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05/07/2013

Waiting for medical records “after discharge” is of no help for decision making

 

Medical records:

Waiting for medical records “after discharge” is of no help. 

Reviewing medical records  in the hospital allows the patient and/or a surrogate decision maker to obtain the greatest amount of information possible over the cross section of medical specialties providing care.  It provides a clear picture of the condition of the patient with respect to cognition, pain and prognosis. Review of reports of CT scans, x-rays, and MRI’s can bring a clear picture of improvement and deterioration in the patient’s condition. All of this will ensure that consent is based upon complete information and make it easier for patients and surrogates to arrive at a truly informed decision rather than on confusion, fear and guilt.

Yet, almost universally, medical records are withheld from patients, their surrogate decision makers, independent bioethicists, and attorneys until well after the patient is discharged from the hospital. In cases of critical care and end of life cases this is especially problematic. It may result in a decision as to whether or not to withhold or withdraw life sustaining treatment to be based upon incomplete and in many cases biased information. 

The patients and their decision makers are entitled to receive all material information required to make an intelligent and informed decision. As the risks of decisions increase the necessity for an increased amount of information must follow.

Today’s patients and decision makers are in a different position than patients 30 or 40 years ago. Their ability to obtain information rapidly using internet searches provide a plethora of information.  Most medical centers are in the process of transitioning to electronic health records. This will ease administrative problems in getting copies of reports by consultants, radiology, labs, etc to decision makers. Medical centers have the ability to establish a “portal” to physicians and can do the same for patients and decision makers.

Accordingly, legislation mandating the release of medical records to patients and surrogate decision makers, in the hospital on a timely basis, must be promulgated with real penalties for failing to do so.

Why wait for a patient to die before providing information?

 

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