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.