Whilst waiting to see if my last specific question is going to be privileged with a response, I would like to pick up a point which is incidental to the central issue of this thread but, in my view, germane to some of the iatric attitudes one can encounter in discussion of it viz. providing patients with copies of their medical records.
If, genuinely and uniformly, it is easy in the States (see Punchaps last post, penult,par.) for a patient to get hold of all of their medical records, from any source - and to my mind, easy in this context should include considerations such as swiftly, accurately, clearly and either freely or at least inexpensively, confidentially and without question or umbrage - then I am , genuinely, glad for your patients.
I have to confess that, pretty much uniformly, that is all most definitely not the case in this old island.
We have had specific legislation covering this issue for about quarter of a century and still doctors parade ignorance and surprise, and indeed resentment, when they are told that they are, with very few exceptions and caveats at all, obliged to give patients copies of their notes if asked to do so, within a statutory time-frame to boot. It can be the devils own business, on behalf of patients, getting practice secretaries and hospital administrators (to whom, largely untrained and unsupervised in this respect, doctors then delegate their statutory responsibilties) to comply with the legal obligations concerned.
Well, ignorantia legis neminem excusat as we used to say to each other lightly at break (ignorance of the law excuses nobody) and welcome to an interview with the Devil. I tell em that if they are one day late with one document I will get a written a ruling indicating non-compliance from our Information Commissiopners Office with the individual doctors name all over it (a process which usually takes 3 to 6 months and includes the doctor having to try to explain herself to the Office,) and send it to whichever newspaper local to the doctor has the largest circulation. I say this obviously before they have even had a chance to comply, and sometimes slip in a old copy of a local rag frontpage complete with picture of smug doctor being chastised. The comparative success rate between doing that and just sending in a routine subject access request (as it is so very clumsily called) is really very startling. The doctor, who, of course, has in any event to sign off the copy info leaving her practice\hospital desk, suddenly takes a real interest in doing what her patient is perfectly entitled to have her do and the whole transaction is done and dusted within a short space of time.
(Dont ya just love the way I can curl my tail round my horns
?)
Seriously though, and without wishing to re-till ploughed land, there is a very real parallel between here between the legal and medical and professions. If I am working for a client, the file on my desk belongs, in most ways that have any real significance, to that client. It is their business, they are paying for the actions and advice all the way, and they are fully entitled to call for the file or, say, to direct me to send it to another lawyer who at any time they think might do them a better job. Thats how I was trained to think on the issue and I believe it is a healthy discipline to remember at all times that my client is looking over my shoulder, and that tomorrow the whole matter may be being critically reviewed, in every detail, by another professional. Why should a patients medical file be treated in any other way by some doctors?
As a final illustrative point on this sub-issue may I share with you all the fact that I was fairly recently in my GPs (local doctors in general practice) surgery (office) on my own personal account and was told that I probably had something which you may be sorry to learn is not considered likely to be fatal but that the GP proposed to write a letter of referral to an appropriate consultant (hospital specialist). As it happened the GP available that day was not one who knows me, but from the look on his face and subsequent expostulation, when I said So be it. I look forward to receiving a copy of the letter, you would have thought I really had sprouted horns and then asked for a date. In all his days in practice, (and he was about half my age, so thats pretty old) he said, he had never been asked to do that!
Oh for goodness sake. Doctors, or rather, some of them, preen themselves as regards their supposed inter-personal and consultation skills, their patient-side manner blah-de-blah. Of course, I shall automatically assume that everyone here is utterly irreproachable in these respects, but frankly guys, you have got to admit that some doctors know very little about effective communication. Their egos are in the way.
tm 2.30pm, my time
