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Parashar K, Grant-Kels JM, Korman AM. Is it ethical to lie by omission for a patient? Clin Dermatol 2024; 42:317-318. [PMID: 38401699 DOI: 10.1016/j.clindermatol.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
In the age of increasing transparency, dermatologists may encounter requests from patients to alter or withhold key medical information from their electronic medical records. Per the Health Insurance Portability and Accountability Act, patients have the right to view their medical record and request amendments; however, the physician is the final decision maker on what information should be included in the chart. It is integral that medically necessary information is included in the chart in accordance with the principle of beneficence and nonmaleficence. Withholding medically pertinent history may cause harm to the patient. Navigating such challenging situations while maintaining transparency requires a thorough understanding of the patient's dilemma. This contribution provides a framework by applying multiple ethical principles and will empower dermatologists to navigate such requests.
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Affiliation(s)
- Krishan Parashar
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Abraham M Korman
- Department of Dermatology, The Ohio State University College of Medicine, Columbus, Ohio, USA.
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Grossman LV, Masterson Creber RM, Benda NC, Wright D, Vawdrey DK, Ancker JS. Interventions to increase patient portal use in vulnerable populations: a systematic review. J Am Med Inform Assoc 2021; 26:855-870. [PMID: 30958532 DOI: 10.1093/jamia/ocz023] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND More than 100 studies document disparities in patient portal use among vulnerable populations. Developing and testing strategies to reduce disparities in use is essential to ensure portals benefit all populations. OBJECTIVE To systematically review the impact of interventions designed to: (1) increase portal use or predictors of use in vulnerable patient populations, or (2) reduce disparities in use. MATERIALS AND METHODS A librarian searched Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews for studies published before September 1, 2018. Two reviewers independently selected English-language research articles that evaluated any interventions designed to impact an eligible outcome. One reviewer extracted data and categorized interventions, then another assessed accuracy. Two reviewers independently assessed risk of bias. RESULTS Out of 18 included studies, 15 (83%) assessed an intervention's impact on portal use, 7 (39%) on predictors of use, and 1 (6%) on disparities in use. Most interventions studied focused on the individual (13 out of 26, 50%), as opposed to facilitating conditions, such as the tool, task, environment, or organization (SEIPS model). Twelve studies (67%) reported a statistically significant increase in portal use or predictors of use, or reduced disparities. Five studies (28%) had high or unclear risk of bias. CONCLUSION Individually focused interventions have the most evidence for increasing portal use in vulnerable populations. Interventions affecting other system elements (tool, task, environment, organization) have not been sufficiently studied to draw conclusions. Given the well-established evidence for disparities in use and the limited research on effective interventions, research should move beyond identifying disparities to systematically addressing them at multiple levels.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | - Natalie C Benda
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Drew Wright
- Samuel J Wood Library, Information Technologies and Services, Weill Cornell Medicine, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Value Institute, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jessica S Ancker
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
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O’Neill S, Chimowitz H, Leveille S, Walker J. Embracing the new age of transparency: mental health patients reading their psychotherapy notes online. J Ment Health 2019; 28:527-535. [DOI: 10.1080/09638237.2019.1644490] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Stephen O’Neill
- BIDMC Social Work Department, Harvard Medical School, Boston, MA, USA
| | - Hannah Chimowitz
- BIDMC Division of General Medicine, Harvard Medical School, Boston, MA, USA
| | - Suzanne Leveille
- BIDMC Division of General Medicine, Harvard Medical School, Boston, MA, USA
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Jan Walker
- BIDMC Division of General Medicine, Harvard Medical School, Boston, MA, USA
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Kosky N, Burns T. Patient access to psychiatric records: experience in an in-patient unit. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.19.2.87] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Forty of 46 consecutive admissions to a psychiatric inpatient unit were encouraged to read their admission notes and discuss them with the Junior doctor. The offer was withheld for two patients with organic impairment. Twenty-eight patients (including 12 on compulsory admissions) accepted the offer. The 12 who refused were characterised by overall lower educational attainment. Diagnosis raised only a few problems, prognosis and maintenance treatment being the focus of most discussions. There was no evidence of a deterioration in the quality of notes or therapeutic relationships as a consequence of access. Only in one case was the exercise judged ‘harmful’, but ‘useful or essential’ in 22. Possible benefits for both patients and doctor are explored.
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Laugharne R, Stafford A. Access to records and client held records for people with mental illness. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.20.6.338] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Increasing involvement of users in health service planning has led to a movement towards patients having more information about their care. Some have advocated patients having access to their medical records and this is now a statutory right. There has been concern as to whether this is suitable in mental health. An addition or alternative to access to medical notes is a client held record which might increase the patient's feeling of autonomy while also improving communication and compliance. In studies on access most patients and staff have found this beneficial. Client held records have also been positively received in the few studies reported but more evaluation in routine practice Is needed.
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Treloar A, Adamis D. Sharing letters with patients and their carers: problems and outcomes in elderly and dementia care. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.29.9.330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodIn a cross-sectional survey, we assessed the attitudes of older patients and their carers towards receiving copies of letters about them and the effects upon outcomes of sharing letters. We also studied the opinions of consultants on letter-sharing.ResultsFew old age psychiatrists shared letters with patients or carers, and many had concerns about this practice. In contrast, letters were considered ‘very welcome’ by 87% of patients and carers who received them, and 81% of those who did not would be ‘very pleased’ to receive them. Patients and carers who had received letters had significantly better knowledge of their care plan, whom to contact and ways of making contact with services.Clinical ImplicationsDespite concerns expressed by psychiatrists, our findings support the sharing of letters with patients and carers of patients with dementia in old age psychiatry services.
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McShane R, Rowe D, Julier D. Will the information recorded in psychiatric notes change when patients have the right to read them? PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.16.7.404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Psychiatric patients have had the right to see their notes from 1 November 1991. The ‘Access to Health Records Act (1990)’ makes provision for certain parts of the record to be exempt, including information which may cause serious mental or physical harm to the patient or anyone else. In addition, patients should not have access to information given by third party informants unless appropriate consent has been obtained. The legislation only applies to records made after 1 November 1991. It does not cover informal arrangements where written application for access is not made.
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Abstract
Recent changes in the law and mental health policy have forced psychiatrists and other mental health professionals to review the traditional cloak of secrecy that surrounds record keeping and letter writing. This paper establishes what proportion of patients attending a psychiatric out-patient clinic are interested in receiving letters from their psychiatrist. Those who are interested tend to be better educated, whereas those who are not interested are much more likely to have an ICD–10 diagnosis of schizophrenia. Overall, there appear to be high levels of satisfaction with the nature of the letters received. The significance of these findings is discussed in relation to the difficulty of engaging people with the most severe and enduring forms of mental health problems as active participants in the process of care.
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Jha A, Bernadt M, Brown K, Sawicka E, Stein G. Access to health records: psychiatric patients and patients with diabetes compared. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.22.5.309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study was undertaken to assess whether psychiatric patients respond more adversely to reading their own records than non-psychiatric patients. Seventy-three psychiatric out-patients and 84 out-patients with diabetes were posted their main clinical summary with a questionnaire about it. For seven of the eight questions, more than 70% of both patient groups gave favourable ratings. However, the psychiatric patients gave significantly less favourable responses than the patients with diabetes on five of the eight questions. Fourteen of 73 (19%) psychiatric patients were upset by reading the clinical summary about themselves compared with four of 84 (5%) patients with diabetes.
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Borkosky B. Who Is the Client and Who Controls Release of Records in a Forensic Evaluation? A Review of Ethics Codes and Practice Guidelines. PSYCHOLOGICAL INJURY & LAW 2014. [DOI: 10.1007/s12207-014-9199-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hanauer DA, Preib R, Zheng K, Choi SW. Patient-initiated electronic health record amendment requests. J Am Med Inform Assoc 2014; 21:992-1000. [PMID: 24863430 DOI: 10.1136/amiajnl-2013-002574] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Providing patients access to their medical records offers many potential benefits including identification and correction of errors. The process by which patients ask for changes to be made to their records is called an 'amendment request'. Little is known about the nature of such amendment requests and whether they result in modifications to the chart. METHODS We conducted a qualitative content analysis of all patient-initiated amendment requests that our institution received over a 7-year period. Recurring themes were identified along three analytic dimensions: (1) clinical/documentation area, (2) patient motivation for making the request, and (3) outcome of the request. RESULTS The dataset consisted of 818 distinct requests submitted by 181 patients. The majority of these requests (n=636, 77.8%) were made to rectify incorrect information and 49.7% of all requests were ultimately approved. In 6.6% of the requests, patients wanted valid information removed from their record, 27.8% of which were approved. Among all of the patients requesting a copy of their chart, only a very small percentage (approximately 0.2%) submitted an amendment request. CONCLUSIONS The low number of amendment requests may be due to inadequate awareness by patients about how to make changes to their records. To make this approach effective, it will be important to inform patients of their right to view and amend records and about the process for doing so. Increasing patient access to medical records could encourage patient participation in improving the accuracy of medical records; however, caution should be used.
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Affiliation(s)
- David A Hanauer
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca Preib
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan, USA
| | - Kai Zheng
- School of Information, University of Michigan, Ann Arbor, Michigan, USA Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Sung W Choi
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
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McLaren PM, Watson R, Wooster A, Morris R. Assessing medical records: Patient preferences and knowledge. J Ment Health 2009. [DOI: 10.3109/09638239309018400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McShane RH, Rowe D. Access to psychiatric records: Bane or boon? J Ment Health 2009. [DOI: 10.3109/09638239408997940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Claassen CA, Lovitt R. Solving ethical problems in medical settings during psychological assessment: a decisional model. J Pers Assess 2001; 77:214-30. [PMID: 11693854 DOI: 10.1207/s15327752jpa7702_05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The unique culture of medical settings impacts the style, pace, and quality of psychological consultation provided in that setting. Matters of life and death and other health emergencies, relationships with the courts, and contact with severely impaired patients are typical events. Medical psychologists (MPs) share many, but not all, of the ethical values that guide provision of services by other medical professionals under such circumstances. This generates the need to develop an interdependent but independent ethical orientation on the part of MPs in all professional activities, including psychological assessment. In this article, background information is presented on values that frequently drive medical treatment that may conflict with the MPs' ethical standards. A model appropriate for use in situations requiring complex decisional processes is reviewed, and vignettes are presented as examples of bioethical problem solving under this systematic decisional framework.
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Affiliation(s)
- C A Claassen
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 75235-8898, USA
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Affiliation(s)
- M Carter
- Health Issues Centre, Melbourne, VIC.
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Carman D, Britten N. Confidentiality of medical records: the patient's perspective. Br J Gen Pract 1995; 45:485-8. [PMID: 7546873 PMCID: PMC1239373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The development of modern information technology and the increasing amount of multidisciplinary teamwork in primary health care mean that the principle of patient confidentiality is becoming difficult to uphold. The debate about confidentiality so far has paid little attention to patients' views. AIM A qualitative study was undertaken to explore patients' expectations and attitudes concerning confidentiality of patients' medical records in general practice. METHOD Semi-structured interviews were carried out with 39 patients from one general practice. RESULTS Patients' expectations diverged considerably from actual practice. The majority of interviewees felt that administrative and secretarial staff should not have access to medical records. Some patients had reservations about a doctor not directly involved in their care having access to their records. They were unaware of the fact that practice staff had ready access to their medical records. Interviewees had particular concerns about recording of nonmedical information in their records, and the confidentiality of computerized records. CONCLUSION Assumptions of shared doctor-patient definitions of confidentiality, at least in this practice, would be misplaced. It is suggested that explicit negotiations about what is recorded in patients' records would go some way to addressing the discrepancies identified in this study.
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Affiliation(s)
- D Carman
- Department of General Practice, United Medical School of Guy's Hospital, London
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Bloch S, Riddell CE, Sleep TJ. Can patients safely read their psychiatric records?: Implications of freedom of information legislation. Med J Aust 1994. [DOI: 10.5694/j.1326-5377.1994.tb126913.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sidney Bloch
- Department of PsychiatrySt Vincent's HospitalMelbourneVIC
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Fisher B, Britten N. Patient access to records: expectations of hospital doctors and experiences of cancer patients. Br J Gen Pract 1993; 43:52-6. [PMID: 8466775 PMCID: PMC1372298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The aim of this study was to examine cancer patients' reactions to the offer of access to their medical records, hospital doctors' preconceptions of patient access to medical records and the reality of access to records for both parties. Semistructured interviews were conducted with 32 patients and 21 hospital doctors. Hospital doctors were also shown letters from their department to the general practitioner and asked about any changes they would have made as a result of knowing about patient access to records. The results showed that most patients were able to judge for themselves if they wanted access or not and that patients who chose to look at their records found access to their records helpful and reassuring even if the news was bad. Doctors expected access to records to be harmful to patients but would not have wished to amend many of the letters they had written. Patient access to records can be a safe and useful adjunct to good patient care.
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Affiliation(s)
- B Fisher
- United Medical School, Guy's Hospital, London
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Reuler JB, Balazs JR. Portable medical record for the homeless mentally ill. BMJ (CLINICAL RESEARCH ED.) 1991; 303:446. [PMID: 1912837 PMCID: PMC1670595 DOI: 10.1136/bmj.303.6800.446] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J B Reuler
- Section of General Medicine, Department of Veterans Affairs Medical Center, Portland, OR
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Hussey RM, Clarke CA. Deaths from Rh haemolytic disease in England and Wales in 1988 and 1989. BMJ (CLINICAL RESEARCH ED.) 1991; 303:445-6. [PMID: 1912836 PMCID: PMC1670590 DOI: 10.1136/bmj.303.6800.445] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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