All too often, travellers whose claims for out-of-country medical services are denied complain that their family doctor never told them they had certain conditions, didn’t specify the results of tests to which they were subjected, or didn’t explain why they were taking certain medications. In effect, they didn’t know the contents of their own medical records. Now, an editorial published in the Canadian Medical Association Journal (CMAJ) has forcefully made the case for patients to have clear access to their medical records, and for physicians to ensure that those records are complete and accurate.
Note: The editorial was written by Dr. Kirsten Patrick, Deputy Editor of CMAJ, and it carries the disclaimer that all editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
Dr. Patrick’s piece noted that 70 per cent of primary care practices in Canada are already equipped with electronic health record systems, allowing physicians to share the contents of their notes on a computer screen with their patients in real time. Referring to recent studies in the US that tracked such pilot “open note” primary care practices, Dr. Patrick noted that 99 per cent of patients in these studies would have liked them to continue beyond their pilot dates, and no doctor chose to stop.
Some patients in these studies would also have liked to be able to approve or amend their records, but physicians resisted that idea given their legal obligation to maintain accurate medical records. “It is no longer appropriate for physicians to want to conceal their version of a patient’s story from the patient. Proper shared decision-making depends on a story on which both agree,” Dr. Patrick wrote.
Applicants for medically underwritten travel policies whose claims have been denied have often contended that their doctors didn’t tell them they had a second-degree heart block, or diverticulitis, or osteopenia, or that the medications they were taking were for diabetes and not high blood pressure—consequently, they didn’t disclose them on their questionnaires.
Doctors have also admitted that they didn’t always tell patients of some conditions they thought were benign, or symptoms they could do little about, and just advised their patients not to worry and go ahead with their travel plans.
Regrettably, many physicians do not have a working knowledge of the purposes and limitations of travel insurance. Perhaps, as patients become more insistent on knowing what’s in their medical records, and as those records become more accessible, there will be fewer claim denials based on the “My doctor never told me” proposition.