First, Do No Wrong

An NPR program on Friday 7/29/2010, which excited listener call-in interest, dealt with patients' rights to their own medical records.  Neither the moderator nor the program's physician consultants mentioned highly relevant federal law on this subject and this blog won't deal with that issue today. The program was short on significant statistics and long on testimonials of questionable value.

The program focused on an experimental New England medical teaching institution-based project to post patients' medical records on a secure internet site for them to review.  The proposed benefits included better patient information about what the doctor was thinking, the availability of records for patients to download and then provide to other doctors, and increased patient trust in physicians because of knowledge of what was in the record. No downside to this process was discussed.

For years, my practice habit was to always dictate my "progress notes"while the patient was sitting two feet away from me. The process took no more than 3 minutes and informed patients about my understanding of their relevant medical histories,  physical findings, interpretation of laboratory data and the diagnosis I had formulated, and my treatment plan and other issues which pertained to that visit.  Unlike the process of later posting the clinician's notes on the internet, my system allowed (the patient was invited to) patient correction of any errors and for me to make the correction or explain why I chose not to.  I had made it my habit to encourage patients (and often accompanying family members) to ask for clarification and for more information about the subjects I had discussed immediately after I signaled that my dictation had ended. When patients left my office, they were secure in their knowledge of what was (and was not)  in their  charts and additional requests by patients for copies of their records was unusual unless they needed records for medical care elsewhere.

The New England experimental program involving electronic health records has several downsides. Patients may self-censor the information provided to physicians and physicians may self-censor what they include in medical records.  Patients' reviews of the their records is deferred which may leave them with significant delay and unnecessary anxiety about what doctors thought. There is no timely patient-physician give and take with a chance for others (i.e., family members brought in by patients) involved in patients' care to participate in the discussion process. And, it takes strong physician training and discipline to provide a complete internet-posted electronic health record which even touches on serious issues such as interpersonal family relationships, the consideration of the possibility or presence of serious social diseases (such as HIV, syphilis, gonorrhea),  or situations, conditions or diseases which may result in deleterious insurer action, employer action, government action or adverse legal consequences.

Maybe we should slow down the use of technology, and bring smart social scientists into the process, so that we do no wrong.

BP's Gift That Keeps On Giving

At 6:15 AM today, on National Public Radio, I heard the word. A scientist was describing the conditions she encountered at the BP oil environmental catasrophe site and she said that she experienced a strong smell of benzene in the air.

Benzene causes bone marrow damage and cancer. Exposure of children, pregnant women, adults and the elderly to toxic benzene will have serious long term effects, including leukemia and other diseases caused by benzene's capacity to cause mutations. The problems BP has created will not be gone by Christmas; BP's gift will  create catastrophes for our people for many years.

Read for yourself and then start writing the White House and your Congress people, since both should shoulder the blame for allowing BP to cause this mess. Ask them to tell the truth about the environmental catastrophe BP has caused for people's health, not just the health of fish and birds and shrimp. Demand that the United States Public Health Service be responsible for tracking and publicly reporting the downstream health effects of BP's polution. Demand that BP pay all of the health care costs resulting from their pollution of the ocean and air, and not dump the costs on the government and its taxpayers. Demand that Congress adequately fund the agencies responsible for regulating oil drilling and that the White House staff the agencies, not with political cronies who will rubber stamp "APPROVED" on every harebrained idea proposed by oil companies which buy unregulated freedom through political contributions.

This was not just BP's failure. It was a failure of our government (the political and administrative actors are attempting to distance themselves from responsibility). Our children, men and women, workforce and industry are suffering from BP's destruction of our environment and continuing American government willful  incompetence.  Demand accountability.