ALMOST PERFECT

I accompanied a person to the doctor, today, and was impressed with what I saw.  First, the staff and the doctor had hard copies of the records, x-rays, reports and materials (from other doctors) he needed. Second, he took a history relevant to the patient's complaint and even prompted for information he thought the patient might have and with a little effort, could produce.  Then the doctor actually physically examined the patient.  He was comfortable with his examining technique and quality and, as a physician, I felt assured that he was demonstrating not only his interest in the patient, but own competence and integrity.  And then he spent a few minutes talking to the patient, reviewing scans and x-rays with the patient, and demonstrating why and how he came to a medical diagnosis, the meaning of that diagnosis, the prognosis and treatment. The visit was everything that a visit should have been.

Unfortunately, if you are a new Medicare patient, this doctor will not be able to see you.  He has closed his practice to new Medicare patients.

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?

Insurer's Religious Principle: It Is Better To Receive Than To Give

Kaiser reports that insurers decline to stop their practice of canceling some of their "insured" ill patients' policies. Read the article by clicking the title above. May not be suitable for all ages and may cause the sudden onset of extreme nausea.