A column I wrote last spring about gaining access to medical records drew wide response. Most letters were from patients eager to see or get copies of their records -- some who were having trouble getting them. One was from a doctor who offered a thought-provoking reason why letting patients see their records might be a bad idea.
The column stated that:
*Most patients do not realize 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. By law in several states, by generally accepted medical ethics and by almost universal court decisions, you should be able to see or get a copy of your important records anytime you ask -- within a reasonable time for a reasonable copying and handling charge (though most doctors will not charge for either a summary or copies of a reasonable number of pages).
*Maryland law establishes a patient's right to access, review and copies of records of a hospital or "related institution" for the "prevailing cost" of copying. Virginia law says a patient is entitled to copies of either a physician's or hospital's records at a reasonable charge within 15 days. (Both laws add a possible exception for psychiatric patients, though such a patient may name a representative to get the records.)
*The District has no such 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 to $1 a page.
But Dr. Charles P. Duvall, a Washington internist, offers a thoughtful caveat:
"In presentations of this type, the most central fact is usually overlooked: the construction of the medical record is a labor of love, characteristic of the physician striving to be his best on the patient's behalf, a ritual deeply rooted in medical heritage.
"At its best, I think, it allows the thoughtful and caring physician to discuss the pros and cons of various diagnostic and therapeutic considerations in a free and unfettered way . . . One might wonder in the record if a gentleman could have AIDS, or that a dowager might be drinking too much, or that a rash might be herpes, or maybe the whole thing is just depression.
"For a patient to turn around on the spot or within five days or some other legislative time frame obtain immediate access to these records seems to defeat their whole purpose . . .
"I am not denying the necessity of records for many legal processes and, as a previous chairman of our local society's grievance committee, I had no patience with sluggish response for transfer of medical information between physicians.
"On the other hand, if the patient is literally looking over your shoulder as the record is constructed, you will get exactly what you bargained for: a record that is so conservatively and tightly worded and uncommunicative that it has lost its sparkle, its imagination, its true value.
"If that is what patients want and legislate, that is what they will get, and I think doctors and patients alike will rue that day."
I can think of many possible reasons why I might want to know what's in my records, but usually, I believe -- unless I had a legal reason to feel otherwise -- I'd be satisfied with a summary. I'd just as soon not read every speculation about my life or my psyche.
There are doctors, however, who encourage their patients to see and keep copies of their records. Different doctors have different practice styles, and different patients may have different needs. Except for the right to truly essential information, this may be a matter best left to doctor and patient.
Any other opinions?