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In (the UK at least) your medical notes follow you as you sign on with a new GP (General Practitioner - first point of medical contact for anything non-urgent).
by goldcd 8y ago
In (the UK at least) your medical notes follow you as you sign on with a new GP (General Practitioner - first point of medical contact for anything non-urgent).
Now knew this theoretically happened, but was quite bemused to see it happen in practice.
I rescued a rat from the silken-jaws of my pseudo-homicidal cat, and the ungrateful rodent bit through half of my finger - I thought it would be sensible to have a checkup/shot.
I've only got a hazy recollection of what shots I've had when, so my notes were consulted.
Seemingly, according to my paper notes produced from the cabinet, 40 years ago "I was an adorable wee thing" (aged 2).
- jermaustin1 8y agoThat's amazing. I guess, in the US, we only started tracking patients recently. I had to call and have my old records faxed from my old GP in Texas to one in New Jersey, and then again from that GP to my NEWER one in New York. Earliest record was from when I was 7, since neither my mother or I remember who my pediatrician was before then.
- limeblack 8y agoI disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even if you are in your 40s Psych drugs at 13 are a disqualifier. "Paying cash" is what some doctors have resorted to. http://www.idealmedicalcare.org/75-med-students-antidepressants-stimulants/ http://www.idealmedicalcare.org/75-med-students-antidepressa...
- jermaustin1 8y agoI could be wrong, that's why I said I guess. It was just based on my personal experience in switching doctors a couple times when I moved away from my home town.
- sxg 8y agoIt absolutely 100% is at least the doctor’s job to know this. If you come back with depression again, the doctor needs to know what medications were used last time to treat you this time. They need to know if you had allergic reactions, no response, or other details regarding your medication history. The doctor may also be able to use a history of depression as a supporting factor for a new diagnosis. Your history of depression may be the thing that tips your doctor toward getting an MRI of the brain to rule out a brain tumor, for example.
- katbyte 8y agoI dissagree. If I have some sensitive medical history and I go in for stitches or some other minor thing with an random doctor I might not want to share all my medical history. It’s my history and I should have the right to control who sees it.
- davidw 8y agoI'd rather opt out of a few sensitive things than not have an ER doctor in another state not have easy access to critical information about me.
- ambicapter 8y agoYou are not a medical professional and the list of medical procedures or remedies that interact poorly with each other is long and full of unexpected things.
- drb91 8y agoYour profession should not dictate your rights to your data.
- ambicapter 8y agoNo one is stopping you from accessing your data. The question is to whether you should be able to stop your doctor (or your emergency doctor) from accessing your medical data. Sounds like a bad idea.
- tivert 8y agoNot necessarily. Some places segregate psychiatry records from general medical records, and won't send them unless specifically requested.
- mulmen 8y agoOr we could just make medical records private.
- standardUser 8y agoThis is a very important point. Individuals should be able to censor aspects of their own medical records. It's not just mental illness. Getting regularly tested for STDs/AIDS or having evidence that could be interpreted as a pre-existing condition are other aspects of a person's medical history that can cause problems with potential employers or insurers.
- camtarn 8y agoHere in the UK, I believe that sexual health clinics keep a separate clinic-local file on you, which is never linked to your main file unless you consent. Any correspondence or samples that go out of the clinic are labelled only with your clinic ID, not your name.
- mrestko 8y agoThis goes back to the central thesis of the article: that interference from non-physicians (i.e. insurers, billers) are destroying the usefulness of notes. Physicians are bound by both a professional duty and oath as well as legal liability to keep your medical information in the strictest of confidence. But it is nearly impossible to know in advance when a particular piece of medical information will become important for the treatment of a patient. Hiding it because of concerns about insurance or employment is not a solution--it's an indication that insurance and employment have undue influence on or access to a professional record.
- thomasfedb 8y agoI think this comment really hits it on the head. Your medical record is meant to be a confidential record read only by those who are sworn to care for and protect you, and by nobody else for no other purpose. As a student doctor it's alarming to think that people do not feel they can trust their doctor with their medical history. I wonder if this is particularly a problem with the US healthcare system.
- rlucas 8y agoYou and all your colleagues should be aware of the Medical Information Bureau and IMS health. Despite all of the kabuki theater about HIPAA and black covers on clipboards and whatnot, every single medical fact that is even considered for payment by an insurance company gets hoovered up into various industry databases and shared with any insurer who bothers to ask.
- vonseel 8y agoYou were downvoted for this, and I agree that it’s a controversial stance, but there is a genuine point to be made here. It’s not uncommon for teenagers to be misdiagnosed with mental illness or ADHD and either of those are disqualifiers for FAA medical certification, military pilot careers, and likely many other military, law enforcement, and intelligence careers. IIRC, a prolonged history of ADHD treatment is enough to disqualify military entrance for any MOS without waiver. Waivering prior ADHD diagnosis requires a costly and difficult process to undiagnose the patient and prove that he or she no longer has the condition and was incorrectly diagnosed in the first place, at least if you are trying to get FAA certified for a Class 1.
- mcny 8y ago> It’s not uncommon for teenagers to be misdiagnosed with mental illness or ADHD and either of those are disqualifiers for FAA medical certification, military pilot careers, and likely many other military, law enforcement, and intelligence careers. IIRC, a prolonged history of ADHD treatment is enough to disqualify military entrance for any MOS without waiver. Waivering prior ADHD diagnosis requires a costly and difficult process to undiagnose the patient and prove that he or she no longer has the condition and was incorrectly diagnosed in the first place, at least if you are trying to get FAA certified for a Class 1. How do you feel about the (I presume underlying notion, at least when it comes to programming jobs) that a "bad" hire is costly and we'd rather let ten potentially great candidates go rather than accidentally hire one very bad candidate?
- maxerickson 8y agoIt's rooted in an absurd confidence in the interview process actually successfully evaluating candidates. In practice, I bet places that emphasize that attitude tend to hire people that the interviewers like socially.
- saulrh 8y agoThe relative risk of driving while having ADD/ADHD (accidents/km with / accidents/km without) is around 1.54 [1]. This isn't horrible, of course, but it's still bad. Non-disqualifying visual impairments have a relative risk down around 1.2, implying a surprisingly low cutoff for a visual impairment being disqualifying. "Severe behavioral problems due to ageing (dementia)" have a RR 1.45. A category covering epilepsy, narcolepsy, and other conditions causing sudden interruptions/disturbances in consciousness is at 1.84, and those conditions require medical sign-off in every country I checked. Diagnosed alcoholism amortizes to around 2, and that'll get you a breathalyzer or suspended license right quick. The cutoff for being ticketed is is observed to lie around a relative risk of 4, which is where cell phones come in. The cutoff for being arrested on the spot, being legally drunk, is a relative risk well above 10 and probably up around 40. Interestingly, almost nothing is as bad as being a teenage male, which carries a relative risk around 7. Teenage females are around 5.5. That all said... while we can certainly complain about rampant misdiagnosis - I wish I had a dollar for every time someone told me that I'm just addicted to stimulants - my opinion is that this particular rationale for disqualification is absolutely justified. There's a reason I don't drive. [1] https://www.toi.no/getfile.php/Publikasjoner/T%C3%98I%20rapporter/2003/690-2003/690-2003-el.pdf https://www.toi.no/getfile.php/Publikasjoner/T%C3%98I%20rapp...
- yomly 8y agoAre you a doctor? (I would guess not) I am surrounded by doctor family members and friends (and nearly trained as a doctor) - diagnosis comes from incredibly vague datapoints and so context (and additional data points) are so valuable. Patients are also often unreliable narrators. Having everything on record (but properly protected) is tantamount to being able to give the best care you can.
- ars 8y agoThe US is trying to do this as well. The very famous HIPAA is actually about that, and not as much about the privacy provisions that made it famous. Implementation of this goal though ..... not as successful. Mostly because those who make the electronic record systems don't understand the field well. See: https://news.ycombinator.com/item?id=18781264 https://news.ycombinator.com/item?id=18781264
- dublin 8y agoGo read the requirements - HIPAA is really 90+% about disclosure and reporting of events that compromised private patient information. There is virtually nothing in HIPAA that is aimed at preventing privacy breaches in the first place. Once a breach is disclosed, the penalties in HIPAA pretty much vanish.
- davvolun 8y agoI was told your permanent record wasn't a real thing!!
- pjc50 8y agoThat's the theory, although between the "NHS Spine", Serco, and a move between England and Scotland's separate systems a big chunk of mine have gone missing.
- IshKebab 8y agoYeah in theory they do but in practice if you move around a lot (like pretty much everyone does these days) they get lost. It's just surgeries posting paper notes to other surgeries. Very archaic and unreliable. They did try to digitise everything several years ago but somehow managed to waste £13bn and produced nothing. Completely incompetent. Record keeping is one area of the NHS that is a total embarrassment.
- timthorn 8y ago> managed to waste £13bn and produced nothing. Not true. A massive amount was wasted, but useful services were delivered as part of that £13bn, such as N3, PACS and the Spine.
- lostlogin 8y agoFunny-Looking-Kid (FLK) and other such diagnostic gems are present in notes of that vintage.
- thomasfedb 8y agoFLK isn't a diagnosis, but it is a useful clinical impression that might lead to one, even now.
- lostlogin 8y agoIt probably shouldn’t be written like that in notes though.
- dublin 8y agoFrequently, those are code words - for instance, at one hospital system I worked with, "quiet lady" might be used to describe a really slow, stupid woman, since they couldn't put "evidence of low intelligence, mental retardation, or mental instability" in the medical record for fear of legal repercussions...
- giobox 8y agoI'm not entirely convinced the UK/NHS should ever be used as a good example for handling medical notes, at least by today's standards. As a Brit who left the UK a while ago, I recently had cause to request my "medical records" from my former GP. Of course such data can presumably be requested via the UK's Data Protection Act, but the lack of any kind of standard process or checks really shocked me, given the care they are treated with in places such as the US via specific legislation such as HIPPA and so forth. My GP posted my entire history after one phone call to their receptionist via Skype, did no checks what so ever on my identity beyond confirming my name and DoB to look me up, I was left close to speechless following the call. I can't profess to be an expert on the topic of rights to medical data in the UK, but the above was true of my own experience and others I know, I've heard similar stories from a handful of GP friends and family. There is literally nothing stopping someone pulling your name and DoB from a Facebook account or similar and doing the same in many cases. The number of GPs without electronic record keeping of any kind in the UK frankly amazes me as well, supposedly the NHS will be paperless by 2020...
- ddingus 8y agoGiven the spotty, lost, inconsistent, difficult to access, difficult to share state of medical records in the US, getting a full set, easy peasy, seems like a wonderful problem to have.
- freedomben 8y agoTotally unsubstantive, but an interesting anecdotal psychological phenomenon occurred while reading your comment. Before I got to this line: > As a Brit I read your comment with no accent, but after I read that line my brain switched your "voice" to a British accented one :-)
- Spooky23 8y agoDon’t worry, US medical practices will give you a big show about doing anything in the name of HIPPA. Rest assured, it is a show, and most of your information is fed in real time to a half dozen different entities whom you have never heard of. The people who sell prescription data provide it to the pharma company before your insurer even gets the claim.
- microcolonel 8y agoI had a surgery a little over a year ago (in Toronto), and before that surgery they were reviewing the just the details from the stay. It was full of stuff that literally never happened, and incorrectly recorded numbers. I was pretty amazed at quite how incorrect it was.