Way to Improve System
Daily Observer
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
“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
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.