I was at the dr’s office this morning for a routine procedure, and before I went into the exam room, I took a look at my charts/files, which were in a plastic tray that hangs on the wall outside the door. You know; you’ve all seen these. Then the nurse comes along and says chirpily, “No looking at the charts!”
I said, “Not even at my own?”
She said, “Yeah, I know it’s dumb, but your insurance company would throw a fit if they knew.”
I was flabbergasted. All along I’ve assumed that I could look at my own charts. It didn’t sound as if I was allowed to do so even if I had asked first.
What could be the reason for this? And how would the insurance co. know if I sneaked a peek? Are they afraid I’m going to alter it?
Yeah, what she said. I hate this neo-paternalism from medical establishment folks. Just when I thought it had really been established that the patient gets to be primary decision-maker in their own health-care decisions, doctors and insurance companies and facilities et. al. are suddently exhibiting this “I’m sorry, but it would not be good for you to know more about your own body than the doctor thinks you should know” attitude.
Here in New York they’re trying to eliminate patient-direct testing, which is already a klunky workaround in the face of laws saying only doctors can order blood urine stool saliva & other such tests, even though they are physically noninvasive. (Under the guise of protecting patients’ rights to over-the-counter preg tests, blood glucose tests for diabetics, and anonymous AIDS tests w/o Dr. Rx, they slammed the door on everything else).
Tell the nurse you don’t care if the insurance company has a hissy fit, and that it’s your damn chart and you’ll read it if and when you want to. AFAIK you still have the legal right to a copy of it, and although to exercise that right through conventional channels means waiting for them to xerox it and send it to you snailmail at their convenience, they have no legitimate reason for keeping you from reading it.
You do have the right to access them, to view the information in them, and to have them made available to other physicians (and to lawyers et. al.) designated by you, but certain procedures and conditions must be observed and met first, which may vary from state to state.
You have a legal right to see and in some cases amend what is in your medical records, if you feel that there is an error. This is one of the things that came out of HIPAA a couple of years ago. You have more rights now to know what’s in your chart than you did three years ago. Insurance companies be damned; you have a right to know. If you have a lot of medical issues that you see a lot of doctors for, you may request and posses a copy of your records to take with you. You may encounter a lot of resistance to this, as up until a few years ago, patient records were treated as super-secret, and the last person allowed to see them was the subject of the records - the patient. HIPAA gas changed a lot of that, giving you more rights.
However, this is not the same as seeing test results before they have been released to a doctor. In most states, only certain types of doctors are allowed to order lab tests, radiological exams, etc. In turn, those results can only be released to the ordering doctor. After they have been released, you can request a copy of the results, usually after you sign a waiver saying you are accepting the results without medical consultation and you do not hold the facility responsible for decisions you make without medical consultation.
I work in a medical lab, and we will not release any results to anyone other than the ordering physician (or their office). If a patient were to call asking for the result of one of their tests, we’d tell them to call their doctor.
While you do have a right to copies of your files (not the originals, which belong to the doctor), I do recommend that (unless you’re a doctor) you have a medical professional go over them with you, instead of just reading them and trying to decipher them on your own. There are some things which sound very scary as written, but aren’t much of anything to worry about. A doctor can help you understand what is what.
A client of mine was enraged and heartbroken when she peeked in her gynecologist’s file and saw that she was listed as having 3 abortions. She’s rabidly anti-choice, and was just fit to be tied that such a mistake was made in her file. Problem is, “abortion” is the medical term for miscarriage, of which she had had three. The charts were correct, but she understood only just enough to make herself crazy.
Where I work, employees are discouraged from accessing their own medical records, however, we can look if we want to. It’s not against the rules, just frowned upon. The reasoning, I’ve always been told, is that there may be some things in there that we don’t understand, and any information about our health issues are best gotten from our doctors, so that it can be explained in layman’s terms and whatnot. Recently I had a brain MRI, and I couldn’t make it to the followup appointment to get the results, but I just couldn’t stand waiting any longer to find out if there was something wrong, so I went ahead and looked at the report. Luckily it was normal. If there had been an abnormality, I would have been freaking out, looking it up in my books and on the internet to see how long I had to live, if I would need surgery, etc. If there was a problem, it probably would have been best for me to find out from my doctor, who would then proceed to tell me how severe it is, what the treatment options are, and maybe I’d be less scared about it.
On one hand, I can understand wanting to be as informed as possible about your body and your health, but on the other hand, much of the information in your medical record is written with a certain audience in mind, those with medical expertise, and a layman probably wouldn’t understand a lot of it, and there is a risk of confusion and taking things the wrong way.
Qadcop: You’re quite right; they are not in my possession. I just didn’t see the harm in peeking at them. I wouldn’t begin to try to analyze the blood test results. I was also looking to see if my previous insurance co. had forwarded my files to my new doctor. (They did.)
I’ll have to try to find out what the laws are about this in CA.
In Ontario, you have the right to access any of your own medical records. Hospitals and family doctors have the right to charge you a reasonable fee for photocopying, patient services, etc. for the records.
My wife, the nurse, just said they allow a patient access to their records/charts but can not allow anyone else to see them (unless you show them yourself)
AFAIK, in NY State you can see anything except for (in some cases) your psychiatric/psychological records. Even those are not totally verboten, but they’re not automatically accessible, either. I don’t know what the rules are for accessing them or who makes the call on what is and is not appropriate, however.
The rule with psychiatric (or, I presume, psychological) records is that the treating physician (or other professional) decides what to release to the patient. If you are not happy with what is being disclosed to you, I’d suggest having them sent to another medical, psychological or psychiatric professional, and let them decide what is suitable to disclose. I know it sounds like a conspiracy, but in that arena, even the disclosure can have effects, and professionals have been sued later -by the patient- for revealing too much, or the wrong things.
It’s not always something deep and dark. A psychiatric professional may have formed an early poor impression or clinical estimate that they revised or completely ruled out in later sessions, still the realization that they at one time reacted a certain way or had a certain clinical hypothesis might affect your therapeutic relationship and/or candor with them. The clinical experience of someone who’s been on “that side of the couch” in filtering out the irrelevant or harmful can be a Good Thing.
But I do understand your concerns. Trust me, it’d bug me, too.
OK, I’ll certainly buy the idea that the physical chart itself belong to the doctor. What about the copyright on the information in the chart? Does that belong to the doctor as well? Or is it some sort of “work for hire” deal?
Can I take a photo of my chart and post it on the Internet? Can I have copies of my chart published and sell them without my doctor’s permission?
Wow, that HIPAA gas is powerful! Could I get my hands on some? I’d like to use the HIPAA gas on car dealers to make them show me the actual cost of the car and all those ‘extras.’
At one time, as I recall, a cancer patient may or may not have been told that he had a terminal illness, at the discretion of the physician. Those days are long gone. The standard now is that the information must be harmful to the patient or others were it to be released.
In general, a patient may request a copy of his own records if the records still exist (all facilities have standards for records retention, usually a couple of years past the last visit depending on the amount of space and the relevant statutes of limitations) and the patient is willing to wait (at my local hospital, the maximum turnaround time is thirty days, sixty if the records are kept off-site) and able to pay copying fees (I have no idea how much these run, but I can’t imagine they’d be an obstacle in and of themselves).
Psychiatric records are a special case, obviously, for the reasons mentioned above. I can’t, offhand, think of any other instance where a patient could be denied access to his own records, especially since HIPAA. (Maybe a physician could help me out here.) The default is overwhelmingly in favor of allowing the patient to know whatever he wants.
As I understand copyright law, it doesn’t really apply to medical records: They would seem to me to be simple listings of fact, like a phone book, and the contents of a phone book are not copyrightable. (FEIST PUBLICATIONS, INC. v. RURAL TEL. SERVICE CO. is the relevant case law on this, decided March 27, 1991.)
Hell, I’d just grab the chart and look anyway, and tell the nurse to kiss my ass. They’re gonna have a hell of a time prosecuting you for looking at information that you have a legal right to look at.