July 2001


By Michael J. Katin, MD

For the 53rd out of 55 times I will be postponing the planned topic because of a more important subject that needs to be addressed: patient privacy.

As has previously occurred, I was prescient (Survey This, Part II, November, 1999) in recognizing the potential for disruption of established habits of clinical practice by an emphasis on making sure that a patient's medical details are protected from access by disreputable parties, particularly other treating physicians. Legislation is now taking effect to specifically define the proper ways to ensure this. Unfortunately, this will make an impact on the ability to rapidly steer a patient through workup and evaluations to most effectively finalize a treatment plan.

For example, consider the scenario that at the time of a status check for Joe Doakes (not a real name), being treated with radiation therapy for locally advanced carcinoma of the lung, he is found to be concerned with a podiatric problem. You call Dr. X (not a real name)and that practitioner is happy to see Mr. Doakes (not a real name) that afternoon. Unfortunately, you (not a real name) find that Mr. Doakes (ibid.) has already gone home. The options are:

  1. You cancel the rest of your schedule, call Mr. Doakes, and have him come back to the office to sign a specific release form for records to go to Dr. X, after you have discussed with him exactly which records should be released. Copy the records for him and have him come back again to pick them up to take with him to Dr. X that day.
  2. You cancel the result of your schedule, go to Mr. Doakes' home with the chart, and get his signed consent as to which items should and can be released You then go back to the office, copy the records, and take them to Dr. X's office.
  3. BUT you shouldn't have taken the chart out of the office. Forget about option 2. You cancel the rest of your schedule, go to Mr. Doakes' home, get him to sign a release to have a notarized copy of the chart made, go back to the office, take the chart copies back to his home, go over them with him, have him sign a consent to release the records of his choice to Dr. X, burn the unreleased copies in front of him and photograph his witnessing this, and then take the released copies to Dr. X's office
  4. Tell him the medical oncologist will take care of it.

The correct answer is, of course, 3, although you're still going to get penalized by HHS since you forgot to get a signed receipt for the records from a legally-designated representative of Dr. X when you went to that office. This blotch on your professional record will be posted on the internet, which will be accessible to anyone with a modem.

email: mkatin@radiotherapy.com