Accessing family members medical records?

Discussion in 'General Residency Issues' started by devildoc2, May 25, 2008.

  1. devildoc2

    devildoc2 Membership Revoked
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    I'm an incoming intern, and one of my family members is concerned about her cancer therapy and wants me to look up her stuff in the online medical records at the institution I'll be doing residency at.

    Of course, I told her this is a big no-no and I could get fired for it. However, is there some way where she could sign a waiver explicitly allowing me access to cover myself? I'd really like to help this person, but of course I dont want to get fired in the process.

    I'm assuming that as long as she gives me written permission to access her records, that its all kosher right?
     
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  3. docB

    docB Chronically painful
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    As far as HIPAA is concerned you don't have to have written permission but you need to be involved in the care of the patient. Since you're not really that could be an issue. With the written permission I think HIPAA would not be a problem. However, you would very likely run into an instutional problem. Most institutions overreacted to HIPAA and created draconian policies about med record access. I think that if you accessed records under these circumstances your institution would punish you because you are not the patient's doc, consultant, covering doc, etc. Should this patient wind up on your service or on a service you are covering then you're completely within your rights to view the records assuming your institution doesn't have a rule against treating family members.

    I suggest taking the signed HIPAA permission to the patient's doctor and telling him that she is hoping you, being the medical person in the family, can explain some things to her. Then ask the PMD or oncologist whatever the questions are. The other option is for the patient to go and get copies of all her medical records, which usually involves some cost, and then she can show them to you.
     
  4. Winged Scapula

    Winged Scapula Cougariffic!
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    1) Why doesn't she request copies of her own records from this institution?

    2) If I were you, I'd stay out of it. She is not your patient and you have no right to be looking at her records.

    She could sign a form releasing the records to you, and then you give them to her, but again, she is not your patient and this verges on unethical, IMHO.

    3) Patients who are "concerned " about their therapy are generally of the impression that they are being managed inappropriately. And when patients are "concerned" about inappropriate management, the next stop is often at an attorney's office.

    She has every right to look at her medical records, but if this ends up in a lawsuit, you don't want your name anywhere near her records. In hospitals which use EMR, all individuals who access a patient's medical record are logged. Again, since she isn't your patient, this could be interpreted as a breach of confidentiality. Hospitals and their employees go overboard and frequently misinterpret HIPAA; most of the time you are not supposed to be looking at your own records, let alone those of a relative.

    I'd suggest she goes to medical records, signs a release and pays whatever fee there is for copying said records. If she needs some help interpreting them, perhaps her PCP can assist or in a pinch, you can.
     
  5. Wednesday

    Wednesday Senior Member
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    You can't do it. Only thing you can do is have her get the records through medical records and give them to you to look at. In my experience with three different large medical centers, records must go through med records to be givable to patients. Technically you're usually not even supposed to print lab results and things out for patients, although I know people do this. You definitely can't access the electronic record yourself willy nilly. I would heed the advice above and try to stay out of your relative's cancer treatment. Could get messy and I imagine you're not a cancer specialist yet anyway.
     
  6. Hard24Get

    Hard24Get The black sleepymed
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    Legally, looking at her own copy of the medical records is best, but it is unlikely that your opinion would be any more expert. I have had multiple suspicious/concerned family members simply request that the physician speak to me (as a lowly medical student) about their case. Docs have been more than happy to call and were able to give me plenty of info and answers to my questions that I could use to spend a lengthy amount of time explaining things to my relatives and finding patient material on their condition for them to read. Just having what their doc says filtered through you can do a world of good in terms of trust. Staying humble throughout my interactions with various docs, I've never had one get offended and I've never had a dissatisfied/still concerned family member, either (of course, my n is only 4).

    Just my $0.02
     
  7. Flopotomist

    Flopotomist I love the Chicago USPS
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    Has anybody thought to ask her WHY she wants to have somebody else looking at these records? It sounds like she may be going through something very scary to her, and she either:

    1. Doesn't understand what is happening to her
    2. Doesn't trust her physician
    3. Is in denial of her diagnosis, and hoping if somebody just looks harder, they will be able to provide a different answer

    While most of the responses above helped deal with the possible situation if #1 is the case (eg finding ways to ethically access the records so you can explain things) they neglect to deal with the bigger issues demonstrated by #2 and #3.

    Maybe just opening up a discussion with her about her motivations would be a good place to start. Curious to see what people more senior to me (which is everybody) think.
     
  8. Winged Scapula

    Winged Scapula Cougariffic!
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    I agree that is certainly a good approach, and I thought I dealt with it in stating that she is likely dissatisfied with her treatment (but of course, it could be that she is dissatisfied with her oncologist or doesn't feel comfortable asking for more clarification). The OP used the term "concerned" which would lead me to believe that she thinks she is being mismanaged.

    If the OP is comfortable getting into that discussion with this relative (and he may or may not be), then its perhaps a good idea to do so, but it doesn't solve the problem which is what he asked advice for.

    Because regardless of WHY she wants the records, the fact is she wants them and he needs to tell her that he cannot access them FOR her.
     
  9. Shalom77

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    If she signed an authorization specifically releasing them to him - he could definitely get a copy of her records. As for looking them up himself after a signed authorization - that's something to ask his institution what their policies are. If she's signed a release it's no longer a HIPAA issue but an institutional rules issue.

    In any case, if she signs a release and he obtains the records from medical records - there's nothing unethical about that at all. That's what releases are for. I could see how this could be very helpful for her. I'd do it for a relative if I worked at a hospital where they had received treatment - especially if it was a pain to get to the hospital etc.

    Just bring a release to her, have her sign it and make sure you are specified as the person the records should be released to and then give it to medical records. (Keep a copy for yourself in case she wants you to access things in the future within the timeframe of the release.) Then pick up the records when they are ready. This is the way to legally access them FOR her.
     
  10. 3dtp

    3dtp Senior Member
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    My dear hot Wing,

    I agree with 2 of 3 points you make. But laypeople really don't understand or care about the nuances of the regulatory environment. Thus points 1/2 are understandable. I'm not sure it's unethical, but it places a relative who is every early in training in a difficult position, lacking adequate knowledge to properly inform/interpret and who is required to be aware of the regulations.

    Point 3, however I strongly disagree with. Many patients are concerned about their therapy and options. That's why they get second or even third opinions. And I encourage them whenever they ask about another institution's capabilities. Most of the time they come back to me.

    Many times, patients will ask a relative "in the profession" their opinion for reassurance. In my present program, we are not allowed to look at our own records, but I was allowed to look at my own records in my previous residency. So, no consistency there.

    In pre-HIPAA, when my wife, a PhD medical professional was hospitalized, we were waiting for blood counts for discharge. She asked me to see what the am labs were. I got them from th e floor nurse, when I was accosted by the resident. I explained that I had permission, was asked to obtain them and my wife was perfectly capable of understanding them, as was I. The nurse and I got a royal tongue-lashing, ending with "If my brother were a patient in this hospital, I couldn't go looking up his medical records!" To which I replied, "Well Dr., I hope you don't have the same relations with your brother as I have with my wife."

    The records do belong to the patient, the patient has a right to access them for whatever purposes, and I agree that they should use whatever hospital procedures are in place to obtain them and not back door through their new intern relative. Not because there is anything sinister or intrinsically wrong, but because I worry, as does the OP that the institution may use that access to reprimand the intern.

    I have been frequently asked to provide a patient with copies of my notes so that their relative physicians at [pick your favorite famous cancer center] can review our proposed plan of care. I do this routinely. It saves the patients time and effort.
     
  11. Winged Scapula

    Winged Scapula Cougariffic!
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    I think you misinterpreted my earlier post.

    I also, as the only person even remotely connected to medicine amongst my family and friends, am often asked to interpret notes and medical records. Patients obviously get 2nd, 3rd or even more opinions all the time and they should be encouraged to do so.

    I have no problem with the OP assisting his family member in understanding her medical records. My point #3 was that in no way should be participate in obtaining medical records in which his name will be logged. Once the OP has his name associated with that patient's medical records, he could now potentially be seen as her medical provider, with all the risk that entails.

    My comment was simply meant to state the above and that he should not participate in obtaining her medical records for her. She or her PCP should be able to do that and then the OP can then review them. I also regularly provide patients with copies of their studies I order, their pathology, etc and review them with them.

    Until the OP posts again we have no way of knowing what her "concern" is. It is certainly possible that by concern she means "confused", doesn't understand her treatment goals. Unfortunately, I have found that assuming the worst, that "concern" also means "I think they are doing something wrong and want my records to prove that and maybe even talk to an attorney". THAT is what I think the OP needs to stay far away from. As an intern, it is unlikely that he possesses the detailed knowledge of oncologic practices required to fully understand her medical records either.

    I don't know if that makes sense, but some information about the OP's relatives motives is probably important. I guess I am also unclear as to why she cannot get those records herself and needs to involve him. I realize she doesn't understand how these things work and doesn't realize that looking at her medical records can get him in trouble, but really...how about asking her PCP to get the records and review them with her, or having the relative go over to medical records and get them herself?:confused:
     
  12. IndyXRT

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    I have only been asked to seriously review medical records for a relative once (there are always the occasional "what does this mean" questions). The relative obtained the records himself. After reviewing them, I gave my general opinion, but recommended that he see somebody more closely related to his problem (I actually set up a consult with somebody I trust).
     
  13. 3dtp

    3dtp Senior Member
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    I think you're right. Unfortunately, [sigh] I still look at the world through the best possible construction despite the battle scars and burn marks and put the best spin on concern. If it weren't for the lawyers, the world would be a better place (or would it?)
     
  14. core0

    core0 Which way is the windmill
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    You are partially correct here. The record belongs to the healthcare entity that created it. Some states have interpreted interpreted the data in the record as belonging to the patient and giving the patient ultimate decision making on what is done with the data. The federal privacy act in any case gives the patient access to the record. If you doubt that the patient doesn't own the record try to physically remove a chart from the hospital. The hospital will gladly give you a copy, but they get to keep the original.

    David Carpenter, PA-C
     
  15. Winged Scapula

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    Perhaps my glasses are less rosy because I work in a highly litiginous field. I frequently see patients who believe they have been mistreated, only to spend a great deal of time deconstructing their records with them and show them that they have received the standard of care. And that *sometimes* people DO get complications, which they were warned about. Known complications does not = malpractice (although some attorney will probably try and make it so).
     
  16. DadofDr2B

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    Having been a patient (with CKD) I can only tell you that it is frustrating to know that as a patient I can not get my own lab results that I paid for from the lab doing the work. They refuse saying only the doctor can have these records. This causes mistrust in the patient when everything is secretive and your own records are not available to you. You often ask "why are they hiding these results".

    My nephrologist was in a city 300 miles away and the 24 hour urine collection was done near my home and I made a request in writing to give me the results and I would take it to my doctor since my appointment was the next day. They refused to give me the information.

    I paid for the tests. I think I should have access to my own tests. Dumb rules.
     
  17. 3dtp

    3dtp Senior Member
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    Therein lies the importance of a fully witnessed consent.
    Procedurally oriented specialty residents take note!
    The properly executed informed consent is well worth the time and effort to protect yourself.

    I was peripherally involved in such a case where a complication did occur, likely not from our treatment, but the estate sued, and the jury returned a no cause verdict that hinged directly on the method and meticulousness of the consent and consent process. Moral: Complications do not = malpractice, but the estate would like to make it so.

    And you are right. I do have an optimistic (and probably naive) perspective on my fellow humans. It do gets me in truuble sometimes.
     
  18. 3dtp

    3dtp Senior Member
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    The media the information is written on (paper, memory chips, disk drives etc.) belong to the institution, its successors and assigns. The information belongs to the patient. This is splitting the hairs on a gnat's 8ss.
     
  19. 3dtp

    3dtp Senior Member
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    Agree with the sentiment. Disagree that who pays for the test owns the results, at least in this day and age. Since you likely didn't walk into the lab, plunk down a couple of pictures of presidents, you didn't pay for the test. Your insurance company/federal government/employer did. Of course, the obvious solution is to remove the middlemen. You are right, dumb rules. You might call the place back, next time and ask to speak to their HIPAA compliance officer and see how far that gets you.
     
  20. DadofDr2B

    DadofDr2B Member
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    I own my company and used insurance completely paid for by me. I am the employer and the employee and the insurance administrator. Further, I use an HSA account with a $5000 deductible. I am laying down all of the dollar bills and even if I were not, I would have earned the insurance through my own work. The insurance company can certainly have a copy but I own my medical records.

    I have a law degree but do not practice. I may file a law suit when I retire to see who owns the medical records. Don't have the time right now. My current doctor gives me his clinical notes on me.
     
  21. docB

    docB Chronically painful
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    the question about who "owns" the records is an interesting one. I have always been told that the patient owns the info and the facility owns the media. That model seems to work for most purposes but not all. For example even if a patient owns the info they can not ask (well they can ask but will be refused) that all their info be deleted or destroyed by a clinic. They can't demand that information be changed although they can request an addendum or clarification be added. A patient's "ownership" of their info is limited.
     
  22. 3dtp

    3dtp Senior Member
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    So, does this mean that the intermediary payers are nothing more than holders-in-due-course? This is a very interesting twist on things. And in your particular situation things are as I think they should be. You can get your info.

    What about the Medicaid patient who pays neither insurance, direct costs nor taxes? I still think the patient owns the record, irrespective of who pays. Is this where the model breaks down?
     
  23. Neuronix

    Neuronix Total nerd
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    For a per page fee, after speaking with an attending, after filling out a form, and then after a couple days for "processing". This is where I take a small issue with "gladly".
     

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