Ethics (4)


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Ethics (4)

  1. 1. By: Kassie Avant & Kacie Soudelier The Right to Access Medical Records
  2. 2. The Right to access of medical records <ul><li>A psychiatric patient’s right to see her medical record. </li></ul><ul><li>Claire is a 38 year old, never married, woman who worked as a secretary off and on over the past ten years. She had difficulty keeping jobs due to disputes with fellow workers often accusing them of not carrying their work load, criticizing her work, and in one case reporting a fellow worker to the supervisor for coming to work late. </li></ul><ul><li>Out of work, she is seeing a psychiatrist at the mental health clinic of the HMO of her previous employer. She pays out of pocket in order to keep the HMO coverage. </li></ul><ul><li>After four appointments with Claire, doctor 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. </li></ul><ul><li>At the end of visit four, Claire, is convinced doctor 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 doctor 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. </li></ul><ul><li>When doctor 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 doctor? </li></ul>
  3. 3. Defend the patient’s right to see the medical record. Stakeholder 1: Claire Whom wishes to view and be fully informed of her own personal medical records
  4. 4. Defend the patient’s right to see the medical record . Stakeholder 2: Doctor Whom has Claire’s best interest in mind & does not want to be reported to HMO management
  5. 5. 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.
  6. 6. Claire <ul><li>Claire is able to review her records: </li></ul><ul><ul><li>Establishes trust between her and Doctor </li></ul></ul><ul><ul><li>Shows Claire that was is charted is truth & not the personal opinion of Doctor but medical opinion </li></ul></ul><ul><ul><li>After review of her medical records it will help to ease her paranoia </li></ul></ul><ul><ul><li>Once she comes face to face with her actual issues & difficult personality traits she will be able to begin resolving them through therapy </li></ul></ul><ul><ul><li>After working through her problems in therapy Claire will be better prepared to find a dependable job. </li></ul></ul>
  7. 7. Claire <ul><li>Claire does not get to review her medical records. </li></ul><ul><ul><li>Will feed her paranoia that she has unknown damaging psychiatric disorders </li></ul></ul><ul><ul><li>Her unpleasant personality traits will worsen making it more difficult to establish a steady job </li></ul></ul><ul><ul><li>Claire will have to find another psychiatric doctor and start treatment all over again </li></ul></ul><ul><ul><li>Due to her continued unemployment Claire’s house & vehicle become repossessed leaving her homeless & without transportation </li></ul></ul><ul><ul><li>She is therefore forced to walk to the public library to go to to leave negative feedback about Doctor, causing him potential patients </li></ul></ul><ul><ul><li>Ultimately Claire’s continued unemployment forces her to look for money in other directions such as drugs & prostitution </li></ul></ul>
  8. 8. Doctor <ul><li>Doctor allows Claire to view her Medical records </li></ul><ul><ul><li>Trust becomes established between doctor and patient </li></ul></ul><ul><ul><li>Doctor can & will begin to work with Claire to resolve her paranoia & unpleasant and difficult personality </li></ul></ul><ul><ul><li>Doctor upholds the medical code of ethics by recognizing his patient’s rights </li></ul></ul><ul><ul><li>Claire recommends friends and future coworkers to Doctor for their needs </li></ul></ul><ul><ul><li>Doctor is not reported to HMO management & remains on their referral list </li></ul></ul>
  9. 9. Doctor <ul><li>Doctor refuses Claire to view her medical records </li></ul><ul><ul><li>Doctor loses a patient that he could have helped live a better, more successful life </li></ul></ul><ul><ul><li>Claire reports Doctor to HMO management </li></ul></ul><ul><ul><li>HMO management removes Doctor from their referral list </li></ul></ul><ul><ul><li>Doctor is put under review for fraud & insurance abuse </li></ul></ul><ul><ul><li>Claire notifies local TV news programs & a special is done on doctors that refuse to respect patient’s rights </li></ul></ul><ul><ul><li>Doctor loses his medical license </li></ul></ul>
  10. 10. AMA Principles of Medical Ethics. (with annotations especially applicable to psychiatry) <ul><li>Section 1 </li></ul><ul><ul><li>A physician should be dedicated to providing competent medical care with compassion & respect for human dignity & RIGHTS </li></ul></ul><ul><li>Section 3 </li></ul><ul><ul><li>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 </li></ul></ul><ul><li>Section 4 </li></ul><ul><ul><li>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 </li></ul></ul>
  11. 11. AMA Principles of Medical Ethics. (with annotations especially applicable to psychiatry) <ul><li>Section 8 </li></ul><ul><ul><li>A physician shall, while caring for a patient, regard responsibility to the patient as paramount </li></ul></ul><ul><li>Section 9 </li></ul><ul><ul><li>A physician shall support access to medical care for all people </li></ul></ul>Section 8 & 9 are the two newest sections adopted by the AMA
  12. 12. Ethical Terminology that supports our case <ul><li>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 </li></ul><ul><li>Fidelity – establishes loyalty and is the foundation for a medical doctor/patient relationship </li></ul>**Court Cases of relevance: US Supreme Court Case Jaffee Vs. Redmond
  13. 13. Health insurance portability & accountability act of 1996 (HIPPA) <ul><li>It also applies to privacy & medical records issues </li></ul><ul><li>Gives you the right to view your records at the doctors office </li></ul><ul><li>Not only gives you the right but REQUIRES that you receive a copy of your medical records </li></ul><ul><li>You have 30 days after requesting a copy of medical records to receive it & it may be prolonged a additional 30 days with just cause </li></ul>
  14. 14. Conclusion <ul><li>So after Claire and Doctor discuss the viewing of her medical records and possible outcomes (as previously stated above) Doctor decides to grant her access. After the viewing they go on to establish a great rapport and doctor patient/relationship. Doctor helps Claire to overcome her paranoia and resolves her difficult personality traits. She establishes gainful employment as Doctor’s Office Manager, overseeing his staff. </li></ul>
  15. 15. Works Cited <ul><li>American psychiatric association: the principles of medical ethics with annotations especially applicable to psychiatry. Rev.ed.Arlington, VA American psychiatric Ass, 2009. 1-41 </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li>Dottie Landry, MSN Principles of Ethics handouts </li></ul>