REFLECT

Model stories written by young professionals/students.

 

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Your Secrets That You Never See 

A student calls for more transparency in medical record-keeping

 

In every medical practice, medical professionals take copious notes, charting your height, your weight, your ring size and your favorite pop star. Charting, recording and typing are such an integral part of the expected dynamics of a typical doctor patient visit that the absurdity of paying someone hundreds of dollars for fifteen minutes of their time while they do their homework in class is rarely even noticed. In a typical visit to the office of any healthcare professional, the patient fills out extensive paperwork which includes records of family history, current and past medications, and symptoms. These never-ending checked boxes are overlooked again as the nurse or technician calls the patient in and takes initial notes on your current conditions. And yet again, the patient often only sees the back of their physician’s head over a clipboard or tablet when the physician comes in for the consultation. The necessity to record and rerecord information seems like a justifiable process: after all, situations in healthcare are often literally flitting between life and death.

The Heath Insurance Portability and Accountability Act (known commonly as HIPAA) was a landmark piece of legislation that redefined medical rights and privacy. Medical information became privileged and accessible on a “need to know” basis following its passing in 1996. HIPAA protects others from your medical information. However, the right to access one’s own medical records is still murky territory. In all of the note-taking and charting, the patient is seldom privy to the extensive pile of information that the medical community accumulates about them. If a patient visits an orthopedist about an injury, the patient may never see the x-ray. If the same patient goes to another doctor for a second opinion, the doctor’s offices directly transfer the medical information. Digitization of medical records both helps and hinders these issues. Many large practices now have online portals where patients can directly log in and access their lab results. However, this ease of access can also decrease accountability and privacy. The patient is a clear outsider and consciously kept in that position, too afraid to ask questions or demand answers.

This limitation in access to medical records brings up an important question: who own these records? Is it the physician who wrote them, the patient that they are about or the institution that they were written in? In all of the privacy afforded by HIPAA, medical offices still seldom need any clearance or verification to access a patient’s file from another medical institution. These medical records remain pages of personal information that the patient has never been allowed to see. Individuals in the medical establishment can access all of your records from infancy at a mere request. These medical records are ultimately supposed to allow physicians to develop a deeper understanding of your past medical history. However, they ultimately often become inerasable paper trails. Without committing a single crime, your medical history is permanently tarnished with every medication you have ever taken, and every cavity you have ever had filled. Accepting medical care and help is a voluntary decision. In fact, aside from life threatening situations, medical care is firmly a privilege in our current healthcare climate. Yet, in these voluntary acts, we are barred from controlling our identities. People are innocent until proven guilty and the average patient has committed no crime, so why must they not be allowed to decide what is in their medical records?

Our current medical system enjoys boasting of patient awareness and autonomy in decision making. However, I do not believe that ultimate patient autonomy can be achieved unless the patient may be able to fully access and be in control of the information that is being recorded in their medical records. The secrecy and lack of access to information that directly concerns you suggests that we are much closer to the paternalistic system of the past than we would expect. 

-Archana Jeeji