Like consent forms...there are no ironclad protections. But, why not record that your patient has long-haired guinea pigs? That human inquiry into how Fluffly is managing next time you meet will let your patient know they are seen and known.
That's always been my approach.. But I'm coming to realize that there are circumstances that I would argue are both 1) very relevant to patient care and 2) may put our patients at risk.
it is all too scary what is happening now in many arenas. It is horrible that people need to worry about these things when seeking health care. I wonder how many it will cause to delay or not seek care?
I have a different but related question as it is about medical records. What is your take on documenting alcohol use or something similar. Now that there is a change in warning labels on the table could a history of that potentially mean the person wouldn't be covered if XXX developed in the future. One hears different things about covering pre-existing conditions etc. thanks.
For providers looking for concrete strategies to resist criminalization of patients, Interrupting Criminalization has a wealth of resources and ways to plug in, there’s a section on documentation and if you sign up for the mailing list there are ongoing opportunities to learn and build more: https://www.interruptingcriminalization.com/beyond-do-no-harm
Thank you for writing about the topic, Mara. I wish more physicians were as sensitive and respectful! I love that you want to engage and develop a whole-person relationship. Having said that, with the medical record being the legal document that it is, Epic and other EHR systems need to develop "safe spaces" for BOTH providers and patients to note the personal details and interactions, like Diana's sticky note suggestion, only in a separate, dedicated, and large enough informal utility.
As a patient, I love that I have a provider who I feel really demonstrates her care for me as a person and as a patient, and I hope that is becoming more common. Interestingly, at my recent checkup, I noticed myself being more circumspect in what I was sharing, knowing that all of it could end up in my record, and I have nothing I can think of that would put me at risk of discrimination. Well, except weight, of course. Ahem. I know that as a pt. I can opt out of being weighed (unless it's related to certain procedures, surgeries or medications when it IS required for safety and correct titration, for example); but can I request that the BMI on my chart (total BS), the "big-fatty" outline graphic, and the term "morbid obesity" be removed? Really grinds my gears. Thanks!
Thank you! Unfortunately, I fear the EHR is not as safe of a space as I'd like it to be.... Because it's used for so many other purposes other than relationship between doctor and patient. Sticky notes are also discoverable in legal cases.
I really struggle with this too... My notes are not very efficient because I love recording these human details about patients that do impact their care in many cases. My patients comment that they feel more known and I feel like it helps my colleagues know my patients too if I'm out of office for whatever reason. But I do see the argument for simplifying notes, both to reduce the amount that I write and to limit potentially exposing information that is now more sensitive. I might move some info into my sticky note (though I am already running up against my word limit for that with unfortunate frequency).
I hate that we may end up speaking in code or having to obscure treatment we're doing in the record to protect patients from harm in the current reality. Our system has added a place in our Epic to document preferred pronouns, sexuality, anatomy to help with trans care and appropriate cancer screenings, but does protecting these patients now mean getting rid of this so it doesn't "out" people? I'm following my patient's lead on things for now, using endocrine disorder NOS if they request it but otherwise leaving it as is.
Thanks for bringing that up — it’s a huge concern! For example, if a patient has to pay $1000 to get basic labs completed, together we can come to a decision that we’ll focus on their urgent health concerns (like pain or hypertension) rather than long-term issues that might be revealed in labwork or age-appropriate cancer screening. It feels awful. The American health care system is deeply discriminatory.
HUGE concern. Thank you for sharing these resources. We need to do better. I fear that possible funding cuts to public programs may exacerbate these disparities.
Like consent forms...there are no ironclad protections. But, why not record that your patient has long-haired guinea pigs? That human inquiry into how Fluffly is managing next time you meet will let your patient know they are seen and known.
That's always been my approach.. But I'm coming to realize that there are circumstances that I would argue are both 1) very relevant to patient care and 2) may put our patients at risk.
it is all too scary what is happening now in many arenas. It is horrible that people need to worry about these things when seeking health care. I wonder how many it will cause to delay or not seek care?
I have a different but related question as it is about medical records. What is your take on documenting alcohol use or something similar. Now that there is a change in warning labels on the table could a history of that potentially mean the person wouldn't be covered if XXX developed in the future. One hears different things about covering pre-existing conditions etc. thanks.
For providers looking for concrete strategies to resist criminalization of patients, Interrupting Criminalization has a wealth of resources and ways to plug in, there’s a section on documentation and if you sign up for the mailing list there are ongoing opportunities to learn and build more: https://www.interruptingcriminalization.com/beyond-do-no-harm
YES. Thank you.
Thank you for writing about the topic, Mara. I wish more physicians were as sensitive and respectful! I love that you want to engage and develop a whole-person relationship. Having said that, with the medical record being the legal document that it is, Epic and other EHR systems need to develop "safe spaces" for BOTH providers and patients to note the personal details and interactions, like Diana's sticky note suggestion, only in a separate, dedicated, and large enough informal utility.
As a patient, I love that I have a provider who I feel really demonstrates her care for me as a person and as a patient, and I hope that is becoming more common. Interestingly, at my recent checkup, I noticed myself being more circumspect in what I was sharing, knowing that all of it could end up in my record, and I have nothing I can think of that would put me at risk of discrimination. Well, except weight, of course. Ahem. I know that as a pt. I can opt out of being weighed (unless it's related to certain procedures, surgeries or medications when it IS required for safety and correct titration, for example); but can I request that the BMI on my chart (total BS), the "big-fatty" outline graphic, and the term "morbid obesity" be removed? Really grinds my gears. Thanks!
Thank you! Unfortunately, I fear the EHR is not as safe of a space as I'd like it to be.... Because it's used for so many other purposes other than relationship between doctor and patient. Sticky notes are also discoverable in legal cases.
So glad you wrote about this. I live in Nashville and that Vandy situation has done so much harm.
Ugh.
I really struggle with this too... My notes are not very efficient because I love recording these human details about patients that do impact their care in many cases. My patients comment that they feel more known and I feel like it helps my colleagues know my patients too if I'm out of office for whatever reason. But I do see the argument for simplifying notes, both to reduce the amount that I write and to limit potentially exposing information that is now more sensitive. I might move some info into my sticky note (though I am already running up against my word limit for that with unfortunate frequency).
I hate that we may end up speaking in code or having to obscure treatment we're doing in the record to protect patients from harm in the current reality. Our system has added a place in our Epic to document preferred pronouns, sexuality, anatomy to help with trans care and appropriate cancer screenings, but does protecting these patients now mean getting rid of this so it doesn't "out" people? I'm following my patient's lead on things for now, using endocrine disorder NOS if they request it but otherwise leaving it as is.
Absolutely. It feels like sacrificing clear medical communication to protect from harmful forms of surveillance. It’s lose-lose.
Thanks for bringing that up — it’s a huge concern! For example, if a patient has to pay $1000 to get basic labs completed, together we can come to a decision that we’ll focus on their urgent health concerns (like pain or hypertension) rather than long-term issues that might be revealed in labwork or age-appropriate cancer screening. It feels awful. The American health care system is deeply discriminatory.
HUGE concern. Thank you for sharing these resources. We need to do better. I fear that possible funding cuts to public programs may exacerbate these disparities.