronic record must not only "sign on", but his/her access is tracked and if there was no good reason to have done so, there can be serious repercussions.
I will, of course, be very interested to see how this commission deals with all of these issues. Certainly, in the end, patients should be able to read and/or obtain copies of their personal records. I am very concerned, however, what impact this may have upon the traditonal physician/patient relationship and the trust that it requires to be effective. I am also quite certain that some patients will be poorly prepared to understand many of the records they may read without a trusted health care professional able to give them the background and the understanding necessary to appreciate those records when taken out of context.

sunnyskeptic said...

I have to say no, for only one reason: I have a hypochondriac relative. These people are a major reason our health care in this country costs so much. If records were open to medical professionals, then they would be able to know if someone was doctor shopping, which I think could really help not just for the cost of health care, but also for individuals' physical and mental health.

As it stands now, owning something and maintaining privacy are not the same things. I don't need to 'own' my medical records in order for medical professionals to keep them confidential.

I am a firm believer that it must be simpler for medical professionals to share information in order to provide adequate care.

Pliny-the-in-Between said...

Thanks to you for commenting. I think it is a wonderful example of the challenge we face in developing a working compromise. In a mere three comments we have an experienced physician, a clinician working in rehabilitation and a person with first hand experience with the challenges of diagnosing and managing a condition that is outside the expertise of most clinicians. Each of you bring a unique perspective and unfortunately you are all correct. I'd like to explore two things in a coming post - 1 - why it's imperative we fix this now, and two the various forms of conflict of interest that can arise depending upon who gets the conch and owns the chart. Thank you again for the thoughtful comments.

sunnyskeptic said...

Oh yeah, sounds awesome! I think that I, of course, see both sides. I can also see how if you don't own your medical records, some people could use them for EVIL... :) I just think it needs to be easier for medical professionals to share records. I've always thought that though, for example, I used to get examined at Planned Parenthood, now I have a regular physician. ALL of my records are electronic and should transfer in a nano-second. That would totally make my day.

PS: I can't believe you weren't on my blogroll! Der. You are now!