Fishing expeditions in doctors' offices
CMAJ 1997;157:370
See response from: D. Dodek & A. Dodek
Everything Daniel Dodek and Dr. Arthur Dodek wrote on patient confidentiality is true ("From Hippocrates to facsimile: protecting patient confidentiality is more difficult and more important than ever before," CMAJ 1997;156:847-52 [abstract / résumé]). However, I believe they omitted the single most sinister invasion of a patient's privacy.
Recently lawyers and insurance companies have begun demanding a photocopy of the patient's entire chart rather than a medical report by the attending physician. Several dangers arise because of this practice. The worst is that it gives lawyers and insurance companies a chance to go on "fishing expeditions" through the whole record, not just search for the facts pertinent to the incident concerning them.
The record is unlikely to record repetitive symptoms every time the patient is seen, especially during a long illness or protracted recovery. To lawyers and insurers, this absence of notation means patients no longer have a symptom, although the physician knows they do. It is not economically viable to write, during every visit, notes that are complete enough to be used in place of a properly constructed medical report. It is also quite impossible to obtain this kind of detailed information from most charts, which I have reviewed for both hospitals and the Canadian Medical Protective Association. Illegibility and personal abbreviations further compound the problem.
It is time for physicians to bring this practice to a resounding halt. If we can stop the demand for the entire chart, we must respond by producing timely and accurate medicolegal reports.
G. Terence Riley, MD
Oakville, Ont.
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