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

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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

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Defe

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the m

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the m

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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

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that

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Eth

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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

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port

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ty &

Healt

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port

abili

ty &

acc

ounta

bili

ty a

ct o

f 1996

acc

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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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