Mary Shomon: Is there any reason why a patient who asks for his or her medical records shouldn't receive those records? Is there an effective way to overcome a doctor's effort to "stonewall" a request for records?
Dr. Savard: There is no valid excuse not to give someone their medical records. Ethically and legally they are entitled to copies of all their information. President Bush approved privacy rules that clearly state that patients are entitled to copies of their records. As doctors rely on medical records to make the most accurate diagnosis, and records are rarely complete or available when needed most, it is just a matter of good sense.
However, many doctors and their office staff don't even realize that people are entitled to copies of their records. The most common response from a doctor's office will be, "I can't give them to you. I would be happy to forward them to another physician." So I recommend that patients first remind the doctor's staff of their rights. Come prepared with a letter signed by you that requests a copy of all your information including consultations with doctors, hospital discharge summaries and operative reports and your laboratory tests including x-ray reports. Give them a self-addressed stamped envelope (a big brown one if you have a lot of records) and offer to pay a small fee such as $15.00 to copy them. Give them two weeks or a reasonable period of time. Then, don't give up. Occasionally I have heard people getting tough and suggesting they will notify their lawyer if the don't get their records. Try honey over vinegar, but the bottom line is this: you really do need to keep a complete set of your own records. They could save your life.
The second most common reason doctor's give: "You won't understand them anyway." I would just smile and let your doctor's office know that not only is it your right, it is a matter of your good health to have your own copy to show future doctors, specialists, or to take to emergency room visits. Of course you WILL learn to understand your records; they are about you.
Mary Shomon: Patients may have the right to have their old records, but should they be asking for them? And what should patients do with those old records?
Dr. Marie Savard: Old records can be incredibly helpful for some people, especially if you had a lot of tests or procedures or a complicated medical history. But the bad news is that records can be legally destroyed after 7 years -- in some states, 5 years -- and old records simply may not be available. You may also overwhelm your doctor by asking for all of them at once. I suggest starting with the current doctor and ask for copies of all test results, doctor consultations, and hospital summaries. If it is too much for them to copy at once, perhaps just start with your next tests, procedure, or specialist consultation. Once you have your current records and do some homework on your condition, you may find that specific old records would be helpful. It is worth a try. Just don't be frustrated if you can't track them down.
Mary Shomon: One thing that is particularly of concern to thyroid patients is "symptom-by-symptom diagnosis." Each visit, you complain of a symptom, such as fatigue, hair loss, depression, weight gain, and each time, you get a separate treatment. An astute doctor should be looking over the chart to see patterns that might point to something like thyroid disease. But how can patients, who may not even see the same HMO doctor from visit to visit -- or whose doctors are so busy they don't have time to review a patient's chart for each visit - ensure that their doctors take a more big-picture, longer-term view?
Dr. Marie Savard: Everyone should keep a health journal/calendar. I recommend a simple lined piece of paper that you can keep in a binder with your other health records. List in chronological order symptoms that are troubling you, changes in your diet or menstrual pattern, changes in your routine and of course, medication changes. Review your health journal with a friend (everyone should have a "Health Buddy" or advocate to go with them to the doctor's office) and list on a sheet of paper the purpose of your visit.