Way to Improve System


Should Patients Have Their Medical Records?


“Here’s an article by Budd Shenken, Simon.  Isn’t he the guy you used to play tennis with; when you used to play, that is.”  No answer.  I peered over to him.  He lay like a porpoise on his recliner, hands folded across his belly, a black cigar poking into the air like a snorkel.


He unclasped his hands as a sign that he was alive.  “Good ground strokes.  What’s he writing about?”


“It’s in the New England Journal of Medicine.  An article called “Giving the patient his medical record; A Proposal to Improve the System.”


Lapius bestirred himself long enough to light the cigar.  “I’ve heard of fresh air, a good night’s sleep, a brisk walk all recommended for improving the system, but I don’t see what giving the patient his medical records has to do with that.  Budd used to come into the net well.”


“He feels that patients should have access to their medical records.”


“Don’t they?” Simon seemed disinterested.


“Apparently not.  According to Shenken and Warner (NEJM September 29, 1973) in 41 states patients can obtain their medical records only by going to court, in three states only through an attorney, although not necessarily by litigation.  Only three states allow the patient direct access to his records.”


“But the medical records are accessible to other doctors and hospitals, are they not?  Budd was weak on the volley.”


“He feels that giving the patient access to his records would improve the medical system, improve the relationship between them and their physician.  The medical record would serve them as an educational tool.  Patients would look up unfamiliar words, would be in a better position to utilize physicians, and thus participate in their own care.”


“Well,” drawled Lapius, “It might save repetition.  Buddy always was a little sluggish going back for a lob.”


“He says that by giving the patients their records published guides to medical care would soon flourish, and professional consultant services for records ‘translation would abound in response to consumer demand.’”


“He says that patients have been forced into dependency on their physicians on faith alone, and have developed paranoid feelings about the medical care system, thus take things into their own hands and consult quacks-.”


“Balderdash.  People consult quacks because they often can’t face mortal or crippling disease and reach for straws.  Even so sophisticated a man as John Gunther went to a food faddist when his son was dying of a brain tumor.  Budd had a sloppy forehand, if I remember.”


“He goes on to say that availability of records would enable physicians to better judge the performance of their colleagues.  Physicians then would have a clear incentive to practice high quality medicine--.”           


Lapius virtually bolted from the recliner and started waving his arms.  “What right does he have to impugn the motives of the physician.  To what other professional does a patient go, often sight unseen and unknown, to place his life in his hands.  I haven’t noticed a decline of confidence on the part of the public in the competence and dedication of the medical profession.  In the distribution of care, yes.  In the inability of some to pay for long-term illness, yes.  But those are economic problems.  They should be rectified.  To blame the doctor for mal-distribution of care is like blaming the airlines because one can’t afford a trip to Europe.  A physician isn’t an industry.  He is a private person working to the best of his ability at his chosen task.  Frankly I resent the slurs aimed at the doctors, the intimations that medical care falls short, the insinuation that they over utilize hospital beds, that if properly scrutinized their patient care will improve.          


Sure we have faults.  But where is the hue and cry when we read that a municipal hospital is pest ridden, or that the kitchen couldn’t pass a health inspection, or that the hospital nursing staff is shorthanded?  Certainly if one were to improve the health system it would seem appropriate to start with the hospitals and institutions, where maladministration, or indifference on the part of the trustees can damage more patients in a week than a poor doctor can in his lifetime.  Budd didn’t have much twist on his serve, if I remember.”


“Shenken says that in the eyes of planners, administrators, and fiscal intermediates, that physician’s autonomy is unchecked, that administrators and policymakers do not have the capacity to evaluate or control the appropriateness of medical care.  That they are increasingly turning to ‘comprehensive organizational solutions that call for increased centralized decision making, and an increase in provider aggregations such as Health Maintenance Organizations, foundations for medical care, neighborhood health centers, hospital based practices, Professional Standards Review Organizations, and comprehensive health planning.’  Most of these solutions would deliver more power to the proposers of reform.  Shenken’s thrust is that by giving patient’s access to their own records, doctors would have an easier time with quality control, and that administrative power in health matters would be decentralized, and leave more power in the hands of the doctors.”


“Nonsense, Harry.  When a doctor becomes an administrator, he speaks of provider aggregates.  He is no longer a doctor.  Only in practice does the M.D. degree confer the title physician.  It’s much ado about nothing.  Budd has an interesting idea, but had made too much of it.  He should have stuck to tennis.”


“Simon, you’ve not only castigated Budd’s article, but his forehand, backhand, volley, serve and speed.  You must have beaten him every time you played.”


“I never beat him,” Lapius sighed morosely.