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
(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:
- 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.
- 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.
- 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
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.