Monday, April 02, 2012

Why should a doctor feel offended if a patient asks for her medical records ??

I just saw a patient who had failed 3 IVF cycles in another clinic. She wanted a second opinion as to what else could be done , to increase her chances of having a successful IVF and getting pregnant. I asked her for a copy of her IVF medical records , so I could review exactly what had been done for her. Based on this information , I could design a better protocol , to increase her chances of achieving a pregnancy.

She told me that she didn't have any copies of her medical records at all . I was quite disappointed and asked her if she could arrange to get a printed summary of her IVF medical records, including photos of her embryos. Much to my surprise, she said - I'm scared to ask my Doctor for copies of my medical records , because I'm worried that he might be offended if I asked him for these. Do you really require them doctor? Can't you just to start my treatment ? or just repeat whatever tests you need ?

I was stunned. I just couldn't believe that a patient could be so scared of offending her doctor that she would refuse to even asked for a copy of her records ! Your medical records belong to you. They are your property , and while it's fine for the doctor to safeguard them, he is obligated by law to give you a copy when you ask for these. In fact , most good IVF clinics will proactively and routinely give patients a copy of their medical records , whether they ask for them or not. It's important for doctors to be open and transparent , and sharing medical records is a great way of doing so.

I wondered about how fragile her doctors ego was, that he would take offense at such a simple request. Would he feel threatened? Or would he feel that the patient was being disloyal and unfaithful by going to another doctor?

What amazed me even more is the fact that the patient was so scared of offending her doctor ! In a good doctor-patient relationship, both doctor and patient are equal partners and there should be no element of fear , if this relationship needs to be a healthy one.

I can understand why some doctors would want to assume a dominant position in this relationship - operating from a position of strength and keeping patients in a submissive posture can help them to increase their throughput , and is quite a rational strategy from their point of view. However, I cannot understand why patients would be willing to put up with this kind of behavior from a doctor , given the fact that they have so many choices today !

Maybe patients who are willing to accept this kind of behavior deserve the kind of doctor they get ?

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7 comments:

  1. Infertile Gynaecologist1:50 PM

    Respected Sir,
    I think I can relate to what you are saying. But blaming the patients alone by saying that ‘these patients deserve these kind of doctors’ may not be entirely correct. It may be true that there are many IVF specialists now a days, but as a patient one is a little skeptical about them, their skill and management protocols ; as unlike other treatments eg Angioplasty, Cholecystectomy etc ; infertility treatment is still kept under wraps, due to the stigma attached to it. Hence very little information is shared, even by the patients undergoing the same agony, even when there are many forums to address the same.

    I myself am your patient, now for almost a year and half; and have undergone two ICSI cycles with you and never thought it would be so simplified (although it was not successful) . I underwent the third ICSI with a very reputed and senior gynecologist in South Bombay & must add that it was extremely tiring. Yes, we did not get the pictures of the embryos as they do not give them as per their policy!!!

    Later I went to a very reputed hospital (South Bombay), where in after a waiting period of almost two – three months, I got my precious appointment of what I a may call very famous “Celebrity Doctor”.
    After waiting for almost 2 hours I finally got to see her assistant and after another half an hour to meet the” Celebrity Doctor”. I think I should be obliged as she gave her precious four minutes to scan me and give a list of investigations. I being a gynecologist myself had a few questions; but she bluntly replied that I need to follow up with the reports for any answer.

    On follow up with the reports (few done at metropolis lab, few at the hospital ), I again waited for a good two hours, to get only one of the reports . I was told that this being a Saturdays, they are too busy and could not find my husband's report (done at the very same hospital, almost 3 weeks back). I came back after four days and waited for a good two hour and 45 minutes to finally get the report (Semen analysis with IMSI morphology- which generally takes not more then 3-4 days!).

    Well there is not much one can do. I presume that waiting endlessly is what these doctors expect from the poor infertile patients. Leave alone asking for your medical records, even your own reports are not given in time! I have faced all this being a gynecologist myself. I just cannot imagine what the poor and uneducated may be facing!

    I, in fact get depressed and frustrated just at the thought of visiting another IVF specialist!
    I think the infertility specialists need to be a little considerate and treat all patients as atleast fellow human beings; and not just another file number!

    ReplyDelete
  2. I think part of the problem is that patients perceive themselves as being helpless and powerless. My point is that they are not !

    You always have choices - and patients don't need to put up with bad behaviour ! If all patients walked out of the doctor's clinic ( when the doctor makes them all wait for no good rhyme or reason) , then I am sure the doctor will improve their behaviour very quickly.

    After all, a doctor cannot survive without patients ! And a doctor is not doing you a favour by treating you - you are doing him a favour by choosing to go to him for your treatment . This is not a monopoly - and patients can help to improve a doctor's bedside manners by providing feedback.

    ReplyDelete
  3. Infertile Gynaecologist2:18 PM

    Respected Sir,

    I agree , but do we really have these many choices?

    Mostly we are under the impression that this particular doctor is very good and learned.It is the hope and desire to have a baby that makes one bear and suffer this nonsense.

    As far as providing feedback is concerned I think you might be one of the very few doctors who actually checks his emails . Most of the doctors have their assistants doing the same, on their behalf ; and during personal visits they all seem too busy. So the problem continues to grow....

    ReplyDelete
  4. Infertile Gynaecologist2:35 PM

    Respected Sir,

    Do you really think we have that many options?

    It is the desire to have a child that makes these infertile couples suffer all this non sense and humiliation. They believe that this learned and acclaimed doctor, will probably be able to help them. It is also the fear of being too arrogant, rigid and demanding. After all how many good infertility specialists do we really have?

    As far as providing feedback is considered, I believe you are one of the very few clinicians who actually replies to the emails. Mostly all emails sent to these infertility specialists are replied by their assistant doctor and secretaries. Also on personal visit they seem too busy to even answer your queries, leave alone your feedback!

    Things which you say Sir, looks good on paper but practically these are still a dream… I believe, patients require more knowledge & empowerment.

    ReplyDelete
  5. Infertile Gynaecologist2:36 PM

    Respected Sir,

    Do you really think we have that many options?

    It is the desire to have a child that makes these infertile couples suffer all this non sense and humiliation. They believe that this learned and acclaimed doctor, will probably be able to help them. It is also the fear of being too arrogant, rigid and demanding. After all how many good infertility specialists do we really have?

    As far as providing feedback is considered, I believe you are one of the very few clinicians who actually replies to the emails. Mostly all emails sent to these infertility specialists are replied by their assistant doctor and secretaries. Also on personal visit they seem too busy to even answer your queries, leave alone your feedback!

    Things which you say Sir, looks good on paper but practically these are still a dream… I believe, patients require more knowledge & empowerment.

    ReplyDelete
  6. Anonymous5:55 PM

    Dear Dr,

    Dr, is it not possible for your secretary to make a call to the concerned infertility clinic and retrieve the files of the patient? That is what they do here. When I switch doctor, I just tell the new doctor’s secretary that my previous doctor is so and so and they make sure that they get my medical records from them. I agree with the gynaecologist. There are places where we patients can’t be demanding and stubborn. What will we be getting in return by displeasing our infertility specialist? How many clinics a patient can change to make the doctor behave himself? Who is going to be affected in the end? In a country like India where there are numerous patient and very few doctors is it even possible to walk out of the clinic and expect that the doctor will learn a lesson? We are just one in hundred and it will not make a difference to them. On the other hand the problem also stems from the rivalry between the doctors and clinics (after all it is not a medical practise anymore, it’s just a business done without any concern for a fellow human being!). Why should a patient be afraid to ask the files? The reason is perhaps she cannot tell the doctor that she is going to see you and get a second opinion. Might be the rivalry is so strong that by mentioning your name she can upset the concerned doctor and we patients do not want to make our situation anymore uncomfortable as we are facing a lot more in life by being infertile! Where will this unhealthy competition between doctors lead to? Why can’t two flourishing IVF specialists be friends sharing their medical experiences and learning from each other? If the clinicians are friendly or atleast diplomatic enough in their relationship; it is not a Himalayan task to get the patient’s medical records, right? We patients are not scared. We are just trying to be polite and decent. That is what we Indians are taught from our young age. Be nice and polite to people who are above you in knowledge and especially to a doctor who is given the place of God. Can you imagine how uncomfortable it will be for a patient if the concerned doctor reacts in a nasty way when her file is being asked? Being polite we deserve better physicians. But the physicians have lost their humanity to money-making. They love money and use people while the reverse should be true!
    Dr, you cannot blame a patient alone for the happenings. I agree that patients have the power to change the medical system. But this can happen only when good doctors and patients join hands together to fight against the evil in the medical profession.

    ReplyDelete
  7. Yes, individual patients may not be able to do much - but as a group, patients have a lot of clout, so don't underestimate your power. Thanks to the internet, it's possible to amplify your voice !

    In India, the medical records belong to the patient, so doctors cannot ask another doctor for them.

    The medical records are a patient's property - and patients need to be possessive about them - and not get bullied !

    ReplyDelete

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