Talk of the Nation: Should Patients See Their Doctors’ Notes? There are some special concerns among psychiatrists.


 

Posted by: Maria Mangicaro

January 5, 2012

From NPR Talk of the Nation:  More than 90 percent of patients in one survey said they’d want to know what doctors write in their charts.  The majority of doctors, though, are reluctant to share their notes.

Time’s Alice Park explains why patients want to see their charts — and why many physicians, especially psychiatrists, are wary of the idea.

A psychologist calls in to discuss how she maintains her records in a way that assumes her patients will read them.   Park mentions there are concerns among psychiatrists who feel patients may be harmed by reading about how their physicians interpret their symptoms.   Click here to listen:  http://www.npr.org/v2/?i=144744439&m=144744431&t=audio

Can Patients Handle the Truth? Getting Access to Doctors’ Notes

A new study asks patients if they want to read what their doctor is writing in their chart.  Overwhelmingly, the answer was yes. Not surprisingly, doctors resist.

By Alice Park | @aliceparkny | December 20, 2011
Read more: http://healthland.time.com/2011/12/20/can-patients-handle-the-truth-getting-access-to-doctors-notes/#ixzz1idlTQJkz

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3 thoughts on “Talk of the Nation: Should Patients See Their Doctors’ Notes? There are some special concerns among psychiatrists.

  1. Thank you for this Maria, you draw some interesting points.

    I love the joke and it’s probably more real than not.

    I will say, when I’m counseling students, I always take notes and refer to them afterwards. They know that I’m engaged with what they are saying, and I’d show them the notes in a hearbeat.

    I’m surprized how it affects them…most will say, “no one ever listened to me like that, and wrote down what I say, as if I’m important.”

    I can have a great affect…

    • Dorothy,

      I am also a member of the Society for Participatory Medicine and I feel a patient is entitled to have copies off all of their medical records, especially those from a psychiatrist.

      One of my personal concerns with the nature of the psychiatric labeling process is that it gives psychiatrists the ability to pass off a patient’s actual physical aliments as psychological and psychiatric patients fail to received the same level and quality of care as other patients.

      For example, I’ve known individuals who have had thyroid problems and complained of being tired labeled as depressed and prescribed antidepressants before the psychiatrist thought to check their TSH.

      The worst case I have heard of was a young girl from Rochester, NY who experienced manic symptoms and was labeled with bipolar disorder. As the disease progressed it affected her neurologically and she was told she had MS. Eventually it was found she had Creutzfeld-Jacob disease which is fatal.

      I did a search on Medline and found several other cases of CJ Disease that were originally diagnosed as bipolar disorder.

      Here is a link to one of them:

      Creutzfeldt-Jakob Disease Presenting as Secondary Mania

      Ours is a report of a patient with Creutzfeldt-Jakob disease who presented with mania and was initiallly diagnosed and treated for Bipolar I Disorder, manic type. Psychiatric disturbances constitute the prodromal manifestations in 18%–39% of those with Creutzfeldt-Jakob disease.1 Dementia occurs in all patients and progresses rapidly. Patients may complain of fatigue and appear apathetic; personal hygiene suffers early; in some cases irritability may be prominent.2,3 Depression has been found in more than 30% of patients with Creutzfeldt-Jakob disease, and 10% of patients with Creutzfeldt-Jakob disease need psychiatric hospitalization for depression.1,2 We were unable to find any report of mania as a prominent presenting symptom.

      Case Report

      The patient, a 45-year-old, married mother of two, was in her usual state of health, working as a secretary until about 8 weeks before admission to a short-term psychiatric inpatient facility. At that time, the patient began to have pressured, incoherent speech, with thoughtracing, and abrupt shifts of thoughts. She went on spending sprees and built up considerable credit card debt, buying unnecessary things. She had severe insomnia, sleeping only a few hours each night. She also complained of blurred vision and gait difficulty, the latter also noted by her family.

      After evaluation of these complaints and a normal magnetic resonance imaging (MRI) of the brain, she was given a diagnosis of Bipolar I Disorder, manic type. After 2 weeks, she was discharged on Haldol (haloperidol: 15 mg/day), Cogentin (benztropine: 0.5 mg bid), and Depakote (divalproex sodium: 750 mg bid). During the first week at home, she became less spontaneous, increasingly lethargic, and less interpersonally responsive, and her gait problems worsened. She spent much of her time staring into space, not speaking. During the second week at home, the patient became increasingly agitated. Her medications were stopped; Klonopin (clonazepam) was started without improvement, and the patient was hospitalized at another acute psychiatric hospital, again diagnosed as Bipolar I Disorder, manic type.

      http://psychoticdisorders.wordpress.com/2011/04/15/creutzfeldt-jakob-disease-presenting-as-secondary-mania/

  2. In my experiences, Dr’s for the most part will not be 100 percent forthcoming with actual facts about the young ones they counsel. Whereas I believe in confidentiality I also, as a parent, feel we should have the right to see what the Dr has to say, really. When I speak with young ones, nothing they say is ever related to the parent but I do take what the young one said into great consideration when talking with the parent. I do the same when talking with the parent. You have to take both sides into serious consideration if there is ever to be an honest and open dialog started between the parent and the young one. However, 9 out of 10 young ones I work with are without a caring adult in their corner. I have experienced Dr’s who would rather hand out prescriptions willy nilly to treat the symptom without even trying to get the root of the issues. Our children are basically used as test rats. Trying one medication after another, stopping suddenly one to begin another. No wonder our young ones are so confused. They get the idea that “well, this med did not work, now they are trying another, this one is not working either so there must be something really REALLY wrong with me.” Experienced this, lived with this and watched a very special young man, my son, battle for 8 1/2 years before he took his life. Yes, I believe Dr’s should share their notes. If not sharing their notes, be honest in their practice and not experiment with our children
    Michael’s Mom
    March 22, 1984 – October 25, 2000

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