Saturday, July 24, 2010

WHOSE RECORDS ARE THEY ANYWAY?


I often peruse the NY Times Well Blog (http://well.blogs.nytimes.com/), where columnist Tara Parker-Pope presents for discussion meaty issues in the healthcare field. On July 22 the piece was by Dr. Pauline Chen, on a movement to assure patients access to their medical records. Most patients never develop any interest in seeing their records, but those who do often find their way obstructed by healthcare professionals for a number of reasons.
Of course, I support people’s full access to their medical records, so I had to write this response to Dr. Chen’s article:

Controversy over patients’ access to their medical records begs a more fundamental question: how is it some physicians have come to fear their patients?
As Dr. Chen wrote, the Health Insurance Portability and Accountability Act (HIPAA) assures patients access to their medical records. It also increases the privacy of those records, restricting entities who shouldn’t have full access. Not one of us docs in a hundred has read the law, so please excuse our misinterpretations, which understandably tend toward our own legal protection. We’ll get in less trouble if we withhold information the patient ought to have than if we furnish info we shouldn’t have. That is, an appreciable quantum of fear has butted into the examining room.
Fear doesn't enhance relationships, as malpractice attorneys will testify. The source of most litigation doesn’t lie in medical mayhem as much as in a poor doctor-patient relationship. If you love your doc you’re more likely to excuse a mistake than if your doc strikes you as a clammy, greedy oaf. One gauge of your relationship with your doctor—or with your patient—is the level of fear you sense in yourself. As a patient, how suspicious are you that your doc might harm you, or hide something horrible in your medical records? As a physician, how much emotional distance do you place between you and your patient?
Dr. Chen quotes Dr. Sara Fazio describing the medical note as a story. I agree: it is indeed a story. The patient, reading the note, might disagree with or even be disturbed by the doc’s version of the story. Indeed, that can happen, but so what? Within a healthy doctor-patient relationship, the patient will inform the doc of his or her perspective, and now the doc knows more about the patient. This sort of give-and-take isn’t any arcane or revolutionary practice. It’s the definition of effective communication.

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