Jan 21, 2011

Medical Paternalism - A Rant

Last week I had an MRI as part of a work-up to rule out MS. Today I emailed my physician's office to request a copy of the MRI report in advance of my next appointment. (Having my information in advance helps to prepare me for the tone of the appointment and allows me to formulate my questions in advance. In other words, it is very important to me.)

"I'm sorry, but I will have to ask the doctor for permission to send this information to you and she won't be back until Tuesday. Thanks!"

This shouldn't come as a huge surprise, this is from the same office that declined to tell me my blood pressure, because it might confuse me.

You need permission to send me a copy? Why? This is MY information. This is an image of MY head. The results are about ME. What gives you the audacity to think its ok that you and your staff can see the results of my test and withhold it from me?

Perhaps there is concern that I will not understand the results? I am reasonably sure that if I were an MD, an MD's spouse, or even a medical student, this would not be happening. I am frustrated that one needs to be a part of the 'members only club' of physicians to be allowed access in advance of my appointment.

No, I don't want to be patient and wait. In fact, I don't want to be yours or anyone's "patient". I want to be your "client", and you, my service provider. And when I ask for my medical record, I don't want to ask for your permission.

Stop withholding information from me. Your actions are paternalistic and offensive.

Rant over.


  1. This is a good post. I read a lot of medical blogs that are from the Dr's perspective and some have a tone of condescension. Sometimes the attitude seems very "us vs. them". Are we at war?? Sure, some patients are clueless. I get that, but if you can earn a medical degree, you should have some ability to discern. Either way, patients should be respected enough to have concerns addressed.

    Fortunately for me, my hematologist is very accommodating. I often bypass my family doc to see my hematologist for that reason.

  2. If it's any consolation, I had to go through the same BS to get a shoulder X-Ray report sent to me.

    This is beyond an issue of paternalism, it's a simple matter of you having the right to your medical records. Anything else is BS.

  3. The office might have standard policies that the staff must follow, but the doctor can make all the difference by stating in your chart that you're an exception.

    I don't know how it works in Canada, but where I live, I can go to the MRI provider and request a disk of the images. It takes two weeks and I have to pay if I say that it's for my personal records; it takes three hours and is free if I say that my physical therapist wants me to hand-carry it to him. I end up with both the report and the pictures.

    Good luck!

  4. Hi Warmsocks,
    I'm sure you are right, it is an office policy, and there probably is a work-around if I speak to my physician about the issue.

    I think what bugs me the most is that they have this crazy policy at all. Perhaps it is more understandable with an MRI, but like I said, when my blood pressure needs to be reviewed by the doctor before they can give it to me, I start feeling like they are my "nanny" more than my health care provider.

    I don't know if any Canadians can weigh in, but I don't think I've heard of any labs sending a disk of images to anyone except a physician.

    Not House - I can't believe that they gave you a hassle for your records. That somehow makes me feel better. *thanks* This is a system-wide issue. I wonder how many other Canadian patients would like access to their records? We can't be that unique, can we?

  5. Sorry, I'm with the office/doc on this one. I think patients should get copies of their results, but the healthcare provider's job is to interpret those results. I don't think there should be exceptions for docs/doctors kids/etc.

    BP is a different thing - I always tell my patients while they are in the room - and it is something that they should be responsible for and understand. MRI or blood results... less so. If I trust a patient on warfarin to manage their dose, of course I trust them to receive their INR direct from the lab [they do this in BC - patients can log in and view there results even ahead of seeing the doc] and only call them about it if I notice the numbers have been off for a while (indicating that maybe they are struggling to manage it).

    I had an MRI on the 1st and will have an appointment with my GP on the 8th to learn the results. Could I look it up myself? Technically, yes. But in case there is something bad, I'd rather have my doctor prepare me for it. I also don't know if I'd freak out if I saw some little abnormality. Better that my doc and I chat about it together, and I'll get a copy as I leave the office if I want one for my records.

    Really what it comes down to is that I have been formally trained in critical thinking, in interpreting tests in the context of a patient. If that patient gets the tests, googles it, and figures they must have lupus/TB/cancer/whatever (it happens!), it can be very distressing to them and hard to unwind those worries. While many patients can think critically, I would argue that that ability is compromised (even if they are an MD themselves) when looking at their own data.

  6. I think this is probably a case of office policy. I've had them tell me the same thing at student health, even though everyone knows we can look up our own records. It's a little infuriating though, I agree!

  7. Drottematic - well then I believe that you are being paternalistic there. Rather than letting the patient decide if THEY want to see their results, and take the risk of being upset etc., YOU are deciding that they should wait for you, with your better critical thinking skills (you believe), to interpret it for them.

    So... should that be your decision, or the patients? Should you "protect them from themselves"?

    As a patient, I would want to see my test results, research them, and be prepared for the discussion with the doctor. I do happen to know how to research things at reputable sites.

    I already had a mom and dad, I don't need another.

    I don't have a problem, of course, with you suggesting the patient that they wait, but I still believe it should be their choice - they are adults after all.

    btw - apologies if I seem harsh, I don't mean to be. From reading your other posts you do seem to be a caring doctor. This is just something I feel strongly about.


  8. Penelope, thank you. I was beginning to think I was the only one who dared to question this ridiculous policy/practice. Just got off the phone from my (US-based) genetics testing center, which has a policy that it will NOT release the results to the patient directly. WHAT? They needed MY permission to release the f-ing results in the first place! I (and my insurance) paid for the results! Ridiculous! I have exactly the same concern you do; I am a busy person (or was, and am trying to continue to be) -- and would like to make my doctors' appointments as useful as possible, so figure if I get in my research ahead of time, I will have better questions. Instead, it's like some big surprise party; everyone else gets to know the punchline before I do, and I have to figure out, in the moment, what questions to ask -- or potentially wait another several weeks before getting an answer. Argh! Hope all turned out well, as I notice this post is nearly a year old. Thanks for the occasion to vent. :)