Source
r/medicine•
Intensive

Are you okay with your patients reading their own charts or not?

Hi r/medicine. I'm a healthcare professional who is also occasionally a patient. I have access to my own chart from the EMR side (not just the patient-facing portal) and my employer's policy is that employees may read their charts using the EMR, just cannot make any changes to it.

Having seen thousands of patients' charts over the years, I like reading mine sometimes. Lab and imaging results show up there as soon as they are available (rather than the days it takes for the patient portal to post some), and I enjoy seeing my own healthcare from the inside, so to say. With that being said, I am sensitive to the thoughts of the professionals involved in my care and wouldn't want to do something that may make them feel uneasy or compromise the way they treat me or document my care. I have not told my physicians that I read my chart, and if you all think it is not my place to do so, I will stop doing so out of respect for them.

How do you feel about patients in my situation, the ones who read their own charts? Are you okay with that, or should I take a step back and only use the patient portal?

Posted Jan 5, 2018, 1:35 AM UTC

2455
DeLaNopeRN Burn ICU•

Weird.

Our system has a no-tolerance policy for accessing your own chart, or anyone who you are not directly involved with. In fact, if I’m looking at a patient who is not on my unit, the system prompts me to confirm where I’m working again.

Honestly if everyone could read their chart I think some people would feel a little offended when staff starts charting... objectively.

49
IntensiveOPRN, Surgical Critical Care•

I remember taking this patient's history, and he mentioned that he "smokes some reefer, but you don't have to write that down". I totally had to.

21
DeLaNopeRN Burn ICU•

Recently it was, “Patient stayed nurse was ‘a f**k’ during attempts to provide education, then ate his nicotine patch. Provider notified.”

32
IntensiveOPRN, Surgical Critical Care•

On another note, on the rare occasion I quote the patient verbatim saying something nasty, I don't censor their wording. With my luck, that chart may end up in court, and some multimillion dollar monster lawsuit is going to hinge on whether the patient said "fuck", or "fire", or some other variation of f***.

21
ShalaiynM5 - EU•

Censoring when quoting is absolutely moronic anyway.

25
MoobyTheGoldenSockFamily Doc•

Yes, that’s totally the reason I do it and not simply because I am immature and enjoy writing curse words all over legal documents.

18
Periscopia•

People need to learn to deal with "feeling a little offended". Fear of patients -- whether they're employees/staff or not -- feeling offended is not a justification for concealing patients' complete medical records from them. When a patient's psychological condition and/or intellectual/cognitive capacity is such that it's harmful to let them see their complete medical records, they should have a legal guardian, or at least a pending court proceeding seeking to appoint one.

5
DeLaNopeRN Burn ICU•

They can go through legal and get their records like everyone else then.

Offended people throw a wrench in your survey results as well.

3
SpartanGuyPRS•

Dude it's not fear because I am worried about them being mad at me. It's fear of negative reviews online, and in patient response forms and having may pay docked or less referrals for surgery. Also the increased risk of litigation when they read physician to physician communication they misinterpret.

What place you practicing where you don't care about this in 2018?

3
Szyz•

Ours is not only you have to be involved, but you can't go randomnly wandering into things which you do not need to see for what you are currently doing. The width of that need obv depends on who is doing what.

2
H_is_for_HumanPGY2 - Internal Medicine•

Yeah we have a zero-tolerance policy for looking at anyone's chart if your interest is not purely clinical or academic. So not your own, not a family member's or friends. Even for benign reasons, like getting them results faster.

To answer the question in general, I'd be fine with patients having access to my actual notes if they wanted them, with the disclaimer that they don't have the experience or training to interpret some of the things that are being said, which could be confusing or scary or otherwise upsetting.

1
NuclearMedicineGuyBS, CNMT, RT(N)(CT)•

This is a slippery slope. Every healthcare facility has different policies regarding this. My health system has a not tolerance policy for opening chats of patients that are not necessary for your job. If you are in imaging you can only look at charts of patients who will be visiting your department. I find it interesting your health system allows you to do this. It can open them up for issues down the road.

44
emergentologistMD - Emergency Medicine/EMS•

I find it interesting your health system allows you to do this. It can open them up for issues down the road.

Really? Every hospital system I have worked for has explicitly stated that you can access your own chart.

16
pushdoseAPRN student•

Every system I’ve worked for has said opening your own EHR chart is not only explicitly prohibited, but is a fireable offense.

38
emergentologistMD - Emergency Medicine/EMS•

Seems ridiculous for that to be the case though, right? It's your own record. You are allowed to have access to your own medical records. Why would a hospital require you to go through the process of requesting a hard copy when you can just view it directly? Every EMR logs access so there is a record of you accessing that record. Makes no sense to prohibit this.

20
grissomzanavy corpsman•

Because a regular patient has a procedure for requesting access, just because you have access logs doesn't mean you shouldn't be following the same process that every other patient does.

4
Szyz•

Same at mine.

5
hedgewigd•

Definitely allowed to look at your own chart at mine and its a major health system.

2
IntensiveOPRN, Surgical Critical Care•

Indeed, another hospital I worked for in town strictly disallows using the EMR to look at employees' own charts. My current one made it clear that we may use it though.

14
multocidaPGY-3 internal medicine•

This is a slippery slope It can open them up for issues down the road.

Why the evasive language? What harm could come from a hospital or health system allowing patients to read their own records?

1
NuclearMedicineGuyBS, CNMT, RT(N)(CT)•

The issue isn’t patients reading their own records. It’s healthcare workers accessing their own chart as a healthcare worker. Both hospitals I work for do not approve of a healthcare workers accessing their chart as a healthcare worker. Their stance is: you only need access to patients charts that are required for your role. If you are in imaging you should only access charts of patients that are ordered imaging in your department. You shouldn’t be browsing through anyone in the hospital. If you are a cardiologist you should only be accessing charts that need cardiologist interventions.

On the other hand: as a healthcare worker you wanted to see your chart you can request a patient portal log in and have a field day in your chart. You are accessing your chart as a patient and follow the same rules as everyone else.

1
PorencephalyMD Pediatric Neurosurgery•

I have worked in centers that allow employees to read their own charts. My family members also had signed HIPAA waivers allowing me to access their charts from the inside. I (and they) found it very convenient. I did not tell providers I had such access.

I don't have problems with a patient reading their own chart, so long as they realize the chart is not for them, and they don't have the right to edit it as they see fit.

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IntensiveOPRN, Surgical Critical Care•

My current employer has a clear "read only" policy for staff reading their charts. I certainly hope that staff don't abuse this privilege, because it truly is one.

9
StvYzermanMD- Heme/Onc•

Our hospital system just made the decision a few months ago to let patients read their notes through the online portal where they were able to already check their labs. I hate it.

I have a patient who calls to correct my note after visits.

I now have to be careful when writing about psychiatric issues, family dynamics, and using words such as obesity.

I'm all for patient empowerment and patient's taking the lead in their medical care, but I believe the pendulum has swung too far.

30
garrett_kAEMT•

Two separate issues:

  • Patient access. Pretty much all ethicists agree that patients should be able to get access to their medical records. They are the patient and the customer.

  • Be a pain in your ass. Sure - they can ask that an addendum be added to their records. A tech answering the phone can do that. "Pt. stated that they are not obese and are big-boned." Whatever. But talking to you to grill you over your charting is a waste of time. If there are legitimate concerns (forgot to mention that an aunt had cancer) they should schedule an appt. to go over them. Just yelling at you for verbiage deserves a hang-up.

As someone who volunteers in EMS, I prefer access to my charts. Usually I look up terms I don't recognize and otherwise leave providers alone.

18
ScaldingLakePA-C•

Are there any policies in place regarding altering a note by patient request? When we began open notes there was an announcement that patients must contact a separate department and submit a form, to be reviewed by said department, before you could be contacted to amend the record.

2
H_is_for_HumanPGY2 - Internal Medicine•

We have a similar policy - notes are not open through the patient portal, but patient's can request a copy of their complete medical record through the medical records department which would include notes. They can request to add an addendum or explanation in their own words if they submit it.

1
fGre•

Working in Germany, every patient has the right to view their chart directly after treatment and it is illegal to withhold it from them. In certain cases (diagnosed depression with a suicide risk for example) the access can be restricted to protect the patient.

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IntensiveOPRN, Surgical Critical Care•

American laws allow patients to request their medical records as well, and healthcare entities must respond to such requests in a timely manner - hospital policies usually allow for 10-14 days. They get the chart, but there is no obligation for hospitals to give them EMR access to view it. It's a paper or electronic (probably PDF on a USB stick) copy.

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LaudablePusMD - Pediatrics /Infectious Diseases•

Of course patients have this right as they should. You are a health care provider so understand the vagaries of taking and documentation. I have had patients read notes and become upset about small details that really don't matter clinically (that fever was 102.7 not 102.5). When the patient sees discrepancies in their history they then may then lose confidence in their provider. I have had this happen. It is nearly impossible to document a history with 100% accuracy. In addition, I have had patients object to my assessment and demand I retract it. (in this case it was a patient who's symptoms were likely secondary to untreated depression). That wastes a lot of time for all those involved. I would like to ask you why do you need to see your record? If you want to know what your lab results are there are other means for that ( for example MyChart in EPIC). Do you feel your provider is not up front with you about something?

14
IntensiveOPRN, Surgical Critical Care•

Mostly just simple curiosity. I have no reason to believe my providers are anything less than thorough in my care and professional, and my chart shows exactly that. I've seen so many patients' charts over the years, I find it plain interesting to look at my own health care through that lens. Which is why I wanted to know what r/medicine thinks. If the concensus is that I should not use the EMR, I'm absolutely willing to abide by that.

7
iBro53•

It is important to point out that one of the downsides you listed of the patient-facing system, delayed test results, is vitally important. If a biopsy result comes back as cancer, there is a delay so that the physician can review the result and tell the patient in the appropriate way.

10
Szyz•

My providers only rarely put imaging and biopsy reports on the patient protal. It drives me batty, because the message I get is never the full picture.

3
IntensiveOPRN, Surgical Critical Care•

Absolutely, that is a valid point.

2
TellGunshotWooWooFNP-C•

I can’t say that it would bother me, I do wonder how some people would respond after seeing their PMP and how it contradicts their story

8
IntensiveOPRN, Surgical Critical Care•

I can only imagine some patients. For what it's worth, I found nothing untoward in my chart and it was all entirely professional.

6
j_itorMSc in Med|NSG (EU)•

I don't mind a read only access, but when we get to edits and comments and sending questions about it I think it is going to far.

It is a tool in my job, and should be used as such. If you want to read it - fine, don't expect me to do it for you.

7
Periscopia•

I think it would actually be very valuable for patients to have the ability to insert comments and suggested edits. These should become part of the permanent record, as they provide documentation of the patient's comprehension and attitude. The physician or other provider whose notes are being edit-suggested or commented on should receive an automatic alert to these, but not be expected or required to read them or respond (though it would probably be a good idea to read at least the first couple of annotations inserted by a patient, to gauge whether there's any reason at all to look at future annotations by that patient, or whether the patient may have just helpfully provided solid evidence of a need for guardianship, social work/psych referral, arrest and prosecution, etc).

Since EMRs are already subject to automated surveillance, it would probably be a good idea to add surveillance of patient annotation events, so that patients who are making an unusually high number of annotations will be flagged, and their annotation history reviewed by an administrator, which would usually avoid the need for the providers to deal with it (but might occasionally bring a problem provider to administrators' attention in a more timely manner).

Health care providers are usually overworked, and while this is a rational basis for providers to want to avoid dealing with patient-annotated medical records, it's also behind the high rate of errors in medical records. Having sane and stable patients reviewing and annotating their own records is likely to catch a lot of errors, preventing other providers from relying on erroneous information, and would also alert providers and their employers to common types of errors so that the error rate can be reduced.

3
billyvnillyMD - Path•

I have had phone calls from patients who see their chart and call the lab and ask for me by name because I'm on a report; I don't like that. Call your doctor.

7
sodiumNA11Medicine•

When I get medical bills, they have the name of the pathologist on them anyway.

1
adenocardPGY3 - Internal Medicine•

I don't like the idea.

In my mind, physician notes are (or should be) intellectual property owned by the physicians who create them, and are generally written for the purposes of inter-professional communication and internal record-keeping. I'm fine with patients having limited access to objective data like labs, imaging reports, etc, but the subjective intellectual consolidation of that data should stay between physicians. I see lots of potential negatives associated with making this portion of the charts entirely visible to patients (especially in how it would change the way physicians document - likely towards more CYA, less frank, less honest, less straightforward language), and I see few potential positives (like OP states here themselves: it's really just a matter of curiosity).

7
MoobyTheGoldenSockFamily Doc•

Making them available electronically (such as via patient portal) is just convenience for the patient. Patients legally have the right to sign out a copy of their chart from medical records at any time.

We have Open Notes on our EMR, which means every progress note I type automatically becomes viewable by the patients. It doesn't change how I document.

5
Generoh•

My hospital forbids this. A nurse at my institution who was receiving chemo read the notes that she was in remission so she decided to stop attending appointments for check ups. A couple of months/years later she develops stage iv breast cancer

5
[deleted]•

This isn't a very compelling argument against it. That is information that her doctor should have given her anyway, and counseled her accordingly.

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j_itorMSc in Med|NSG (EU)•

Stupid people will find ways to fuck up everything, the world should not be made to protect the dumbest moron.

Remission doesn't mean "cancer free for the rest of her life", it doesn't even imply that.

11
AngryGooseLayperson•

I had a chance to glance at the notes the previous MD had left while the one I was currently seeing was reading them. There was language in there I didn't understand and in a format that wasn't immediately clear. If I had time and google I could have figured it all out.

The point is, this is written by doctors for doctors. Also like others have said, some people might get offended or confused. I still think they have the right to access it, but I don't expect them to understand it accurately or objectively.

4
MoobyTheGoldenSockFamily Doc•

Yep, that's definitely true. Our health system automatically makes our notes visible to the patients and our administration warned us to be careful with abbreviations like SOB for "shortness of breaths" because some patients may read it as "son of a bitch."

2
eoJ1Student paramedic y2•

I will occasionally share something with a patient, not necessarily their whole chart (that I will very occasionally show, but most of the time I'll suggest they request it through the normal mechanisms after the fact).

If someone's curious about their ECG for example, then providing they're not having a heart attack (then it's up to individual judgement, but typically I'd say that would increase stress) I'm happy to show them. If it looks good on the screen, I'll often pass a med student/nurse/doctor the first copy once it's printed.

I would say it's best just to ask if it's okay. If you're a reasonable, calm person, who won't start trying to over-direct treatment, then I think many people would be happy to let you look, depending on the situation.

2
Szyz•

I wish I could read mine. My providers tend to turn the screen towards me and show me anything they are accessing or reading, but I don't get to read most of their notes. The patient portal drives me insane, I can't imagine how awful their EMR must be if their portal is this bad (I don't bleed where I work).

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[deleted]•

[deleted]

1
albone74MD, Davis, California•

Anything written on a computer is there for posterity. Write your notes with that in mind. You have 3 audiences: colleagues, lawyers, and patients.

Patients will absolutely see what you write. It won’t help their medical care, but that’s beside the point. People want to see their medical records. Even if there is no patient portal, someone else can easily print your notes and give the printout to the patient.

1
PasDeDeuxPGY 2 - Psychiatry + Informatics/Machine Learning•

Multiple medical systems in Boston allow patients to read their notes. Also, patients in most systems can request a copy of their medical record.

I've only had one patient ask for their note to be changed (which is apparently a legal right, not sure if federal or state), but I said no (which is my right by the same statute.)

1
sodiumNA11Medicine•

We aren't allowed to access our own charts, and it bothers me.

1