Have you ever wanted a peek at your medical records, a look at all the statements about you in your doctor's files?
Have you been embarrassed about asking for them when you changed doctors or wanted another opinion?
Or had trouble getting them?
Most patients do not realize that they have a legal right to the essential information in their records in a doctor's office or hospital, though a doctor's notes and the records themselves are the doctor's or hospital's physical property.
The paper is theirs, but the facts are yours. By law in several states, by generally accepted medical ethics and by almost universal court decisions, you should be entitled to see or get a copy of your records any time you ask. The copy should be delivered within a reasonable time for a reasonable copying and handling charge.
Most doctors, if they are cooperative in the first place, will not charge for either a summary or copies of a reasonable number of pages. Unfortunately, laws or ethics or court decisions may not always help either you or your doctor get your records from another doctor or hospital quickly and easily.
The American Medical Records Association, the association of the record-keepers in clinics and hospitals, says "it is still rare for the patient to exercise his right to direct access" or "have the opportunity to review the record for completeness, accuracy or timeliness."
Dr. William Phillips of the University of Washington in Seattle wrote the Journal of the American Medical Association: "I would like to make a plea to my fellow physicians to take one small step that will decrease costs through avoiding repetitive diagnostic tests while improving the care of our patients -- respond as quickly as possible to requests for release of medical records."
Now, he said, one can either repeat all the costly tests "or send off a request for records and hope they arrive within a few months."
Teaching centers are often the worst offenders, he added. He sent for a complicated obstetric patient's records when she was just six weeks pregnant. They arrived four weeks after she had her baby.
A District of Columbia Medical Society official reports "many complaints" from frustrated patients. The society phoned one doctor who charged a patient $10 for sending copies of records to her new physician and told him this wasn't "normal behavior." He refunded the money.
Even when a patient owes them money, doctors should forward the records. "The interest of the patient is paramount . . ." the American Medical Association's Judicial Council says on this issue.
Many patients nonetheless have to sue for their records. "In every state, if you sue, you get access," George Annas, professor of health law at Boston University reports. "But you shouldn't have to sue. We have too many lawsuits as it is."
Such suits were common in California, for example, until the California legislature in 1982 -- over the opposition of the California Medical Society -- passed what may be the nation's best law from the patient's viewpoint. It guarantees patients the right: to read their records within five days of making a written request and paying reasonable clerical costs; and to get copies within 15 days of a written request, with copying fees not to exceed 25 cents a page (or 50 cents if copied from microfilm) and reasonable clerical costs.
California doctors or hospitals may refuse inspection or copying of mental records if the patient might be harmed by seeing them. But the patient may then name a physician or psychologist to see or get them.
A 1981 Maryland law established a patient's right to "access," "review" and "copies" but only of records maintained by a hospital or "related institution" for the "prevailing cost" of copying.
A 1977 Virginia law is broader, though not as detailed as California's. A Virginia patient is entitled to copies of either a hospital's or physician's "records or papers . . . at a reasonable charge . . . within 15 days."
The Maryland law includes a possible exception where a doctor believes a psychiatric patient might be harmed; the patient may nonetheless get a summary of the records. The Virginia law adds such an exception whenever a doctor declares that seeing the records might harm the patient. An affected Virginia patient may designate an attorney or, in some cases, a family member to receive them.
The American Medical Record Association (875 N. Michigan Ave., Suite 1850, Chicago, Ill. 60611) can tell you where to write for details of any state's laws.
The District still has no access law. But the D.C. Medical Society backs patients' rights to their records, and hospitals generally let patients read them -- and have copies for 50 cents or $1 a page.
It can pay to read them first. One hospital here told a woman it would send her her records and bill her $1 a page, but she would have to pay in advance if the bill were over $50.
The hospital would have sent her records to a physician without charge. But she planned to become pregnant. She wanted to have the baby at home, using a midwife, if possible. She had had surgery at the hospital but had no regular doctor and wanted to show the records to some practitioners to ask, "Is it safe for me to have my baby at home."
Both doctors and hospitals do need signed requests before releasing your records.
Some doctors believe seeing the full record would just frighten some patients. Perhaps so, in some cases. But a study at the Medical Center Hospital of Vermont found that routinely giving patients their records increased cooperation and relieved rather than caused anxiety.
Just the same, be sure you really want to know what's in your record. You might get some unpleasant surprises.
In general, believes Prof. Annas, author of "The Rights of Hospital Patients," an American Civil Liberties Union guide, seeing your records "can be a powerful means of health education" -- for "checking the accuracy of family and personal histories," for more informed consent to future treatment and for "better understanding" of your own role and the doctor's.