Should patients be allowed easy online access to the notes that their physicians write about them?
Absolutely.
Legally we all have the right to obtain or view copies of our own medical records. However, even with the promulgation of the electronic medical record (EMR), patients in most health systems still do not have online access to the clinical notes that their doctors write about them.
Today an article in the Wall Street Journal discussed a study that is currently underway called the OpenNotes project. The one-year study will evaluate what happens when 25,000 patients have access to their own health records. Their primary care physicians will also be participants.
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While correctional health care workers may be sued for malpractice, the most common type of lawsuit filed by inmates about health care in the U.S. involves allegations of “deliberate indifference.”
According to US Legal, Inc., “deliberate indifference” is “the conscious or reckless disregard of the consequences of one’s acts or omissions.” To be found guilty of deliberate indifference, prison employees must know that they are creating a substantial risk of bodily harm. So, knowingly ignoring an inmate’s serious medical complaint would be one possible example of this concept. Deliberate indifference violates the inmate’s Eighth Amendment right that prohibits cruel or unusual punishment.
What can you do both to minimize your risk of having lawsuits or other complaints filed against you, and increase the odds that any frivolous complaints that do get filed are dismissed as expediently as possible? Here are a few ideas. This list is by no means comprehensive.
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Doctors, nurses, and other health care professionals often find themselves in situations where they must speak up for their patients. Typically such patients either do not realize what they need, do not know how to ask for what they need, or they lack the authority to obtain what they need.
The circumstances and challenges of advocating for patients vary significantly depending on the practice setting. I’ve previously written about how practicing in correctional settings presents unique challenges. Essentially the main challenge in any jail or prison, regardless of how “treatment-friendly” it may be, is that a correctional facility exists for the primary mission of security, not treatment.
So, if you’re a health care professional in corrections and you have a patient who needs your voice, how can you go about being an effective advocate?
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PATIENT:
adjective: bearing pains or trials calmly or without complaint
noun: an individual awaiting or under medical care and treatment
from Merriam-Webster Online
Photo by frances 1972
But, like it or not, the world is filled with situations where we commonly have to do so. Sometimes the waits are excusable and even predictable, and other times they are not. At most doctors’ offices, one can expect to wait to varying degrees beyond their scheduled appointment time. It’s predictable. But is it excusable?
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Great doctors listen to their patients. They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact with their patients and do not bury their heads in charts and computer screens. Their patients leave their appointments feeling respected and heard.
Of course no doctor is likely to be able to do all of these things all of the time, but some come closer to this ideal more consistently than others.
But great doctors additionally have a “sixth sense.” They can “read between the lines.”
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Saying or hearing “no” in any circumstances involves setting a limit with others or having them set a limit with you. It invariably involves some degree of confrontation. Although learning to say no can be liberating, most people would prefer not to be put in situations where setting limits is necessary.
One of my least favorite but necessary tasks as a physician is saying no to patients.
In the ideal world, doctors wouldn’t have to deny patient requests. Patients would read information only from reliable web sites. Direct-to-consumer marketing of pharmaceuticals would not exist. Patients with addiction histories wouldn’t ask for potentially habit-forming pain and anxiety medications. Doctors would always listen carefully to patients. Doctors would arrive at carefully thought-out formulations of their patients’ problems and then would explain all reasonable treatment options thoroughly. Ultimately patients would then make informed, logical decisions about their health care. Everyone would be happy!
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I’ve previously written about the many challenges of practicing medicine in correctional settings. But if there are so many cons (pun intended), why should anyone consider such a career?
Well, there are many benefits to it as well. If you are a psychiatrist or primary care physician and are either looking for a change or just starting your career, you may want to consider correctional medicine.
Although I’ve done correctional work for quite a few years, my experience has been limited to one geographical area of the country. I contacted correctional healthcare recruiter, Vikkie Schill, from MHM Services, Inc., to help me to convey accurate information about this topic. I want to take this opportunity to thank her for her input. I have no relationship either with Ms. Schill or with MHM Services, Inc.
Here are my top 5 reasons to consider a career in correctional medicine:
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It’s probably happened to all health care professionals at some point: Patients, especially those considered “difficult” for some reason, fail to improve despite our best efforts. Eventually we become frustrated enough that we then blame them for their lack of progress.
There are endless possible scenarios where this might occur:
- A depressed patient, who transiently appears to have a personality disorder because of her inadequately treated depression, is not progressing in psychotherapy and has not responded to two different medication trials.
- An elderly man bounces back for readmission to the hospital for a CHF exacerbation. He arrives in the ER with a pack of cigarettes in his shirt pocket.
- A morbidly obese woman continues to have poor control of serum glucose, blood pressure, and lipids despite aggressive pharmacotherapy. Yet the patient has lost no weight despite being counseled for years about the need to do so.
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Fortunately most patients are honest. They mean what they say, and they realize that ultimately it is in their own best interests to be truthful about their health issues. However, it is a stark reality that many patients lie to health care professionals.
According to a WebMD survey about patients lying to doctors, out of nearly 1,500 respondents, 45% admitted they had either lied (13%) or “stretched the truth” (32%).
It is likely that an even larger percentage of jail and prison inmates lie to health care providers.
Patients are untruthful for different reasons.
People everywhere typically want
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Physicians learn a lot about many different topics, both in medical training and in practice. However, there are some life lessons that we never learn as well as when we become patients ourselves.
When I was 13 or 14 years old, I regularly interacted with 2 different physicians with disparate interpersonal styles. Little did I know then that these seemingly meaningless encounters would indelibly shape my own beliefs about how people should treat each other. Ironically, many years later the experiences would help guide me as a physician in my interactions with my own patients.
For a couple of years I was the regular patient of a dermatology clinic. Two dermatologists ran the practice together, and in order for me to get an appointment that worked with my family’s schedule, occasionally I would need to alternate seeing each of them. I’ll refer to one of them as “Dr. A” and the other as “Dr. F.”
I was somewhat shy as an adolescent, and sitting in an exam room wearing only a gown and underwear always made me a little anxious.
However, any unease I may have experienced evaporated when
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