First, Do No Wrong - Continued

In my blog of July 31, 2010 dealing with an experiment in which physicians' clinical notes are posted on the internet so that patients can read them (or possibly anyone whom the patient permits to see the notes can read them).  I mentioned patient and physician self-censorship with the comment that I would come back to the subject.

In my clinical experience, the most common situation in which patients withheld important information because of fear that it would be released to a third party, was spousal physical abuse about which California  physicians were (are) required to contact appropriate government agencies and patients did not want that report to be made. In spousal  physical abuse, there were telltale signs on examination which told the story even when patients' words did not. And I and other physicians would tell our doubly injured patients (physically and emotionally damaged) that we were required by law to report and that we would comply with the law. Should that information also  be recorded in a medical note to which the offending spouse might gain internet access even before the authorities intervened?

Less common patient censored information included sexual practices, sexually transmitted diseases, patient or familial mental disorders, childhood abuse,  alcohol and other substance abuse, and even the eating of food representing different ethnic practices which patients felt would lead to shame if disclosed to the physician or others. Physician inquiries about familial diseases were often responded-to with "I don't know" rather than the facts which (as time revealed) were well-known to these patients.

Physicians may censor information, which they know may lead to patient difficulties (i.e., advise patients to pay cash for certain tests because insurers might use the insurance-billing information, or information provided which might get back to an employer, in a way which might cause patients to lose insurance or their jobs) and make no mention of their advice or the conditions they were concerned about in their notes.

What do my readers think? For or against posting physician clinical notes on the internet? And why?