I just came upon a stirring article in the New England Journal of Medicine, entitled “The Road toward Fully Transparent Medical Records” (sic). It’s a little long, but well worth reading, because it contains truly revolutionary ideas.
By now, everyone in the healthcare field, and some patients, have become aware of the increasing use of electronic medical records, or EMRs. Patients of cutting edge medical practices now have access to patient portals through which they can view some of their records, such as lab results, and can communicate with their physicians. My own primary care physician’s practice group has such a set up, and it has been quite useful to me. But as the authors of the NEJM article point out, patients have not had access to their clinician’s notes. Physicians have been uneasy about granting such access, and understandably so. “Writing accurately about a suspicion of cancer…can be difficult for clinicians who don’t want to worry patients unnecessarily, and addressing character disorders or cognitive dysfunction in ways that are useful to patients, consulting providers and others…requires carefully considered words.” What the article did not address, but should have, is the concerns most physicians have about the role such transparency might have in exposing them to potential medical malpractice liability.
Yet there are significant benefits to such transparency, including improved patient safety, according to the authors. “[O]pen notes can help improve patient safety by allowing contributions from patients and families who may catch questionable statements or clinically important mistakes in notes or find lapses in follow-up that need to be rectified.”
Naturally, the easy availability of clinician’s notes has its downsides, too. As the author’s note, “patients may choose to post their provider’s progress notes on Facebook, Twitter, medical forums, and other social media, potentially exposing clinicians to public scrutiny.” But consider this. The authors believe that such open records will become the standard of care; that patients and doctors will participate in their creation; and that ultimately, both patients and doctors will sign off on them. And this collaborative process appears to be a good thing.
The study that is the focus of the authors’ article, OpenNotes, found that patients who read the notes had better understanding and recall of their care, and felt more involved in it. Compliance with taking medications improved. And the contents of the notes did not upset the patients who read them. So, isn’t this an idea whose time has come?
Physicians who have made medical errors have traditionally been warned against apologizing to a patient’s loved ones. This is due to the fear that such expressions of regret would be understood as admissions of liability.
A new law passed in Pennsylvania will permit physicians to apologize for mistakes without the fear that their remarks will be used against them in future litigation. The Benevolent Gesture Medical Professional Liability Act was signed into law by Governor Tom Corbett on October 23rd, after years of debate surrounding the issue. Read More
USA Today ran a disturbing article with a dramatic title earlier this week: Dangerous Doctors Allowed To Keep Practicing.
Before you stumble backwards, reeling from shock, be assured that the article is talking about a minority of doctors. Most physicians are solid, well-trained and educated professionals who are dedicated to providing optimal care to their patients.
Like any group of professionals, there are a few bad apples among them. The problem, and the focus of the USA Today article, is that the medical industry does such a poor job of disciplining its incompetent doctors that innocent patients remain vulnerable to their errors. That is the tragedy that continues to go unaddressed. Hospital administrators, heads of disciplinary boards, and the insurance companies that provide malpractice insurance to doctors know which doctors have provided substandard care in the past, and therefore, which of them are likely to injure or kill patients in the future.
And they usually fail to corral such wayward doctors, unless a particular case attracts enough negative press to force their hands.
USA Today’s investigation found:
“the nation’s state medical boards continue to allow thousands of physicians to keep practicing medicine after findings of serious misconduct that puts patients at risk”; and that “[e]ven the most severe misconduct goes unpunished: Nearly 250 of the doctors sanctioned by health care institutions were cited as an ‘immediate threat to health and safety,’ yet their licenses were not restricted or taken away.”
And transparency is not something the medical establishment is particularly fond of. While there is a public file, the National Practitioner Data Bank, that is supposed to receive reports whenever any of the nation’s doctors face “adverse actions,” the public cannot view any identifying information about a particular doctor. Perversely, the only people who have full access to such information are part of the very medical boards and hospitals that are supposed to be protecting the public from incompetent doctors, and who continue to fail to do so.
Not surprisingly, it’s only getting worse, as is illustrated by the stonewalling being encountered by Public Citizen, one of the most tenacious consumers’ rights groups in the country. USA Today found that the “Federation of State Medical Boards has stopped issuing medical board enforcement data that Public Citizen uses to rank the rate at which different boards discipline physicians.”
Why does this sad state of affairs continue?
The reasons given in the article are disturbing: red tape, hospital politics, the chronic failure to report doctors to the Data Bank. In my own experience, while I was still working on the defense side, I recall multiple lawsuits filed over multiple poor outcomes following surgery by a “renowned” surgeon who attracted big business to a particular hospital. He may have once been excellent at his job, but the facts suggested that if there had been such a period, it was far behind him. Yet he was kept on, and even celebrated by the hospital, in its ad campaigns. If I were as cynical as my friends and family think I am, I might suggest that the medical industry can be a profit-driven business like any other, and that cash flow is sometimes valued over patient safety. But I would never suggest such a thing.
What can you do? Given the current news headlines, there have been few more opportune times to call for greater transparency from the medical industry. Sure, transparency in government, and in the NSA is valuable. But so is the transparency that would allow U.S. consumers of medical care to protect themselves from avoidable, predictable injuries and deaths.