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medpundit |
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Saturday, August 10, 2002When they take effect, for the most part next spring, the rules will require a host of new protections, including guaranteeing that people may inspect their medical records and correct mistakes, find out who else has looked at them, and seek penalties against anyone who misuses the information. I've always wondered about the the right to "correct mistakes" in a medical record. What constitutes a mistake? What if a patient reviews their medical record and objects to a diagnosis of depression or somatoform disorder? Does he have the right to force the doctor to change the diagnosis? If the doctor refuses, is he going to end up in court defending himself? The final regulations, however, omit a requirement that patients' written permission must be obtained before their personal health information can be handled by doctors, hospitals, pharmacies and insurance plans -- a protection that lawmakers and two White Houses have contemplated for years. In some ways this is good. If I refer a patient to a specialist, I want to be able to discuss the case with him and to exchange information in writing to facilitate patient care. The way the rules were written by the Clinton adminstration, the specialist and I both would have had to get written permission from the patient to do that. We'd also have to get permission to give insurance companies information when we have to argue with them about paying the bills (which is the rule rather than the exception). Since the lack of payment on behalf of the insurance company doesn't inconvenience the patient, only the doctor, it's not too hard to imagine how difficult it would be to get a patient's permission to share that information. The rules go further than the administration previously considered to rein in the use of medical information for the marketing of products, particularly prescription drugs, by companies that gain entree into individuals' records. That's good. Patient confidentiality should always trump marketing. The final rules keep a controversial provision that Clinton had endorsed over the objection of civil rights groups, allowing law enforcement agencies relatively unfettered access to people's records without telling them. That's just plain disturbing. As a physician, I've always understood that law enforcement is not privy to my patient's medical information. In fact, physicians are only justified in reporting a patient to authorities if there is a clear and present danger to others.(For example, if someone divulged that he was going to shoot his co-workers or his boss, I would be obligated to tell the police.) To allow law enforcement unrestricted access to medical records is more than a violation of civil rights, it's a violation of human decency. posted by Sydney on 8/10/2002 08:59:00 AM 0 comments 0 Comments: |
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