Clueless in Healthcare

Mark Metherell is reporting that patient control over what goes into their electronic medical records faces resistance from some Australian medical leaders, who are calling for a delay, to what they call “the potentially hazardous patient control feature”. Steve Hambleton, the vice-president of the Australian Medical Association said, at an Australian Health Department summit conference on e-health in Melbourne, that patients wanting to hide their treatment for depression, for example, raised the possibility of a dangerous medication interaction if the patient was later prescribed painkillers by a doctor unaware of an earlier anti-depressant prescription. Such information needed to be available to all doctors. ''It should only be able to be changed by doctors who understand the implication of what is recorded - and this can certainly be done in consultation with the patient.” In addition, he said that patient control of records should be held off until the electronic records transfer system had won the confidence of doctors and patients. However, the right of patients to hide elements of their records from some health professionals who do not need to access the information has been hailed by the Australian government as a central element of the e-health plan, due to start in July 2012. Australian Health Minister, Nicola Roxon, told the conference that privacy was a key concern and the electronic records would be ''truly personally controlled''.
While there may be legitimate reasons for allowing providers access to patient records against the will of the patient, the scenario that Dr. Hambleton suggests, doesn’t fit the bill. The problem that he suggests may occur, is indeed already happening, without Electronic Medical Records. It is well known that some patients simply don’t tell their providers everything that they could. Sometimes, the physicians have “no clue” regarding the missing information and sometimes they are suspicious or even in fact are aware that the patient is not telling the full story. The physicians are still responsible for the decisions they make regarding what they know and do for these patients. This is not a phenomenon created by Electronic Health Records. Those physicians that believe patients will always tell them everything, once everyone gets an Electronic Health Record, are simply mistaken. Physicians have and will remain responsible for what they do or what they should have done, given the information that is available to them. Electronic Health Records will not change this reality. If the Healthcare system persists in pursuing a course that excludes patient access and control of their personal health information, it will undermine patient trust in the Electronic Health Record system for some, in the same way that some patients today, have problems trusting the current system. In fact, it may be, that in the future, patients will deem it to be in their best interest, to withhold information from their providers, because of the risk the disclosure might have on their future insurability! If the healthcare system wants full disclosure from its patients, it should be willing to give full control of the health information, to their patients. Only then, can the vision of equitable, patient-centered, shared decision making, which is so often espoused as the ideal, have any chance of becoming a reality.