What Happened To That "Passion For Caring"?

      I decided to start helping answer patient's questions about their medical records after reading this story in my local paper. How A Head Injury Turned Into A Sanity Test For Woman Regardless of what really happened in this case, the outcome was a big headache for everyone involved. In my most recent job I spent 4 years evaluating soldiers with traumatic brain injury (TBI) from service in Iraq and Afghanistan. It is a very difficult  problem to deal with even when you are used to seeing it all day long but in the civilian world I would guess that most might jump to a wrong conclusion just because they haven't seen much of it. That shouldn't mean you have to call the swat team.

     There are a number of reasons that smart patients should always keep an up to date copy of their medical records. Many don't realize that this became a "patient's right" in 1995 and in most cases is very simple to do. (Just ask the front desk on your way out.) Here are some of the reasons it's useful:

1. Be able to easily review old test results and assessments and show them to any new doctors you see. This can save time, money, and allow quick comparison with new results. Old x-rays, C-T Scans and MRI's on a CD are especially valuable and easy to keep in one place.
2. Avoid medical identity theft. This problem has been growing a lot since 2007 and can get you saddled with a diagnosis (like drug abuse or a mental illness) that isn't true. Try getting a job with a diagnosis of Alzheimers on your medical records!
3. Find out what was or wasn't done for you and whether it was recorded correctly. Most patients don't realize that you can request to have errors in your medical record corrected.
4. The patient in the story above might want to know if she was mis-diagnosed and whether that led to mistreatment and medical harm. This brings up another important aspect of your medical records:

         THEY DON'T HAVE TO RELEASE THEM TO YOU IF DOING SO MIGHT CAUSE YOU TO HARM YOURSELF OR OTHERS.

      Most of the time people will be refused access to their medical records that pertain to a mental health diagnosis. They cannot keep this from your doctor though. In the above case obtaining those records as soon as possible could be doubly important: You need to know if you have been wrongly labeled and you need to know what if any thoughts the doctor(s) had that might suggest what further help you need. The case above is missing a whole lot of detail. Getting the nurses notes and medication orders would show how the whole thing evolved over 3 days. It's possible that everyone was just as baffled at the end as they started. On the other hand, they may have realized their error at some point and just decided to politely dump her out after covering their diagnostic bases.

     If you have questions about your medical records that your doctor can't answer for you send them to us for a review.  Here is the procedure: 1. A brief, general email stating the questions you would like answered. Always be sure who you are dealing with before giving any personal medical information. We will respond promptly.