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By: Kassie Avant
By: Kassie Avant
& &
Kacie Soudelier
Kacie Soudelier
The Right to
The Right to AccessAccess Medical
Medical RecordsRecords
The R
ight
to a
ccess
of
medic
al
The R
ight
to a
ccess
of
medic
al
reco
rds
reco
rds
A psychiatric patient’s right to see her medical record.
A psychiatric patient’s right to see her medical record.
Claire is a 38 year old, never married, woman who worked
Claire is a 38 year old, never married, woman who worked
as a secretary off and on over the past ten years. She had
as a secretary off and on over the past ten years. She had
difficulty keeping jobs due to disputes with fellow workers
difficulty keeping jobs due to disputes with fellow workers
often accusing them of not carrying their work load,
often accusing them of not carrying their work load,
criticizing her work, and in one case reporting a fellow
criticizing her work, and in one case reporting a fellow
worker to the supervisor for coming to work late.
worker to the supervisor for coming to work late.
Out of work, she is seeing a psychiatrist at the mental
Out of work, she is seeing a psychiatrist at the mental
health clinic of the HMO of her previous employer. She
health clinic of the HMO of her previous employer. She
pays out of pocket in order to keep the HMO coverage.
pays out of pocket in order to keep the HMO coverage.
After four appointments with Claire, doctor identified
After four appointments with Claire, doctor identified
patterns of paranoid thinking and determined her to be an
patterns of paranoid thinking and determined her to be an
unpleasant and difficult patient. She was not psychotic,
unpleasant and difficult patient. She was not psychotic,
nor did she have major psychiatric disorders. But she did
nor did she have major psychiatric disorders. But she did
exhibit personality traits that are causing her problems.
exhibit personality traits that are causing her problems.
At the end of visit four, Claire, is convinced doctor does
At the end of visit four, Claire, is convinced doctor does
not like her. She thinks he is implying that her
not like her. She thinks he is implying that her
employment problems are her own fault and that she
employment problems are her own fault and that she
needs further therapy to address these issues. She
needs further therapy to address these issues. She
suspects that doctor is keeping notes on her that reflect
suspects that doctor is keeping notes on her that reflect
his poor opinion of her. She is certain he is trying to make
his poor opinion of her. She is certain he is trying to make
it hard for her to get future jobs and has written his
it hard for her to get future jobs and has written his
opinion in her chart. She asks to see her medical record.
opinion in her chart. She asks to see her medical record.
When doctor hesitates, she states she will report him to
When doctor hesitates, she states she will report him to
the management of the HMO. The law is currently in flux
the management of the HMO. The law is currently in flux
regarding rights of patients to see their medical records.
regarding rights of patients to see their medical records.
Moral uncertainty exists. In particular, many physicians,
Moral uncertainty exists. In particular, many physicians,
especially psychiatrists, are concerned that granting
especially psychiatrists, are concerned that granting
patients the right to see their records may harm patients
patients the right to see their records may harm patients
as well as violate the privacy rights of the provider.
as well as violate the privacy rights of the provider.
Regardless of the legal wrangling, what is an ethically
Regardless of the legal wrangling, what is an ethically
appropriate decision by doctor?
appropriate decision by doctor?
Defe
nd t
he p
ati
ent’
s ri
ght
to s
ee
Defe
nd t
he p
ati
ent’
s ri
ght
to s
ee
the m
edic
al r
eco
rd.
the m
edic
al r
eco
rd.
Stakeholder 1: Claire
Whom wishes to view and be fully informed of her own personal medical
records
Defe
nd t
he p
ati
ent’
s ri
ght
to s
ee t
he
Defe
nd t
he p
ati
ent’
s ri
ght
to s
ee t
he
medic
al r
eco
rd
medic
al r
eco
rd. .
Stakeholder 2:Doctor
Whom has Claire’s best interest in mind & does not want to be reported to HMO
management
Does Claire actually have a psychiatric diagnosis?
No
The doctor only identified patterns of paranoid thinking and determined her to be an unpleasant and difficult patient. She exhibits personality traits that are causing her problems, but she is NOT psychotic NOR does she have major psychiatric disorders.
Claire
Claire is able to review her records:
Establishes trust between her and Doctor
Shows Claire that was is charted is truth & not the personal opinion of Doctor but medical opinion
After review of her medical records it will help to ease her paranoia
Once she comes face to face with her actual issues & difficult personality traits she will be able to begin resolving them through therapy
After working through her problems in therapy Claire will be better prepared to find a dependable job.
Claire
Claire does not get to review her medical records.
Will feed her paranoia that she has unknown damaging psychiatric disorders
Her unpleasant personality traits will worsen making it more difficult to establish a steady job
Claire will have to find another psychiatric doctor and start treatment all over again
Due to her continued unemployment Claire’s house & vehicle become repossessed leaving her homeless & without transportation
She is therefore forced to walk to the public library to go to RateMD.com to leave negative feedback about Doctor, causing him potential patients
Ultimately Claire’s continued unemployment forces her to look for money in other directions such as drugs & prostitution
Doctor
Doctor allows Claire to view her Medical records
Trust becomes established between doctor and patient
Doctor can & will begin to work with Claire to resolve her paranoia & unpleasant and difficult personality
Doctor upholds the medical code of ethics by recognizing his patient’s rights
Claire recommends friends and future coworkers to Doctor for their needs
Doctor is not reported to HMO management & remains on their referral list
Doctor
Doctor refuses Claire to view her medical records
Doctor loses a patient that he could have helped live a better, more successful life
Claire reports Doctor to HMO management
HMO management removes Doctor from their referral list
Doctor is put under review for fraud & insurance abuse
Claire notifies local TV news programs & a special is done on doctors that refuse to respect patient’s rights
Doctor loses his medical license
AMA Principles of Medical Ethics. (with annotations especially applicable to psychiatry)
Section 1 A physician should be dedicated to
providing competent medical care with compassion & respect for human dignity & RIGHTS
Section 3 A physician should RESPECT THE
LAW & also recognize a responsibility to seek changes in those requirements which are contrary to the best interest of the patient
Section 4 A physician shall RESPECT THE
RIGHTS OF THE PATIENTS, colleagues and other health professionals & shall safeguard patient confidence & privacy within the constraints of the law
AMA Principles of Medical Ethics. (with annotations especially applicable to psychiatry)
Section 8 A physician shall, while caring
for a patient, regard responsibility to the patient as paramount
Section 9 A physician shall support
access to medical care for all people
Section 8 & 9 are the two newest sections adopted by the AMA
Eth
ical T
erm
inolo
gy
that
support
s our
Eth
ical T
erm
inolo
gy
that
support
s our
case
case
Autonomy – the rights of individuals to decide on the best course of action for themselves. It upholds the individual values and the rights of the patients
Fidelity – establishes loyalty and is the foundation for a medical doctor/patient relationship
**Court Cases of relevance: US Supreme Court Case
Jaffee Vs. Redmond
Healt
h in
sura
nce
port
abili
ty &
Healt
h in
sura
nce
port
abili
ty &
acc
ounta
bili
ty a
ct o
f 1996
acc
ounta
bili
ty a
ct o
f 1996
(HIP
PA)
(HIP
PA)
It also applies to privacy
It also applies to privacy
& medical records issues
& medical records issues
Gives you the right to
Gives you the right to
view your records at the
view your records at the
doctors office
doctors officeNot only gives you the
Not only gives you the
right but REQUIRES that
right but REQUIRES that
you receive a copy of your
you receive a copy of your
medical records
medical recordsYou have 30 days after
You have 30 days after
requesting a copy of
requesting a copy of
medical records to receive
medical records to receive
it & it may be prolonged a
it & it may be prolonged a
additional 30 days with
additional 30 days with
just causejust cause
Concl
usi
on
Concl
usi
on
So after Claire and Doctor
So after Claire and Doctor
discuss the viewing of her
discuss the viewing of her
medical records and possible
medical records and possible
outcomes (as previously
outcomes (as previously
stated above) Doctor
stated above) Doctor
decides to grant her access.
decides to grant her access.
After the viewing they go on
After the viewing they go on
to establish a great rapport
to establish a great rapport
and doctor and doctor patient/relationship. Doctor
patient/relationship. Doctor
helps Claire to overcome her
helps Claire to overcome her
paranoia and resolves her
paranoia and resolves her
difficult personality traits.
difficult personality traits.
She establishes gainful
She establishes gainful
employment as Doctor’s
employment as Doctor’s
Office Manager, overseeing
Office Manager, overseeing
his staff.his staff.
Work
s C
ited
Work
s C
ited
• American psychiatric association: the
American psychiatric association: the
principles of medical ethics with
principles of medical ethics with
annotations especially applicable to
annotations especially applicable to
psychiatry. Rev.ed.Arlington, VA American
psychiatry. Rev.ed.Arlington, VA American
psychiatric Ass, 2009. 1-41
psychiatric Ass, 2009. 1-41
• http://www.hhs.gov/ocv/hippa
• www:jaffee-redmond.org
www:jaffee-redmond.org
• Dottie Landry, MSN Principles of Ethics
Dottie Landry, MSN Principles of Ethics
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