Dr. Marie Savard Talks About Your Medical Records and Rights
"You really do need to keep a complete set of your own records. They could save your life."When it comes to the reasons why you should be an active participant in your health care, there's no more dedicated advocate than Dr. Marie Savard, author of "How to Save Your Own Life: The Savard System for Managing and Controlling Your Healthcare and The Savard Health Record . Dr. Savard, an internist, women's health expert and patients' rights champion, knows that in today's managed care, HMO, world of ten-minute doctor appointments, it's even more critical than ever before to become a partner with your own medical team to ensure that you receive the best possible care. Here, we have an opportunity to follow up with Dr. Savard about some of her suggestions for patients.
Mary Shomon: People who ask for their medical records frequently are given excuses for why they can't have them. What are some of the most common excuses patients get from medical offices and doctors, and any of them valid? How can patients effectively respond to "stonewalling" of their efforts to get their records?
Marie Savard: There is no valid excuse not to give someone their medical records. Ethically and legally they are entitled to copies of all their information (as of last Friday, President Bush approved the new privacy rules which clearly states that patients are entitled to copies of their records). As doctors rely on medical records to make the most accurate diagnosis, and records are rarely complete or available when needed most, it is just a matter of good sense.
However, many doctors and their office staff don't even realize that people are entitled to copies of their records. The most common response from a doctor's office will be, "I can't give them to you. I would be happy to forward them to another physician." So I recommend that patients first remind the doctor's staff of their rights. Come prepared with a letter signed by you that requests a copy of all your information including consultations with doctors, hospital discharge summaries and operative reports and your laboratory tests including x-ray reports. Give them a self-addressed stamped envelope (a big brown one if you have a lot of records) and offer to pay a small fee such as $15.00 to copy them. Give them two weeks or a reasonable period of time. Then don't give up. Occasionally I have heard people getting tough and suggesting they will notify their lawyer if the don't get their records. Try honey over vinegar, but the bottom line is this - you really do need to keep a complete set of your own records. They could save your life.
The second most common reason doctor's give - "You won't understand them anyway." I would just smile and let your doctor's office know that not only is it your right, it is a matter of your good health to have your own copy to show future doctor's, specialists, or to take to emergency room visits. Of course you WILL learn to understand your records; they are about you.
Mary Shomon: While patients have the right to have their old records, should they be asking for them? And if they get them, what should they do with them?
Marie Savard: Old records can be incredibly helpful for some people, especially if you had a lot of tests or procedures or a complicated medical history. But the bad news is that records can be legally destroyed after 7 years (some states 5 years) and old records simply may not be available. You may also overwhelm your doctor by asking for all of them at once. I suggest starting with the current doctor and ask for copies of all test results, doctor consultations, and hospital summaries. If it is too much for them to copy at once, perhaps just start with your next tests, procedure, or specialist consultation. Once you have your current records and do some homework on your condition, you may find that specific old records would be helpful. Just don't be frustrated if you can't track them down. It is worth a try.
Mary Shomon: One thing that is particularly of concern to thyroid patients is "symptom-by-symptom diagnosis." You go in and complain about constipation, and end up with recommendations to treat that problem. Six months later, you go in complainant of depression, and you get an antidepressant. Six months later, it's hair falling out, and the doctor puts you on Rogaine. An astute doctor should be looking back over the records to see patterns such as this that might point to a problem like thyroid disease. But how can patients, who may not even see the same doctor from visit to visit at an HMO -- or whose doctors are so busy they usually don't review a patient's chart for each visit - ensure that they get their doctors to take a more big-picture, longer-term view?
Marie Savard: Everyone should keep a health journal. I recommend a simple lined piece of paper that you can keep in a binder with your other health records. List in chronological order symptoms that are troubling you, changes in your diet or menstrual pattern, changes in your routine and of course, medication changes.
Review your health journal with a friend (everyone should have a "Health Buddy" or advocate to go with them to the doctor's office) and list on a sheet of paper the purpose of your visit. Include anything that has not been quite right. If your doctor sees in advance what your concerns are, hopefully it will help them to get right to the point. By having your records with you, can share copies of prior specialist or other doctor visits, all previous test results and anything else that might be important.
The most important thing you can do is to prepare for the visit and take a friend to be your advocate.
Keeping a Health Calendar and noting your symptoms by dates can also help your doctor.
Mary Shomon: One of the big controversies these days is how much information patients share with their doctors about alternative treatments. Many patients do not share information about herbs and supplements they are taking -- probably out of fear of being chastised or lectured at by unreceptive physicians. Do you feel that it's important for patients to let their doctors know what alternative treatments they are pursuing, and if so, do you have suggestions for how patients can do this productively?
Marie Savard: Sharing information about everything we do to our bodies can be important. Anything that you put in your mouth or on your skin hoping for a therapeutic effect could also conflict with something else of cause an adverse effect. Most patients are afraid their doctor will laugh at them when they describe their daily routines. I recommend you keep a running list of everything you take on a daily basis, including the dose and directions, and share it with every doctor and pharmacist. The more professional you act, the more serious you will be taken. And please carry a card listing all your vital health information (keep it up to date) in your wallet.
Mary Shomon: One of the challenges thyroid patients face is a doctor's refusal to test for thyroid disease. Patients who have numerous symptoms go in asking for a thyroid test, but are told, for whatever reason (cost-controls? doctor's ego? inaccurate information?) that they don't need to be tested. I've heard from women who just had a baby who were told, "You can't have a thyroid problem or you wouldn't have been able to get tested." Doctors who palpate a neck and say "If you had a thyroid problem, I'd be able to feel it!" Men who are told that "Men don't get thyroid disease." Do you have suggestions regarding how patients with thyroid symptoms who are facing these sorts of refusals can get tested?
Marie Savard: The more information you come armed with and the more "important" and serious you look, the better. But I don't mean bring stacks of articles. I mean you and your health buddy come as informed as possible with the information in your head. If you have a single reputable article -- Mary, you have tons of great information -- you could bring that too. Show the doctor your list of concerns and questions. Be very specific as to why you want your thyroid tested. Be persistent. Tell your doctor that you need the reassurance that all is well and that you realize doctors can sometimes be wrong.
Mary Shomon: Do you have any particular advice about testing and record-keeping for patients who have chronic conditions like thyroid disease, or autoimmune conditions like Hashimoto's or Graves' that may ultimately result in other autoimmune conditions?
Marie Savard: Again, the most important way a doctor can spot a new condition or a new association not previously recognized, is to have a complete copy of all your information. If you can, track some of your blood work, diagnosis, etc. in a chronological format or use a calendar. Finally, the more you read up on your condition, the more likely you are to alert your doctor to any new problems. There is no way doctors can keep up with everything about you.
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