Despite Federal Regulations That Mandate Patient Access to Their Medical Laboratory Test Results, Survey Shows Most Physicians Oppose Patient Access to Other Clinical Information
In a poll of 2,300 physicians, more than 66% responded that they would not support giving patients access to their full medical records
In recent years, a new federal law made it mandatory that medical laboratories provide patients with access to view their lab test results. However, many healthcare providers continue to resist the concept of allowing patients to have access to their full clinical record.
SERMO Poll Receives Mixed Results
This fact is supported by a recent poll of 2,300 doctors. More than two-thirds of physicians (66%) participating in the survey said that they are reluctant or opposed to giving patients access to their complete medical records, according to a Forbes report.
The poll was conducted by SERMO, a global online social network for doctors. SERMO has 305,000 U.S. members, as well as about 38,000 U.K. members. The poll asked: “Should patients have access to their entire medical record—including MD notes, any audio recordings, etcetera?” The results were mixed:
• 49% of physicians who responded indicated that they would permit access on a case-by-case basis;
• 17% were opposed to giving patients access; and,
• 34% responded that patients should always have access to their complete medical record.
Doctors Have Opposing Views Concerning Patient Access to Medical Records
In answering this question, some physicians provided comments on their position. A U.S. Internist who responded “No” wrote: “Many times [patients’ clinical records] contain useful information for patient management that may be offensive but true. Some people can’t handle the truth and that will lead to vilification of the physician.
“Full access [by patients to their medical records] also means generating questions for which there is no time to lecture the patient,” continued this physician in her survey response. “I have, on more than one occasion, been forced to explain though. I could bring all my understanding from years of practice to a patient who recreationally reads about healthcare. The records remain private property of the physician who generated it for the care of the patient. If the patient doesn’t like that fact, then they can go elsewhere.”
Steven Campau, MD, an Internist and Family Practitioner in Algonquin, Illinois, and SERMO member, defended the stance of physicians who would only provide patients access on a case-by-case basis.
He noted that electronic medical records (EHRs) contain data tied to reimbursement and regulatory requirements that are difficult to explain to patients.
“A full record—taken out of context—with no opportunity to help translate and decipher the clinical information can easily lead to wrong and painful conclusions very quickly,” contended Campau. “That’s why the most popular answer to the question was for the doctors themselves to make that decision on a strictly case-by-case basis.”
Peter Elias, MD, a Family Medicine Practitioner in Auburn, Maine, and a SERMO member, holds an opposite view. He shares all medical information with patients, including his notes.
In a blog post on the KevinMD website, Elias responded to criticism of OpenNotes, a national initiative dedicated to providing patients access to physician notes that is primarily funded by the Robert Wood Johnson Foundation. The argument Elias felt compelled to challenge is “the principle that the clinician knows best and needs to keep secrets in the interest of the patient.”
The Forbes article also quotes Elias: “[Providing patients with their medical information] profoundly changes the nature of the relationship. If the record (or visit note) is written explicitly as a shared document, it is no longer possible to maintain a relationship based on asymmetric power. I can no longer keep secrets. If there is an issue or potential issue impacting care, I have to address it with the patients.
“This is often what clinicians find objectionable,” continued Elias in the Forbes story. “The thinking is ‘how can I document that I think the patient is being unreasonable or that depression is contributing to their pain or that their report of symptoms is exaggerated if they will see it?’ This is exactly why I think it is so important. Hiding these issues and using them to alter care without involving the patient is manipulative and paternalistic and keeps the patient from being fully autonomous.”
Multiple Ways Patients Already Have for Accessing Their Medical Records
The iBlueButton app pulls patient data from Medicare, the Veterans Health Administration (VA), private insurance plans and other sources. It organizes this patient data by medications, conditions, allergies, immunizations, and more. The app also enables patients to share information from fitness/health monitoring devices or apps with their physicians.
Additionally, patients also can access their medical data on the Internet with HealthVault, a free online service provided by Microsoft Corporation. HealthVault gathers patient health data, including medications and clinical laboratory test results, from different providers and stores it on a secure server. Patients can access their health information online from a computer, smartphone or tablet.
Although these two Web-based services compile a patient’s health data they do not, however, include physician notes.
Some pathologists and clinical laboratory managers may wonder why federal regulations require medical laboratories to provide patient access to their lab test results, but do not similarly require physicians to provide patients with access to their patient health record. Given the survey results discussed above that tallied 66% of physicians opposing full patient access to their clinical health records, it is a fair assumption that lobbying by national physician associations, up to this time, has discouraged federal officials from enacting a regulation that would require patient access to their medical records. However, given the trend of greater engagement by patients in their own healthcare, this situation is likely to change.