DISQUS

The Refugee · 7 months ago

I actually don't have this happen too often. In training, I was told that the family could do so, but had to be supervised in medical records. (I presume that was a paranoid hospital's policy).

Since I've been a hospitalist, it's only happened once. But think about why they're asking. It's because they feel like they haven't been communicated with appropriately/sufficiently. I find that when I take over a service for the week, they're often right.

My approach then is what I think it will be in the future. I take the chart into the room with me, sit down with it open, and ask then what I can help then with. It actually diffused the situation nicely.

That said, this is going to be a harder request to fulfill since you can't exactly "log in" the family members to the EMR and let them rummage around... especially when we assume secretarial duties... I mean... when we go to physician order entry.

Anonymous · 7 months ago

I will bloodydamnwell sue the shorts off anyone or any hospital that lets my family look at my chart without my permission.

Nurse K · 7 months ago

A nurse at my hospital's dad was admitted; she was a visitor in his room and used her hospital log-in to look at his chart. She was fired for the same later that week---in a union hospital.

When I worked the floor, I didn't allow family members to read the chart even if the patient said okay (usually the family member was a medical person). I said I would answer their questions about the plan, test results, etc, however, and have them write down their questions for the doctor if I couldn't/shouldn't answer them myself.

Anonymous · 7 months ago

I've seen this in two scenarios:

most commonly it's a non-medical person who has no idea what they are looking at; it's being used as a control tactic against the patient or the docs (or both). Occasionally family will insist something be changed and will call administration over something they don't like. Usually it's an an overdose pt or someone admitted for panic attack that the family insists has a disease they don't. Sometimes it's family who plans a lawsuit (you have to say the weakness is from the acccident, not the cocaine induced stroke...)

Other times it's a doc who is either distantly realted to the pt or a friend of the pt's relative. Family has no clue what is going on and hospitalists/consultants/nurses have tried to explain (or are to busy to explain) but family doesn't get it. Usually family is perseverating on something meaningless (number of IVs, pt needs foot cream while in ICU for MI, I think she needs new glasses..) In these cases I've read the pt's chart so I can spend the next few hours trying to explain to the family (my family...) what's really going on and what they need to do.

Sometimes we can say things to our own relatives that the hospital staff is too professional to say. If one of the docs is able to talk to me, then I don't need to see the chart but it does make my aunt and uncle happy if I pretent to study it.

When someone asks to see my patient's chart, I just ask "why?" - usually this solves the problem.

Zoe · 7 months ago

I think I have had one family ever year or so ask to read the chart. I also ask why and quickly review the chart for any undignified "chart wars" that may have occurred. This assessment is usually done in 5 minutes, and then I let the family look with the patient's permission. No one can read the progress notes, because the handwriting is so bad, and the family feels secure that there are no unnatural secrets occurring. Most are bored with the chart in a few minutes and give it back. I always want to review my parents' charts when they are admitted, just to make sure no one has missed anything important, because as doctor/daughter I consider myself part of a team focused on getting my parent well. Too much paranoia just makes you look guilty.

MrsB · 7 months ago

When our son was in the NICU we read his chart all the time. It was sitting out where this was easy to do. No one seemed to think this was unusual for a couple of educated but non-medical parents to be doing. I would have been upset if this had not been permitted.

Reality Rounds · 7 months ago

We let families read the charts if the patient gives permission. I see absolutely no problem with this. We make sure their doctor or nurse is available to answer any questions.

PJ Geraghty · 7 months ago

I review patient charts all the time as part of my job, but I was chastised for reading my *own* chart while admitted for my tibial plateau fx almost two years ago. A transporter left it at the foot of my stretcher while I waited for a CT, so I picked it up and started reading it. When he saw me doing so, he took it away from me and admonished me that I was not allowed to ready my chart. I didn't fight it because I had seen enough to answer my questions.

But, betcherass that if I wanted to see MY chart again, I'd be allowed to do so, and if I wanted to read my kid's chart, I'd be allowed to do so, even if it came after performing unlicensed and duplicative colorectal surgery on the individuals trying to prevent me from doing so.

When my nephew was in the NICU I didn't ask to see his chart, but I told my sister (a "civilian") that if she would like me to review it, she should ask permission. I did look at some x-rays with the NICU attending as we reviewed the baby's chylothorax. I explained who I was and why I knew something about CXRs, and with my sister's permission, we had an intelligent discussion about the situation. No problems.

Anonymous 1:57: you are correct that no one outside of the care team should be allowed to read your chart without permission. No one has suggested otherwise.

Nurse K @2:50: the nurse reading her father's chart online should have been fired, union or no union. There's a proper sequence of events to follow in this case, and she didn't follow it. But if a patient consents to someone else reviewing his record, that person should be allowed to do so. What are we all so afraid of?

~ Erica ~ · 7 months ago

The chart can be viewed with permission of the patient. It is viewable after discharge anyway as well so what ever is in there prior to discharge is in there after discharge...legal and binding. Its the permission part that is the sticky area....be sure the patient is alert and in the right state of mind. I would make sure the hospital has or does not have a release form policy for viewing the chart prior to discharge. When I worked on the floor no one ever asked about viewing the chart...I think it is a 'fear' of crossing the line for most folks.

Grumpy, M.D. · 7 months ago

Agree with refugee. I go over it with them.

Frank Drackman · 7 months ago

Are you really a Doctor??? Thats one of the most stupid things you can ever do... You could put on a clown nose and some big shoes, but that wouldn't be quite as bad...Ever heard of HIPPA??? Maybe the patient doesn't want his wife knowin about that case of GC he had in 1982, or his positive drug screen or maybe its the wife who's blood typeo , he's AB, and the new baby is "O"...DOH!!!!!!
Its a bad idea, but someones gotta do it,

Frank

Anonymous · 7 months ago

Seriously?!
Since some of ya are OK with tossing $$ away... can you toss some my way?...just say'n.
-Second career nursing student