Continuing on with the topic of trusting doctors and the medical profession,
here is a topic which I hadn't as yet covered on my blog but which must be of concern to many patients and perhaps one of the reasons why such distrust is expressed by patients in general. This topic was initially posted on my now inactive "Bioethics Discussion Pages" in 2002 and I got a few responses. I have reproduced the posting and responses below. I have a feeling that this topic should stimulate a few more comments on this blog. ..Maurice.
The Ethics of Transfer of Patient Information from One Physician to Another: Concern about "Blacklisting"
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A visitor to these pages wrote me the following: "I am also interested in the ethics of the 'grapevine' phenomena in blacklisting patients via word of mouth..." It appears that she was concerned that when she has left one doctor and has requested that her records are sent to another doctor, the previous doctor may by talking to the new doctor also provide him/her with what the patient may consider personally negative and harmful information. This information may include the previous doctor's evaluation of the patient's personality, behavior, medical compliance, payment history, drug-use history and many other aspects of the patient's history including the physician’s conversations with former physicians that might not be present in the patient's written record. This additional information may lead the new doctor to change his/her approach to the patient's medical management but also may encourage the new doctor to refuse to accept the patient for treatment.
The concern is that when the patient authorizes transfer of his/her medical record should any other information be transferred orally? Should a physician be prohibited from revealing any information to another physician that is not in the patient's chart? Would it be more acceptable if this information were part of the written record? Should a patient be allowed to review his/her medical record and specifically dictate which portions should be transferred to the new doctor and which should not? Should a patient also specify what should or should not be orally communicated? Would this patient empowerment improve or hinder proper medical treatment?
Here is the question:
How much control should a patient have in the selection of what personal information is transferred by one physician to another?
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Date: Fri, Sep 27, 2002 4:20 PM From: sakers@choctawnation.com To: DoktorMo@aol.com
Health care providers and patients can have bad experiences. If I were the provider I would be asking myself why is this patient transferring care? Is there anything I can do to resolve the issue? The answer for the most part must be a collaborative effort for both parties. The effort must be professionally addressed in the patients record and should be included in the transfer allowing the next provider to have a clear picture of the case. However, we have heard the term "cherry picking", and unfortunately this does happen in the presence of personality conflicts and the almighty dollar(or the lack of). I have observed some pretty fancy foot work in the past. Regardless it is our responsibility to handle difficult cases and follow them through until patient is in the care of another provider, and that includes thorough and accurate documentation (all of it).
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Date: Wed, Sep 11, 2002 1:00 AM From: carlwedell@earthlink.net To: DoktorMo@aol.com
It seems to me that the tough part of the issue is the *way* in which the new physician treats any "negative" information. I don't know a solution, of course, because compassion and tolerance can't (or shouldn't) be enforced.
As with any relationship, both parties (patient and doctor) must be considerate of one another. Transfer of medical information is necessary so that the patient isn't "starting over," so to speak, with the new doctor. Likewise, the new doctor should not have to be "surprised" by a new patient's difficulty with paying bills, difficulty with medical compliance or addiction to illicit substances (the knowledge of which, being important to medical care, should remain a "patient-doctor" priviledge whenever possible). But this also assumes that the new doctor will give the patient at least one chance.
As far as "personality" and "behavior" are concerned, information should be very objective and should only be passed along if it would probably affect *any* doctor's ability to administer proper care. In other words, it requires a certain degree of emotional self-awareness on the part of the prior physician; is the patient truly difficult to deal with, or does he simply push that particular physician's "buttons?" This last bit, self-awareness, should be a part of the training of any medical school program.
In any case, I think all communications from old doctor to new should be documented. And, especially if there are any negative connotations, the patient should be given control of whether or not the records are transferred. But I would say the whole record must be transferred--it's either all or nothing.
Thank you. Carl Wedell, Denver, CO, USA
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Date: Thu, Sep 5,2002 11:35 AM From: moharrisiii@hotmail.com To: DoktorMo@aol.com
You need to be far more concerned about the woman who complained to you, and much less concerned about the "ethical issue". In some medical communities, this can(and has) escalated to an illegal medical blacklisting. She may have impending risk that could eventually cost the woman her life, or cause perrmanent harm, possibly sooner than she thinks. And she may have a very serious legal problem-- potentially a criminal law problem as a potential victim-- and not an issue that belongs in the "juristiction" of ethics at all. When the woman used the terms "the ethics of" and "blacklisting", the term "blacklisting" is the far more important term. This can be criminally illegal. It can also result in death or permanent harm in the longer term. If nothing else, she could be financially "ripped off", along with her insurer, in a trial-and-error effort to find suitable medical services. She could end up with a "medical records reputation" as a nusiance patient, and possible face higher insurance rates or difficulty getting insurance later on(and die eventually from "poor & uninsured" disease). Most Americans-- 95+%, and likely including this woman-- are literate and smart to use simple terms like "blacklisting" quite accurately. And whenever anyone does, it must be taken with extreme seriousness, since this term can refer to a criminal illegality. Whenever anybody, for any reason, makes a statement that indicates a possible criminal illegality of any kind-- and proof is not required, just the smallest probable cause-- it is a very very serious matter, and the worst must be assumed when potential bodily harm could result. This is as much the case in the world of medicine as it is when criminal risk might exist anywhere else, such as the back alleys of the world. When probable cause exists, medicine and its' people are not exempt from the scrutiny of law.
At the very least, this woman should make written statements, possibly in certified letters, and send copies to all concerned-- all the doctors involved and possible her local medical society. She should have these filed in at least one law office. If her statements indicate that a criminal complaint should be made, then a lawyer should advise her to do so, and assist her as much as possible. Regardless, she should be "on the record" with her statements in writing.
The doctors involved are "on the official record" in their medical records, which you can bet will look legally and "ethically" good for them(and not for the patient) in any dispute. If the woman gets "equally on official records" in a way that shows that the doctor's story is not the only story, that the doctor's way is not the only way, that the doctor's judgement is not the only or final judgement-- if the woman does this, then the doctors might decide to behave in "a different way". They might decide to work on their "behavior problems". When medicine and it's people are exposed to reality-- that they are subject to the scrutiny and judgement of others, including the law and those who pay their bills and support their livelihoods; that their judgments are far from final, that their authorities are not the most powerful or enforceable authorities(doctors in "my neck of the woods" don't like this at all)-- when medicine is faced with this "spotlight of scrutiny" from the bigger world outside their own, doctors will often "rethink their ethics and policies". If the woman "gets on the written record" with her own well worded statements, it may avoid more serious legal problems later on, and reduce the chance of physical harm. She might also end up with smaller medical bills without a loss of service!!
M O Harris III
Well, what do my blog readers think? ..Maurice.
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