1. To Show or Not to Show—That is the Question or should it be…… The Patient’s Right to access Medical Records Or is it? Presented by: Kayla Poret, RN, WCC
2. Meet Claire Claire is a 38 year old woman who has never married. She has worked as a secretary off and on over the past ten years. She has difficulty keeping jobs due to disputes with fellow workers. She often accuses them of not carrying their work load, criticizes their work, and in one case she reported a fellow worker to the supervisor for coming to work late. Out of work, she is seeing a psychiatrist at the mental health clinic using the HMO of her previous employer. She pays out of pocket in order to keep the HMO coverage.
3. After four appointments with Claire, Dr. E identified patterns of paranoid thinking and determined her to be an unpleasant and difficult patient. She was not psychotic, nor did she have major psychiatric disorders. But she did exhibit personality traits that are causing her problems. Meet the Man with the answers,Dr. EvalUator
4. And the visits continue…. At the end of visit four, Claire is convinced Dr. E does not like her. She thinks he is implying that her employment problems are her own fault and that she needs further therapy to address these issues. She suspects that Dr. E is keeping notes on her that reflect 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 opinion in her chart. She asks to see her medical record.
5. OMG, what if I let her see what I wrote in this chart….. When Dr. E hesitates, she states she will report him to the management of the HMO. The law is currently in flux regarding rights of patients to see their medical records. Moral uncertainty exists. In particular, many physicians, especially psychiatrists, are concerned that granting patients the right to see their records may harm patients as well as violate the privacy rights of the provider. Regardless of the legal wrangling, what is an ethically appropriate decision by Dr. E?
6. And the dilemma shows its ugly face Should Dr. E show Claire her medical record or not? She may not like what she will see…
7. Come on People: Of course he should allow her access Claire has a Right!
10. Both solutions offer positive and negative consequences.. That is what makes it an ethical dilemma.. Allowing Claire to see her record Positive—Claire’s trust may increase with Dr. E., She has a right to see it. Her autonomy will be enhanced due to her being involved in her treatment and POC. Negative—Claire’s feelings may be hurt, Dr. E’s evals of Claire will be revealed (he did think she was a difficult patient). Not allowing Claire to see her record Positive—it will save Claire the potential for reading psych notes that may confuse her and increase her paranoia. Dr. E’s privacy will be protected. Negative—Claire’s rights will not be honored. A legal issue may arise in Dr. E’s future. Claire’s paranoia may increase. What is Right for the Patient What is Right for the Doctor
11. Now, as a HCP, what is Dr E’s Responsibility to Claire?
13. Autonomy: the freedom to make decisions for oneself Which one? Claire’s decision proceeds all others! --Nurses and doctors have to support the patients method of decision making --A Second opinion may be the case of needing her medical records --Control is needed in this situation by Claire, and retrieving her medical records is something that she has control over.
14. Beneficence: demands that good be done for the benefit of others What will benefit Claire? Seeing her records will benefit her. It is apparently a need in her life at this time in order to feel involved in her care. She initiated the request. Yes, she is paranoid, but she is still a human with rights and this will benefit her by heightening her right to Self Determination (Provision 1:2 of the ANA Code of ethics). It is our duty as a HCP to support her decision making, unless it causes her physical or emotional harm. As nurses, our primary commitment is the patient (Provision 2 of the ANA Code of Ethics). At this point, she feels helpless and needs to participate in her own care. She is not gaining benefit from the previous Plan Of Care.
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16. According to the Journal of the Royal Society of Medicine, September 1988 (Article 81: 520-522) a study showed, One paranoid patient described feeling angry when he had read nursing comments on his reaction to a relative’s visit, but found that reading the comments enabled him to discuss the situation more openly with his key worker.
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19. His priority should be Claire’s wishes over any internal feelings he may have.
20. The HIPPA form filled out in his office was an agreement that Claire could have her medical records.
21. Claire may have the need to get a second opinion and it is Dr. E is accountable to release it to her per her request.
22. Dr. E is considering putting his practice in a legal battle if he refuses to be accountable for releasing what is rightfully Claire's
23. Dr. E. has to honor Claire’s right to informed consent
27. Dr. E. makes the decision to allow Claire access to her medical records and offers to discuss them with her…… He chooses to honor the Ethical Principles on which he practices and grants Claire’s wishes to obtain a copy of her medical records. And, he also makes $0.47 a sheet on the medical record copied for Claire.
