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Trisha Torrey

Doctors Find Their Objections Unwarranted

By October 23, 2012

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For many years now, patients have sought access to their entire medical records, from test results, to diagnoses, to insurance submissions and yes, to the notes their doctors wrote about them and their care.

But there have been, and continue to be, major roadblocks put in our way. For one thing, not nearly enough doctors even use electronic medical records - so patients can't gain access except by asking for paper copies. They may be stymied trying to get those copies, or they may find the copies are incomplete. That's roadblock numero uno.

But even with the electronic records, doctors have done their best, in general, to be sure patients didn't get hold of much more than some test results, or appointment reminders. Despite Meaningful Use Rules, many providers have blocked access to the one thing that might provide patients with the most information; that is, the doctor's notes.

Their excuses sound lame to us patients (although I'm sure doctors think they are valid.) There are the excuses you'll actually hear come out of a doctor's mouth, such as "I need to explain the information because my patient won't understand it" ... to... "It could be dangerous for a patient to read my notes and jump to the wrong conclusion."

Then there are the excuses you'll never hear a doctor use, but to them are probably just as valid. "God forbid my patient should see what I wrote about her - she wouldn't be happy with me" ... to... "I don't want my patient to see what I wrote because it wasn't really what happened, but I need to cover my backside."

There will come a day when no excuse is valid any longer. There will come a day when patients have access to all aspects of their records, in real time. That's because the Meaningful Use Rules are getting the ball rolling, despite protestations from groups like the American Hospital Association.

With all this as a backdrop, some further impetus was created recently when the Robert Woods Johnson Foundation published the remarkable and astounding results of their Open Notes study. The study involved 105 primary care practices in Seattle, Boston and rural Pennsylvania, plus 13,000 of their patients who were given total access to their electronic records, including the doctors' notes about their care. Some highlights:

  • 87% of the patients actually accessed their record at least once in the course of a year
  • 40% of patients responded to surveys about the Open Notes
  • While about 25-33% of the patients expressed some privacy concerns, 99% of them wanted to continue accessing their records even after the study ended.
  • Just as surprising - the doctors involved found that their fears of patients not being able to understand was moot, and 86% of them decided to continue allowing their patients access to the records.

Other studies have shown similar results in the past, including one that concluded that patients with better access feel more in control of their health.

Of course, the largest health system to allow open access to medical records is the VA's program, now called "The Blue Button."

An article describing the study in Reuters provides the real bottom line, though. That is, that if patients want access to their records, they will need to continue asking for that access. Unless providers are pushe... er... encouraged to provide access, they just aren't going to do it.

Meaningful Use provides encouragement... but you can, too.

Learn more about the Meaningful Use Rules

How to Get Copies of Your Medical Records (if you don't have electronic access)

How to Review Your Medical Records for Errors

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Agree? Disagree?
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Comments
October 25, 2012 at 6:14 pm
(1) Bob James, M.D., J.D. says:

Trish: Me again! As a former practicing physician I really can’t understand why any physician would not want a patient to have a copy of their complete record. We always dictate with the thought that you shouldn’t include anything that you wouldn’t want read in open court so there shouldn’t be anything derogatory that a patient shouldn’t see. Other then the aggravation and minimal costs of providing copies it really doesn’t make any sense. Of course if having the info generates multiple phone calls for explanation I might change my opinion! See…we DO agree sometimes!!! Keep up the good work!

October 26, 2012 at 1:54 am
(2) Deb Williams says:

I have transcribed doctor’s evaluations, etc. over a period of years and I agree with the above statement, as a general rule. I must say though sometimes if you could see the raw first handwritten (especially before progress notes etc were entered into computer it seems) entries quickly, and in some instances before there is an intervention by an administrating authority i.e. hospital — oh heck let me spit it out — in some instances there are errors and they rush in to CYA… perhaps that is one of the biggest fears as well — I feel if these were immediately available it would cut down on their ability to cover mistakes, etc… something very real to fear.

October 26, 2012 at 3:50 pm
(3) gemdiamondintherough says:

To comment #1, I say “right on”!
But not everyone is as “honest” as you may be. As a medical professional myself, I am horrified at the judgement calls people put in writing! If you are charting what you see, hear, smell and feel, then you should have nothing to hide!
That however today is not always the case.
In the majority of cases, it will be a line of communication, rather than a stumbling block.
I have pulled my records frequently, and am appalled at what is said in the record, from what I told them. Or things that I was never asked or were not examined! I think it will help people be more accountable.
On the flip side, there will be a minority of people that will be a problem. But these people are probably a problem, anyway!
My very first job utilized bedside charting, and I am a big believer in that. If you happen to forget something, you can look up and see.
Also, patients see that you are actually doing something. You may have to say, I will sit here to chart now, so I will not be able to talk for a while and then I will have to go on to my next patient.
You will be amazed that this will have a very positive effect on your relationship with most patients. There are some exceptions to every rule, however!

October 28, 2012 at 5:01 pm
(4) MDM says:

Does anyone know and under what regulations can you obtain telephone and emails between your physician and another regarding your care. Any assistance would be greatly appreciated.

October 29, 2012 at 4:34 pm
(5) Trisha Torrey says:

MDM,

Your question is a little unclear – but I’ll take a stab at it.

There are no regulations that require any physician to provide a phone number or email address at all. Phone numbers are usually easy to obtain for offices, of course.

Further, since there is no reimbursement for emails between physicians and patients (or anyone else), there are few physicians who engage in email with patients at all.

If you are asking about whether a physician can be forced to converse with a representative for the patient – I don’t know of any regulations that require it, but there are also no rules that get in the way of it as long as the proper paperwork is signed.

Here’s more: http://patients.about.com/od/yourmedicalrecords/ss/hipaamyths.htm

Good luck to you.

November 14, 2013 at 6:08 pm
(6) gemdiamondintherough says:

Hi Trisha,
I think perhaps the person was wondering if you can determine if one care provider contacted another care provider to have a discussion.
If that is what MDM is asking – good luck! I do not think you will ever get that information out of them, of course unless they are under oath in a courtroom! I would like to think that a care provider would document something that they did! But I know that does not always happen. And I am not certain if or what regulation that would fall under, other than HIPPA, where you have given permission to discuss you information with another care provider that is also treating you or “in the need to know”!

I apologize, if I have misunderstood MDM’s question, but that is what I understood MDM was asking.

November 18, 2013 at 12:14 am
(7) Donna Lou says:

My husband and I just got a new cardiologist. (Old one retired).The new one actually read aloud everything as he was rapidly typing it into my husband’s records on his laptop! Our hospital has also just given us a website where we can access all our records. Aren’t we blessed?–Twin Falls Idaho

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