Medical Records

It has always bothered me that at most doctor's offices, medical records are treated like secrets. It would bother me that when the nurse left the examination room, she would take the records with her and plop them in the door. Heaven forbid I should sneak a peak at records describing me!

According to the government, "The Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule." But actually getting providers to hand over those records can be expensive and sometimes frustrating. 

I have had a few doctors offices that are great. When we asked our cardiologist how we could get a copy of the echocardiogram he was running on our son, he happily popped in a CD and burned us a copy on the spot. When I went by later to get a copy of his EKG, the receptionist printed it out from her computer. Part of the trick is knowing who to ask. When we arrived for the echo, we asked the receptionist if we'd be able to get a copy ad she acted like it wouldn't be possible--in reality she just had no idea. Persistence paid off and the doctor gave us no trouble over it all. 

Many offices and especially offices out-source their records to third-party companies. That means if you want a copy, you usually have to fill out a form and commit to an indefinite amount of money for copying said records. How much they can charge you varies from state to state. You can look for your state here. 

After fun experiences with knee surgery and a decision to never go back to the Carilion hospital near us, I wanted to gather all the records from their system. After talking to the records department on the phone, I filled out the necessary form and submitted it. The records office warned me that asking for all my records could result in thousands of pages and thousands of dollars so I might want to be more selective. I wanted it all so I continued on. I was very surprised when I received a very thin envelope from HeathPort, the 3rd party information company that Carilion uses to store and retrieve its medical records. There were so few pages that it fell into the free category. The documents contained spotty information on a few procedures I'd had done and none on others. We called HealthPort. Their customer service was unfriendly and unhelpful. They insisted that they'd sent my complete records and demanded to know how we could know something was missing.  Hmmm, because they were missing entire procedures! We finally got them to grudgingly agree to try again. A few weeks later we got a larger package. This time it included an invoice for around $20. This time it at least had mention of all the procedures and had a more complete record of the surgery I'd had done. The copies were terrible quality but at least they were there. Still no images, though, even though we'd expressly checked that box on the records request form. No images from EKG, EEGs, MRIs, surgery, etc. We called HealthPort again and were told they don't do any images and that we'd have to contact the hospital. 

Back I went to the hospital record office. I sat there for over an hour while they tried to find and print out my images. They kept asking, "Are you really sure you had it done here? We can't find you?" That is definitely confidence-building. Finally they managed to find and print one EKG. I was told that they didn't have my EEGs. I'd have to try to contact the neurologist who ordered them. And they didn't have any images from the surgery. I'd have to ask the orthopedic surgeon about that. They also told me that I'd have to go to Imaging to get copies of the MRIs. That would have been nice to know before I'd already waited an hour because when I went to Imaging, sure enough, they could burn a disk for me, but it would be an hour or two wait. And no one ever, in the process of getting the MRIs, had let me in on the fact I could get copy of the images or how to do so. They only tell you if you ask. 

It was a long and frustrating day. I still haven't gotten up the energy to go through all that again with the orthopedic surgeon's office, but one of these days, I will.

So why bother getting them at all? Because unless you stay in the same town with the same doctor your whole life, this information will disappear. And someday you might want it. After all this, I realized I should try to get some records from a previous doctor in a previous state. I called... but it was too late. They'd been destroyed. How long medical facilities must keep records varies from state to state. You can check out yours here. 

Even if you stay with the same practice, if your doctor changes it seems to make your records vanish. I requested my records from the family physician's office I've been using. It came from another third party and was decently complete, except that it contained nothing from the first doctor I'd seen at that practice years ago. She was my doctor for several years and then left the practice and I was transferred to another doctor. The records contained none of the tests or visits I'd had with her, and there were a few things I wish I had.

So the moral of the story is: demand what belongs to you. You paid for these tests and treatments. You should have a record of what was done and how it was done. Don't wait for some one to offer the records to you (they won't).  Don't wait until you need them or they may already be gone.

Carilion hospital Patients are denied Emotional Support

Carilion hospital denies patients emotional support

After moving to the area 10 years ago we went to the Carilion hospital (New River Valley Medical Center) for some tests.  We found some of their policies a bit strange and uncomfortable.  We chalked it up to new laws or something.  Over the years we have been back to the same hospital and found the same uncomfortable treatment.  After a extremely stressful situation before outpatient surgery we did some checking.  What we found was it was only their hospital policy and nothing to do with ANY laws.   

Carilion's policy is to isolate the patient from their support to interrogate them.   Right before a medical procedure is a super stressful time and when a patient needs support the MOST.  It is not the time to be isolating them.  Other times it is irritating and annoying but before a traumatic experience, like surgery, it can be emotionally damaging.  Practically all, if  not all, patient advocates recommend patients should have their support person present at all times to listen and assist in preventing errors.  Even Carilion’s own over-site commission (Joint commission) recommends that that patient advocates always be present.

After our emotionally traumatizing experience we contacted the Carilion management and asked why this had happened and that we did not want to be treated that way.  They stated that all their patients are required to be questioned alone.  They said in order to better serve illegal drug users this was the best policy.  They treat all patients that way and will not make any exceptions.  Nice to know my emotional welfare means less to them than protecting illegal drug users.

It may seem like a minor issue but if they will not work with their patients on a seemingly small issue, you can imagine how inflexible their management is on big issues.  It is absolutely not a legal requirement to be questioned privately.  We will no longer allow separation for questioning at any medical facility.  Which leaves us with... 

Since Carilion demands its patients be isolated when questioned they left us with only one choice, change providers.  Which we did and we have found that the LewisGale hospital has more patient friendly policies.  It has been years now and the only time we returned to a Carilion facility was to get copies of our records. (And that was yet another unpleasant Carilion experience).

As a society we do not have to put up with bad service from hospitals.  Everyone should consider carefully where they choose to go.  Do not support business with bad policies.  And above all, never ever let "it's our policy" be the end of the conversation.
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From the joint commission: who oversees Carilion Hospital (New River Valey Medical Center)

Communication with a patient’s family members or friends

" Health care providers can share and discuss health information with family, friends or other individuals who are directly involved in a patient’s care (HHS, Office of Civil Rights, Sharing health information with family members and friends). The law allows sharing information when the patient either agrees or if present in the room with the patient, the patient does not object. For example, providers can talk to a patient about his or her condition when a family member or friend is present at the patient’s request. Information about a patient’s needs also can be shared with a health aide, interpreter, or person driving a patient. In some situations, HIPAA also allows health care professionals to use their own judgment about whether the patient wants health information discussed in front of family members, friends, or other individuals involved in a patient’s care (HHS, Office of Civil Rights, Sharing health information with family members and friends). If a patient specifically asks a provider not to share information with an individual, then that decision must be respected. (HHS, Office of Civil Rights, Sharing health information with family members and friends)." link


 HIPAA is not about isolating the patient. 

Patient Modesty

Patient Modesty

"We all see you naked, but we don’t care" (but does the patient care?)

From a doctor:

"during the first operation that I witnessed as a medical student, I immediately realized that no one in there cares. We’ve all seen it a million times, and trust me, despite what you may believe, yours is no different than anyone else’s. I’ve had many patients who have been apprehensive about disrobing before surgery, but there is nothing remotely titillating in the operating room. Nothing."link

I've heard similar responses like this so many times.  It is such a big lie. It just makes me sick. First off, he says "the first operation that I witnessed."  There is a first time for EVERYONE.  There is no med student or nurse that was born with having "seen it a million times".  And keep in mind not only doctors are in the operating rooms.  A nurse, scrub tech, other techs, trainee, visitor, auditor, management all could be there watching.  I've read where a guy boasts that his friend that worked in the O.R. took him in to see a woman being prepped for a GYN surgery.  Woman totally exposed to a stranger off the street.  Without her knowledge at all.


Second " there is nothing remotely titillating in the operating room. Nothing." heard that from medical professionals all the time too.  Is that for real?  Let's look at some real world examples:

Examples:
 "New Orleans breast surgeon sent himself 'surreptitious' photos of naked patients during surgery"
"A noted New Orleans breast surgeon “surreptitiously” took nude photographs of patients during surgery, emailing himself pictures showing the patients’ “faces, breasts and vaginas,”

Seems this doctor didn't get the message.  Maybe he hasn't seen enough yet?  And notice he took pictures of their "vaginas"  His purpose is to work on their breasts.  But he takes advantage of the fact that the hospital doesn't allow patients to cover themselves.  Have to wonder what kind of person is making the rules.

For some practical tips and suggestions for maintaining modesty, check out our post on maintaining modesty.

"Doctor accused of taking photo of unconscious patient's private area"
How could she notice the tattoo and be interested enough to take a photo.  I thought they had seen it all a million times. Apparently sometimes it is interesting enough to warrant taking a personal photo.


Doctor taking photos of Sedated patient
Tell me again doctor that patients are all the same and the medical staff doesn't notice anything?

Doctor sexually assaults patient while unconscious
He also performed genital exams on a female despite being an Ear Nose and Throat specialist.  But they have seen it all, "yours is no different than anyone else’s". Apparently not all Doctors feel that way.


Prominent Emergency Room Doctor accused of four sexual assaults
This doctor seems to have made a habit of preying on young adult women who happened into his emergency room-- yet they "all look the same"...


Cardiologist snapping nude pictures of a girl in the bathroom.
If he's seen it all a million times why is he trying to sneak a pic?

And it is not just a problem with male health care workers. Female workers notice and respond to their patients' bodies as well.
Nurse texts photo of unconscious patient's penis

Female ENT doctor accused of routinely giving genital exams to male patients while they were sedated. 

Here's a whole article on protecting patients from sexual predators in the OR.

Why do these things happen?

The above are just a few examples of countless cases of criminal sexual misconduct in a medical setting. Cases where someone actually got caught.  Which you know that most of the time they aren't caught. Since they've "seen it all" and there is "nothing stimulating," why do these things happen? Why do we pretend that professionals aren't human and don't even see their patients? That is simply unrealistic and not accurate.

A medical training document published by the government of the United Kingdom states:

"Students must be taught that there is nothing unusual or abnormal about having sexualised feelings towards certain patients, but that failing to identify these feelings and acting on them is and likely to result in serious consequences for their patients and themselves."

"If a healthcare professional is sexually attracted to a patient and is concerned that it may affect their professional relationship with them, they should ask for help and advice from a colleague or appropriate body in order to decide on the most professional course of action to take. If, having sought advice, the healthcare professional does not believe they can remain objective and professional, they must:
• find alternative care for the patient
• ensure a proper handover to another healthcare professional takes place
• hand over care in a way that does not make the patient feel that they have done anything wrong."
link

"There is nothing unusual or abnormal about having sexualized feelings towards certain patients." It is biology. It is going to happen. So rather than pretending that doctors can turn off their sexuality like a switch, which they can't.  Why isn't the topic dealt with realistically so that proper protections for patient and doctor can be provided for?

What about chaperones in the room during exams? This article talks about how seldom chaperones are used and how often patients are more uncomfortable when one is used. I can understand this since the general approach to chaperones is to grab some other employee (so generally a stranger to the patient), so now the patient has two strangers ogling them instead of one. And sometimes that extra has little medical training. Plus, if there is an environment of inappropriate behavior at a medical facility, it often involves more than one employee or else other employees are quiet out of fear of employment repercussions. This case, where a surgical tech was both sexually assaulted and witnessed inappropriate behavior towards patients, is an example. Bringing in a coworker does little to encourage patient trust. In fact, when chaperones are used, it is generally to protect the doctor (from accusations and lawsuits) rather than the patient. This article  explains how and why chaperones are typically used and how they aren't much help to the patient. It also includes this great reminder that doctors are human and aren't magically blind to their patient's appearance:
"A third reason respondents said they used chaperones was protection from their own sexual feelings. One male doctor talked about a female patient of his who he considered “gorgeous.” He had a difficult time examining her. “…I needed to use a chaperone." he admitted. "A chaperone not for her comfort but for mine.”

Wouldn't increased modesty for patients make the situation more comfortable for both the patient and for the doctor and other medical staff who may be sexually aroused, in spite of his/her best intentions? The less they can see, the less likely they will be notice something they wish they hadn't. You can read more on this topic here.

Isn't there also a very logical argument for using doctors and nursers of the patient's gender for intimate procedures and exams? This article shows that patients would prefer it, but are often too embarrassed to request it, in part because of the derision with which medical personnel tend to respond to these requests.

For some practical tips and suggestions, check out our post on maintaining modesty.