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People are bad at managing themselves, especially when they are ill. It is a bad idea to expose patients to their health records. It will get lost, they will ch

by jbob2000 9y ago

People are bad at managing themselves, especially when they are ill. It is a bad idea to expose patients to their health records. It will get lost, they will change things, they will fight with their doctor over what is put in the record, they'll want things clarified they don't understand putting undue burden on overworked doctors. Health records need to be impartial and unbiased so future medical care can be given with the best possible information.

moonka 9y ago
>they'll want things clarified they don't understand putting undue burden on overworked doctors. People should be able to have things they don't understand about their body clarified. There's fewer things scarier than not understanding why your body isn't reacting the way you'd expect.
macintux 9y ago
People can't be trusted to write their own records, but they can't not be allowed to see them. The consequences of that access have to be managed, for better or for worse.
jmull 9y ago
Patients just get a read-only copy of their records. Also, providers don't use the patient as an intermediary when updating and exchanging medical records. That addresses most of your concerns. - "they'll want things clarified they don't understand" This is, by far and overwhelmingly, the reason it is a good idea to expose patients (and their defacto caregivers, AKA, their families) to their medical records. When it comes to preventative medicine and chronic conditions people have far more control over their health than the doctor does and the better they understand their health, the better they are able to do something positive about it.
- macintux 9y ago
  I'm reminded of a sad story about a kid, probably 10ish, who overdosed on prescription meds designed to help him not sleep so deeply (he had problems with bedwetting because his bladder wasn't noisy enough to wake him). Failing to understand the purpose of the pills, he decided that if he just took all of them, his problem would go away. Granted, adults (usually) have better judgment than a 10-year-old about things like that, but nonetheless patients almost inevitably are able to make better decisions when they understand why they're being asked to do things.
- jbob2000 9y ago
  The things that are in your medical record are technical and won't help you at all. "Patient's CD4+-T-Cell count reduce from 5^9/L to 5^6/L, advised increase Prolenaslezapam from 50mg to 75mg" (I'm making this up). Your doctor won't tell you this, instead they'll say "Your HIV is progressing and we're upping your dosage". There's no benefit to reading the technical note, you'll just ask for the clarification... which the doctor already gave you. Or you're going to waste his time having him explain undergrad biology to you. Think of it like this: Would you want your customers reading the comments you leave in your code? Probably not! They'll waste your time asking you about the comment you left saying "this could cause an error and bring the servers down". Or they completely misunderstand something and cancel the service. Or they'll complain that you left a swear word in. Etc. etc.
robbiemitchell 9y ago
> Health records need to be impartial and unbiased Sorry, but they're already neither. Medical records are also the same mechanism used to determine reimbursements, meaning the codes in them that represent diagnoses and treatments are subject to multiple incentive structures.
- criley2 9y ago
  Care plans and diagnosis codes are very different things. Just because a coder massages the specific codes in use doesn't mean the clinicians are altering care. Honestly, there's a lot of new incentive structures on care givers and their institutions focused on so many things, like reducing readmissions (thereby reducing all forms of medical error in the process), or forming provider cohorts and using comprehensive comparison metrics between similar hospitals in similar areas and situations, to incentivize and reward those facilities which achieve the best care. And, on the subject of the MR/EHR itself, of course most of it is unbiased! Do you think your lab results, prescriptions, vital signs, demographics are subject to bias? Your medical record isn't where a doctor leaves a long note about their opinion of you. It's where all that stuff above, and allergies, and outpatient care history, and inpatient history, and all kinds of factual unbiased things go.
EamonnMR 9y ago
Let's solve the issue of healthcare providers not playing nice with each other (will only communicate via fax, etc) before we worry about the very rare case of mentally ill patients falsifying records and such (which does happen, but not nearly on the scale of healthcare companies simply being difficult to wrangle.)

moonka 9y ago

>they'll want things clarified they don't understand putting undue burden on overworked doctors. People should be able to have things they don't understand about their body clarified. There's fewer things scarier than not understanding why your body isn't reacting the way you'd expect.

macintux 9y ago

People can't be trusted to write their own records, but they can't not be allowed to see them. The consequences of that access have to be managed, for better or for worse.

jmull 9y ago

Patients just get a read-only copy of their records. Also, providers don't use the patient as an intermediary when updating and exchanging medical records. That addresses most of your concerns. - "they'll want things clarified they don't understand" This is, by far and overwhelmingly, the reason it is a good idea to expose patients (and their defacto caregivers, AKA, their families) to their medical records. When it comes to preventative medicine and chronic conditions people have far more control over their health than the doctor does and the better they understand their health, the better they are able to do something positive about it.

macintux 9y ago
I'm reminded of a sad story about a kid, probably 10ish, who overdosed on prescription meds designed to help him not sleep so deeply (he had problems with bedwetting because his bladder wasn't noisy enough to wake him). Failing to understand the purpose of the pills, he decided that if he just took all of them, his problem would go away. Granted, adults (usually) have better judgment than a 10-year-old about things like that, but nonetheless patients almost inevitably are able to make better decisions when they understand why they're being asked to do things.
jbob2000 9y ago
The things that are in your medical record are technical and won't help you at all. "Patient's CD4+-T-Cell count reduce from 5^9/L to 5^6/L, advised increase Prolenaslezapam from 50mg to 75mg" (I'm making this up). Your doctor won't tell you this, instead they'll say "Your HIV is progressing and we're upping your dosage". There's no benefit to reading the technical note, you'll just ask for the clarification... which the doctor already gave you. Or you're going to waste his time having him explain undergrad biology to you. Think of it like this: Would you want your customers reading the comments you leave in your code? Probably not! They'll waste your time asking you about the comment you left saying "this could cause an error and bring the servers down". Or they completely misunderstand something and cancel the service. Or they'll complain that you left a swear word in. Etc. etc.

robbiemitchell 9y ago

> Health records need to be impartial and unbiased Sorry, but they're already neither. Medical records are also the same mechanism used to determine reimbursements, meaning the codes in them that represent diagnoses and treatments are subject to multiple incentive structures.

criley2 9y ago
Care plans and diagnosis codes are very different things. Just because a coder massages the specific codes in use doesn't mean the clinicians are altering care. Honestly, there's a lot of new incentive structures on care givers and their institutions focused on so many things, like reducing readmissions (thereby reducing all forms of medical error in the process), or forming provider cohorts and using comprehensive comparison metrics between similar hospitals in similar areas and situations, to incentivize and reward those facilities which achieve the best care. And, on the subject of the MR/EHR itself, of course most of it is unbiased! Do you think your lab results, prescriptions, vital signs, demographics are subject to bias? Your medical record isn't where a doctor leaves a long note about their opinion of you. It's where all that stuff above, and allergies, and outpatient care history, and inpatient history, and all kinds of factual unbiased things go.

EamonnMR 9y ago

Let's solve the issue of healthcare providers not playing nice with each other (will only communicate via fax, etc) before we worry about the very rare case of mentally ill patients falsifying records and such (which does happen, but not nearly on the scale of healthcare companies simply being difficult to wrangle.)