Patient viewing his/her own chart

[doozenberg]

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[tripleJ]

Of course, allowing reasonable time and cost to reproduce these documents; in other words a patient can't have the chart- but is welcome to the entire photocopied thing

 

[smq123]

if a patient asks for permission to view his or her own chart, does the patient have the right to access this information unfettered?

Why shouldn't they? 😕

 

[docB]

Why shouldn't they? 😕

I thought there were some limitations on patients accessing their psych charts.

 

[smq123]

I thought there were some limitations on patients accessing their psych charts.

Yeah, I guess I wasn't thinking about that. But isn't that the only exception to a patient's right to otherwise see their medical record?

 

[Laryngoscope]

There was a recent article in the LA Times about this. In California, you have to provide the medical records if requested by a patient within 15 days. There are also limits on how much you can charge for copying, etc.

Here is the article:
http://www.latimes.com/features/health/la-he-medical-records-how27-2009jul27,0,1345364.story

 

[SoCuteMD]

Where I work, we tell patients that they are welcome to a copy of their chart but it has to be obtained from the medical records department.

 

[Doctor Bagel]

My understanding is that one of the aspects of HIPAA is to allow patients access to their own medical records. I think the one caveat is that you should avoid harm in this process, so you can hold the records if you think reading them would be harmful to the patient. I'm guessing that's what's going on in some psych cases.

My dad was treated at MD Anderson, and they have a thing now where the patient can see all their medical records online, which seems pretty cool to me. My parents had fun reading all the stock language we put into our documents. Apparently my dad is "pleasant" and "well-nourished." The downside of their system is that test results pop up online in about a week, so the practitioner has to be sure to notify the patient of anything bad before they find it online. Of course, they should be doing that pretty much instantly anyway.

 

[gutonc]

Both of the hospitals I work in (Univ and VA) allow patients online access to their charts. I only have one patient for whom it is a problem. He always comes to see me with complaints about something another provider wrote about him, usually something he disagrees with in his pan-positive review of systems.

 

[adam6]

I think refusing to let a patient see their chart, or acting cagey about it, is one of the worst things you can do in terms of cultivating a relationship. Patients have a right to review their medical record, and have addendums inserted for any information that they believe is incorrect or incomplete.

Although you certainly have the right to say, "Sorry, you have to request it through medical records," in many cases patients just want more insight into their condition, and just want a few minutes to look through the notes. In those cases, I tell them that that's fine, but that I will be in the room with them while they do it in case they have any questions or don't understand what they are reading.

Most of the time, my patients spend five minutes looking at it, ask a couple questions, and then give up because they don't understand the language. But they also seem appreciative of the openness.

I wholeheartedly agree! It is the "patient's" chart and should be treated as such. And the fact that patients can have access to the records should remind us to be careful with our documentation - ie: avoiding inappropriate or offensive language/characterization and avoiding chart "wars" with nurses, other services, etc.

 

[docB]

I think we need to temper our idealism with the realities of the system. There are very good reasons why a patient may own the information in the chart but they do not own the physical chart. They can amend it but they can't take it, remove items from it or change entries. The chart does more than just chronicle test results and consultant recommendations. It is where we protect ourselves from the patient and their future lawyers by documenting non-compliance, informed consent and actions taken by the patient against medical advice. We also record in the chart items which invariably anger the patient such as reporting substance abuse and drug seeking behavior.

 

[QofQuimica]

I think refusing to let a patient see their chart, or acting cagey about it, is one of the worst things you can do in terms of cultivating a relationship. Patients have a right to review their medical record, and have addendums inserted for any information that they believe is incorrect or incomplete.

I agree. This actually happened to me while I was on psych doing a consult for delirium. The pt saw me taking notes and wanted to read them. I was totally unprepared for the situation. But I thought, why the heck shouldn't she, and I handed over the notes. Then, like you said, I sat there with her while she read them, and told her to tell me if she thought I got anything wrong or if she had questions. She didn't like some of the questions I had to ask her (lord knows psychiatrists have the need to delve into every personal issue in the world), but she read through the notes, gave me them back, and we got on fine. I asked my attending later if I had done the right thing, and she told me I had, basically giving the same reasoning that you did.

 

[sarcopenia]

I don't mind patients viewing their charts (as is their right), but I'm not very comfortable with this occurring in real time.

1. It can be distracting or disrupt my line of thought (yes, you can say this is a personal failing, but if I forget to chase down an important ddx pathway it can impact the patient) if an ER patient peeks over my clipboard and tries to make sense of my chicken scratch.

2. It can (at least theoretically) create a "Heisenberg Effect" especially for psych patients.

3. It can negatively affect rapport for the rest of the clinical encounter, again impacting on patient care ("I am NOT delusional ... the FBI really IS after me because I'm going to go public about the aliens who are controlling the president through telekinetic anal probes).

It can be problematic for EMR particularly. I know there are some schools of belief that you should give the patient your full attention first, and then magically remember the entire conversation, all pertinent positives and negatives, and then record everything later. While I can agree that there might be a better dynamic with this approach (arguably more "patient-centred"), my retort is that there is nothing more patient-centred than a medical record that is thorough and complete, and that leads to / supports an optimal Dx and Tx plan. Maybe I have the STM of a gerbil, but I record everything "on the fly" and this saves time. I can type nearly at the speed of my thoughts (comparable to what my dictation speed would be), so why not? The problem is when switching from Hx to PE, the patient would often be able to view what's on my screen, so I usually make a point of hitting a bunch of hard returns or pulling up a random lab report before getting the patient onto the exam table.

 

[michaelrack]

The medical record is there to document your encounters with the patient, not to record your thoughts on the situation. Nobody should ever be writing anything in a chart that they haven't already discussed with the patient, no matter how upset it may make them.

I disagree with this. Although the patient is (occasionally) the person paying for our services, as doctors we have some duties to the general public- preventing diversion of controlled substances, for psychiatrists taking steps to prevent patients from acting on homicidal ideation, etc. Driving safety is another public duty that some docs have (preventing car accidents due to sleepiness). I do sometimes record my thoughts on a situation.