7 ms·

I 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 kno

I 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 ago
I 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 ago
It 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 ago
  I 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 ago
    I'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 ago
    You 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 ago
      Your profession should not dictate your rights to your data.
      - ambicapter 8y ago
        No 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.
        int_19h 8y ago
        It might well be, but shouldn't it be up to you to decide that? It's your private data.
        freedomben 8y ago
        Agreed. It's your private data and it's also your body! If you end up getting worse treatment due to not sharing data, it's on you. As an adult and the owner of my body, that's my right to decide for myself.
        yomly 8y ago
        Quite surprised to see such strong opinions on this issue - I can obviously sympathise with a desire to privacy but personally hold faith in doctor confidentiality. More pressingly - how can a doctor provide the best care in the absence of records? Imagine trying to ship a bugfix for a complex system where you don't have the source code and the business owner is refusing to give you the documentation but will sue you and ruin your career if you make a mistake. I'd probably refuse to see the patient given how much pressure doctors are under to not make a mistake. What happens if you got a nasty gash and wanted the wound treated and the doctor wanted to issue antibiotics as a precaution but you had a penicillin allergy (which you either forgot to disclose or simply didn't know about but were tested for at some stage in your childhood)
- mikecsh 8y ago
  I agree with this completely; not being able to understand a patient's medical history often makes it much harder to treat them effectively. Especially in an emergency setting. That said concerns about the sensitivity of information are absolutely valid and should be at the forefront of EMR systems. In my experience (UK) access to records is reasonably well restricted to relevant staff. Access is audited in efforts to identify unauthorised access and this is taken extremely seriously; for example opening records for patients not under your direct care with no valid reason. Further, for particularly sensitive information such as some psychiatric histories, or medical photography of sensitive areas, this is kept behind a secure area within the EMR systems, not generally accessible. Opening it requires signing a declaration that you have either discussed it with the patient and gained consent, or that you do not have consent and you are opening it in the patients best interests in an emergent situation as they are unable to consent (e.g. history of depression with paracetamol (acetaminophen) overdose brought in unconscious by ambulance.
- limeblack 8y ago
  I have friends disqualified from legitimate jobs after taking Psych drugs from decades ago. Somehow I think there needs to be a line. Doctors have known the way around the system for quite a while.[0] EDIT: left original link tried to clarify. [0]: "I drive 300 miles to seek care and always pay in cash." http://www.idealmedicalcare.org/75-med-students-antidepressants-stimulants/ http://www.idealmedicalcare.org/75-med-students-antidepressa...
  - biotech 8y ago
    This is a serious issue: doctors have a huge disincentive to receive psychiatric care in the US. It is also completely off-topic.
  - dublin 8y ago
    Anyone who would ever consent to psychiatric care or treatment of any kind (especially pharma) should have their head examined! ;-) Seriously, the risks of seeking such care far outweigh the potential benefits in virtually every circumstance. NEVER forget that your EMR is forever - it will outlive you, and could well become a curse upon all your progeny.
- bobowzki 8y ago
  As an MD, thank you for this comment.
  - Gibbon1 8y ago
    Beware, people with mental illness also suffer from ordinary ailments.
    - bobowzki 8y ago
      Obviously. I'm not a psychiatrist :-)
- Gibbon1 8y ago
  A huge problem for people with a mental health dx in their history is doctors reflexivity dismiss complaints as a 'mental issue'.
- xfitm3 8y ago
  I'm ok with my doctor knowing my complete history, but I do not want my insurance company or any third party to have access to these records.
tivert 8y ago
Not necessarily. Some places segregate psychiatry records from general medical records, and won't send them unless specifically requested.
mulmen 8y ago
Or we could just make medical records private.
standardUser 8y ago
This 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 ago
  Here 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 ago
  This 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 ago
    I 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 ago
      You 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 ago
You 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 ago
    It'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 ago
  The 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 ago
Are 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.

jermaustin1 8y ago

I 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 ago

It 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 ago
I 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 ago
  I'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 ago
  You 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 ago
    Your profession should not dictate your rights to your data.
    - ambicapter 8y ago
      No 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.
      - int_19h 8y ago
        It might well be, but shouldn't it be up to you to decide that? It's your private data.
        freedomben 8y ago
        Agreed. It's your private data and it's also your body! If you end up getting worse treatment due to not sharing data, it's on you. As an adult and the owner of my body, that's my right to decide for myself.
        yomly 8y ago
        Quite surprised to see such strong opinions on this issue - I can obviously sympathise with a desire to privacy but personally hold faith in doctor confidentiality. More pressingly - how can a doctor provide the best care in the absence of records? Imagine trying to ship a bugfix for a complex system where you don't have the source code and the business owner is refusing to give you the documentation but will sue you and ruin your career if you make a mistake. I'd probably refuse to see the patient given how much pressure doctors are under to not make a mistake. What happens if you got a nasty gash and wanted the wound treated and the doctor wanted to issue antibiotics as a precaution but you had a penicillin allergy (which you either forgot to disclose or simply didn't know about but were tested for at some stage in your childhood)
mikecsh 8y ago
I agree with this completely; not being able to understand a patient's medical history often makes it much harder to treat them effectively. Especially in an emergency setting. That said concerns about the sensitivity of information are absolutely valid and should be at the forefront of EMR systems. In my experience (UK) access to records is reasonably well restricted to relevant staff. Access is audited in efforts to identify unauthorised access and this is taken extremely seriously; for example opening records for patients not under your direct care with no valid reason. Further, for particularly sensitive information such as some psychiatric histories, or medical photography of sensitive areas, this is kept behind a secure area within the EMR systems, not generally accessible. Opening it requires signing a declaration that you have either discussed it with the patient and gained consent, or that you do not have consent and you are opening it in the patients best interests in an emergent situation as they are unable to consent (e.g. history of depression with paracetamol (acetaminophen) overdose brought in unconscious by ambulance.
limeblack 8y ago
I have friends disqualified from legitimate jobs after taking Psych drugs from decades ago. Somehow I think there needs to be a line. Doctors have known the way around the system for quite a while.[0] EDIT: left original link tried to clarify. [0]: "I drive 300 miles to seek care and always pay in cash." http://www.idealmedicalcare.org/75-med-students-antidepressants-stimulants/ http://www.idealmedicalcare.org/75-med-students-antidepressa...
- biotech 8y ago
  This is a serious issue: doctors have a huge disincentive to receive psychiatric care in the US. It is also completely off-topic.
- dublin 8y ago
  Anyone who would ever consent to psychiatric care or treatment of any kind (especially pharma) should have their head examined! ;-) Seriously, the risks of seeking such care far outweigh the potential benefits in virtually every circumstance. NEVER forget that your EMR is forever - it will outlive you, and could well become a curse upon all your progeny.
bobowzki 8y ago
As an MD, thank you for this comment.
- Gibbon1 8y ago
  Beware, people with mental illness also suffer from ordinary ailments.
  - bobowzki 8y ago
    Obviously. I'm not a psychiatrist :-)
Gibbon1 8y ago
A huge problem for people with a mental health dx in their history is doctors reflexivity dismiss complaints as a 'mental issue'.
xfitm3 8y ago
I'm ok with my doctor knowing my complete history, but I do not want my insurance company or any third party to have access to these records.

tivert 8y ago

Not necessarily. Some places segregate psychiatry records from general medical records, and won't send them unless specifically requested.

mulmen 8y ago

Or we could just make medical records private.

standardUser 8y ago

This 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 ago
Here 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 ago
This 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 ago
  I 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 ago
    You 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 ago

You 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 ago
  It'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 ago
The 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 ago

Are 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.