Tuesday, January 10, 2012

Patients Owning Their Medical Records

Traditionally, the patient chart stayed in the doctors office and rarely did a patient get a glimpse of anything in the record.  Photocopying the chart is expensive and no physician would let a chart leave her office because the record must be held safely for a minimum of 7 years.   Now more and more offices are doing away with clunky paper charts and electronic medical records are becoming the norm.  With electronic portals, is there any reason a patient shouldn't have access to their own medical record?

A study published in the Annals of Internal Medicine reported that up to 97% of patients queried thought the ability to have "open visit chart notes" was a good thing.  Doctors weren't quite so eager.

The study found that doctors worried that open visit notes would result in greater confusion and worry among patients and they anticipated more patient questions between visits.  But the patients overwhelmingly wanted to see the notes and were not worried about being confused.   They thought seeing their own record would provide information that would help them be healthier.  They could see the treatment plans and the test results directly.

One of the study authors, Dr.  Joann Elmore at University of Washington School of Medicine, said that access to records is important for indigent patients or people who move frequently for continuity of care.

It is a new world of sharing of information and there is no reason medicine shouldn't be part of the change.  Patients have access to research studies on-line as well as multiple medical websites  to look things up. (Some  are just junk and filled with ads).   If open records helps create a dialog about good health and allows patients to understand and take ownership of their own life it can only be a good thing.

I do worry a bit about the overly obsessive patient who might misinterpret every slight lab value that is outside of normal.  They will need to understand that not everything carries the same weight in medicine and slight variations of normal can in fact be...normal.

What do you think?  Do you want to see your medical record?


Dr Paula said...

In Chad, Africa the people carried their medical records with them in a a small booklet. When we saw them or did surgery on them we made a notation in the booklet. It was amazingly efficient - no requesting and waiting for records. Also they were very diligent about bringing their records when they came for care.

#1 Dinosaur said...

"Very diligent about bringing their records", eh? In the US, not so much. We can't even get people to remember their insurance cards, and half the time they don't even have their co-pay. Now if we were allowed to send them away uncared for without it...that might work. I just don't see the entitled patient standing for it.

Anonymous said...

I'm going through some testing (blood tests, XRays, CT Scan, EKG, doppler echocardiogram, spirometry). I have access to the blood test results, but that's it. I get the bills from the one radiologist, two cardiologists, and the two pulmonologists who have seen those tests. I don't know what they said about them. When I saw my doctor last month she asked if I got to see the CT or the XRays. I said no. She turned her computer screen so I couldn't see it, then told me some preliminary findings.

I don't want to play doctor. I'm worried that if I google what she's told me thus far I'll somehow look like a hypochondriac. I wonder if feigning complete disinterest and ignorance is the right attitude.

I don't need to see the doctors' notes about me (am I "difficult" yet?). I would like to see the test results and diagnoses for myself. It was startling to look at the doppler echocardiogram screen before the test began and see one new diagnosis there. Yes, my doctor had told me the radiologist found it, but that was the first (and last?) time I saw it in my permanent record.

I'm not a doctor. I do want to own what's happening to me.

sherri said...

I request copies of my medical records every two years (when I go through a review with my private long-term disability company). I keep these records in a binder organized according to specialist. I also keep all of my MRIs on CD-ROM. Occasionally I'll request copies of my labs and MRI reports during the course of treatment because I want to know about pertinent results that may affect my care. As a nurse, I feel knowledgeable enough to read doctors’ notes, decipher test results and discern between good and bad.

I believe patients need to be proactive and take control of their health. There’s nothing wrong with a patient having a copies of medical records. In fact, I believe it opens up dialogue between patient and doctor and allows for a more cohesive plan of care.

Cary said...

Patients should absolutely have access to our records. The handful of obsessive patients who would misunderstand and misuse the information are a minor concern compared to the good that open records will do. Perhaps doctors are worried that they will have to start writing legible notes? ha

DAWN said...


Michael Kirsch, M.D. said...

I think the current system is working well, but I'm okay with greater access for patients. I think that much of this info won't be that useful for most patients. I suspect many seek greater info without considering the use and value of the info. We physicians know this when we review our colleagues' records or hospital reports. When I do so, I often trash 90% of the pages. Nice comment, by the way, from Dawn!

Anonymous said...

"They will need to understand that not everything carries the same weight in medicine and slight variations of normal can in fact be...normal."

Well Doc, since you put it that way. being the reasonable person that I am, I can appreciate that.

I tend to think that many of us resent the feeling of "exclusion" when it appears as though knowledge regarding our health is being withheld.

Speaking for myself, I have great admiration for my own MD who has no hesitation in turning a monitor my way and saying to me, "see that number there? .... ". I take it as a show of respect and trust.

Anonymous said...

Cancer patients often have a huge binder with test and scan results, pathology reports, chemo info etc. if the computers are down, none of this is available to a physician? And not all physicians see all the results.. I suspect few offices do backups so records are available off line. they use a "cloud" or similar. Second, patients spot errors. I recently read the results of a PET/CT that noted I had had my lungs removed! Transcription error, but signed off and in my records. No one was concerned so I went to medical records and asked for correction. The entire paragraph of findings was nonsensical. I have seen lists of my meds include things I've never taken, and so on.
Yes, patients need to see their records.

Tick Paralysis

 We spotted a Coyote in our backyard, laying near some outdoor lawn chairs.  When we approached she did not jump up and run, as would be...