The Covert Rationing Blog

Another Reason Patients Should Review Their Health Records

August 30th, 2007 by DrRich

In the Wall Street Journal today, Victoria E. Knight writes that smart patients will always review their medical records for accuracy.

“Not only can incorrect medical information lead to ineffective or harmful treatment — the Institute of Medicine estimates that as many as 98,000 patients die each year in hospitals from medical errors — it can also affect your insurability.”

Your health records, she points out, are analogous to your credit scores.

“Savvy consumers know to check their credit score before applying for a loan. What is less well known is that consumers can improve their chances of getting insured — and of paying lower premiums — by checking that medical information held by doctors, hospitals and pharmacies is accurate.”

There are a lot of reasons errors can appear in your file.

“Mistakes can arise from a mistyped diagnosis code or transcription error to an inaccurate diagnosis or a diagnosis that is out-of-date, say because a patient has gotten his or her cholesterol under control. And, if you have a common name, other peoples’ records can end up in your file. . .”

This is all very true, and these are very good reasons you should check your medical records. But in the spirit of this blog, DrRich would like to point out another reason.

You should check to see if your doctor is using your medical records for CYA purposes. This is especially true if you are a patient with a potentially expensive medical problem which, if your doctor followed all the guidelines to the letter, could result in substantial “medical loss” for the third-party payer (i.e., the doctor’s boss).

An example (which, in DrRich’s own clinical experience, is distressingly common): Say you’re a recent heart attack survivor. You’re pretty conscientious about taking all the medicines your doctor has prescribed to reduce your risk of another heart attack, and you’ve even changed your diet and started a walking program. Truth be told, you’re actually feeling better than you have in years. But then one day while putting the dishes away you have some kind of “spell.” One moment you’re opening a cabinet, feeling absolutely fine; the next, you find yourself laying on the floor with a bruised chin. Your wife, having heard a crash, is just now rushing in from the next room - so you know you were “out” only for a couple of seconds.

So, you go to see your doctor. You tell him what happened. He asks a few questions, nods, looks serious for a moment, then smiles and says, reassuringly, “Well, <Your Name>, I don’t think this is really anything to worry about. Sounds like you were just a little dehydrated. Happens all the time after a heart attack, what with all the pills and all. Really, nothing to worry about.”

Happy that the doctor thinks it’s nothing, you leave the office relieved. But might be surprised to read the note your doctor has put in your medical record:

“<Your Name> in for checkup. Doing well. Complained of an episode of significant lightheadedness two nights ago. Lost balance and fell, with minor trauma. Says thinks he was dehydrated from exercise program. Has felt well since. Nothing to suggest arrhythmia.”

This is a classic CYA note. Sudden, unexpected loss of consciousness after a heart attack is OFTEN due to potentially life threatening cardiac arrhythmias, and should ALWAYS be treated as a potential harbinger of impending sudden death. Unfortunately, treating it as a serious problem is usually expensive, requiring at least a hospitalization, and (if the evaluation is positive) the insertion of an implantable defibrillator. Such an outcome will not improve the doctor’s cost profile with his master, the third-party payer.

Your doctor should know that you are potentially at very high risk for sudden death. If he doesn’t know that, he’s stupid, and stupid is bad when it is seen in doctors. But stupid isn’t as bad as dissembling. And dissembling is what his note indicates.

Your doctor’s note does not accurately reflect what happened to you, or what you actually told him about the episode. Instead, it alters the facts just enough to make it seem reasonable for him to skip any further medical evaluation. If you have no further problems, no unnecessary dollars will have been spent and everybody’s happy. If you die, that’s terrible and all, but nobody reading the records will be able to fault him for doing what he did (or rather, for not doing what he didn’t). So it’s a win-win.

This is another reason for routinely reviewing your health records. In an era of covert rationing, you can protect yourself by not exposing your doctors to the ever-present temptation to “spin” the records. (Some doctors are regular DJs.) If your doctor knows you are going to read whatever he puts down, he’s a lot less likely to color the story to your disadvantage.

Indeed, for this very reason, DrRich would be especially suspicious of doctors who refuse to give you copies of your own health records.

Posted in General Rationing Issues

3 Responses to “Another Reason Patients Should Review Their Health Records”

1. Pete Casella, R.N., BSN wrote on 08/30/07 at 7:46 pm :

   Bravo.

   Here in Richmond, we (several nurses and interventional cardiologists started a company in 2004. It provides a REAL service that researches, collects and archives patient’s COMPLETE record for secure access online. Not just reports but media (XRays, Cath films, angio, MRI, etc.. This has helped many patients because o the disclosure you spoke about. The patient can access their record and provide access to providers. No more hiding. Check it out, I think you’ll find what we do interesting. click the link to see the flash presentation.
   http://www.physiciansrecords.com/movs/UniversalRecordsAccessF.swf

2. Greedy Trial Lawyer wrote on 09/1/07 at 7:59 am :

   Your Widow Has A Better Chance Of Reading Your Medical Records Than You Do…

   You can file this item in the “Great Ideas With No Prospects For Success” category.

   Another Reason Patients Should Review Their Health Records

   You should check to see if your doctor is using your medical records for CYA purposes. This is especially…

3. Trusted.MD Network wrote on 10/1/07 at 10:22 am :

   Fixing American Healthcare…

   “If Martians were to come to Earth and study the US federal budget, they would immediately see (given their entirely objective, completely apolitical, incinerate-entire-cultures-now-and-ask-questions-later natures) that the main job of the now-defunct…

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