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Is it ethical and legal and professional for one doctor to "blacklist" their former patient on communicating the patient's history to the new doctor that the patient is to consult?
A visitor to my bioethics website wrote me the following: "I am also interested in the ethics of the 'grapevine' phenomena in blacklisting patients via word of mouth..." It appears that she was concerned that when she has left one doctor and has requested that her records are sent to another doctor, the previous doctor may by talking to the new doctor also provide him/her with what the patient may consider personally negative and harmful information. This information may include the previous doctor's evaluation of the patient's personality, behavior, medical compliance, payment history, drug-use history and many other aspects of the patient's history including the physician’s conversations with former physicians that might not be present in the patient's written record. This additional information may lead the new doctor to change his/her approach to the patient's medical management but also may encourage the new doctor to refuse to accept the patient for treatment.
So here are some questions I would appreciate Medpedia readers to consider and to possibly respond:
The concern is that when the patient authorizes transfer of his/her medical record should any other information be transferred orally? Should a physician be prohibited from revealing any information to another physician that is not in the patient's chart? Would it be more acceptable if this information were part of the written record? Should a patient be allowed to review his/her medical record and specifically dictate which portions should be transferred to the new doctor and which should not? Should a patient also specify what should or should not be orally communicated? Would this patient empowerment improve or hinder proper medical treatment? ..Maurice.
So here are some questions I would appreciate Medpedia readers to consider and to possibly respond:
The concern is that when the patient authorizes transfer of his/her medical record should any other information be transferred orally? Should a physician be prohibited from revealing any information to another physician that is not in the patient's chart? Would it be more acceptable if this information were part of the written record? Should a patient be allowed to review his/her medical record and specifically dictate which portions should be transferred to the new doctor and which should not? Should a patient also specify what should or should not be orally communicated? Would this patient empowerment improve or hinder proper medical treatment? ..Maurice.
asked Jan 13, 2011 at 10:30PM in Other
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answered Jan 14, 2011 at 03:20PMI don't think "blacklisting" is acceptable in any context, whether political, medical, or otherwise. All that should go to the new doctor is the medical record, with one exception. If there is a safety concern that the transferring doctor wishes to impart to the new doctor, that is acceptable in my mind. For example, if the patient is threatening in any way to doctors, or to him/herself, that should be communicated. Anything else is not ethical, in my view.
Patients shouldl not be allowed to dictate what is in their charts, but also should have access to it. "Empowerment" in making content could end up as censorship of necessary medical data.
Once again, this is my layperson opinion, and not necessarily right. -
1Votesanswered Jan 14, 2011 at 08:33PMKim, I understand clearly how you feel about the action. Perhaps you might find even the expression itself in need of being more descriptive of what is occurring. Any suggestions?
What do you think is unfair to the patient for one doctor to tell another about the doctor's assessment of the patient's personality and behavior? Do you think that description is biased, evaluated only through the eyes of the beholder, and misses needed objectivity that should be the only way to evaluated the patient and the disease? Should the practice of medicine be purely based on objectivity and objective data be the only data to be recorded in the chart or transferred orally to the next physician?
But in medical school, we teach our students about the Unified Concept of Disease which involves more than the biological aspects but also the social and psychological components associated with the disease. That means that all aspects of these components including the patient's actions and behavior as observed by one doctor may be pertinent for the next to be aware. I am not sure though that the communication between doctors should be limited only to patient threats to others or patient self-harm in the context of safety Instead. I would hope that all doctors follow an ethical guide in this communication between themselves where the goal is only for the benefit of the patient and not simply for the self-interest of the doctors. If this was the followed goal then the term "blacklisting" might be deleted from the vocabulary and another term applied for that revised goal. Again any suggestions? ..Maurice. -
0Votesanswered Jan 15, 2011 at 09:19AMThank you, Dr. Maurice, for exploring the issue further. "Blacklisting" has a negatvie connotation, so perhaps it is a knee jerk reaction to not be supportive of the concept in medical records transfer regard. The Unified Concept of Disease sounds like a "good" approach, because it is holistic. Also, physicians are trained observers of patients, and one would hope that such observations are always meant to help the patient in their medical stuation. I am not aware in my own life of physicians communicating anything other than a straight medical records transfer; perhaps there hasn't been the need, or if there was such communication, I certainly wasn't aware of it or it hasn't negatively impacted on medical care I have received. I am wondering if physicians actually do communicate with one another over the phone, considering how busy they often are, every time or even sometimes, when there is a transfer to another physician. If there is a threat of harm to self or others, or if it is a positive thing to holistically support the patient, I am in favor of such communication, but wonder if it really does go on? One concern is that not all physicians will have a good relationship with a patient, and there are even the odd unethical physicians out there, who may communicate unhelpful or even damaging data, which is purely subjective. Surely this is rare, but it is a risk. That would be "blacklisting", at least in the rare circumstance. How would a patient even find out this has been done?
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0Votesanswered Jan 15, 2011 at 09:52AMOne issue regarding physician to physician communication about the patient would involve the passage of information to the new doctor regarding the patient's previous behavior as told to the revealing physician by the patient's former doctor or doctors. This would be truly the "grapevine" mechanism of spreading information. But is taking the views and words of previous doctors and delivering them to the new doctor really an ethically just way of patient introduction and education of the new doctor? I think that simply carrying the words over of others without also reporting on their apparent validity or significance would be wrong. The communicating doctor must through his or her own experience with the patient establish whether the words of others bear attention by the new doctor. To simply "gossip" about a patient, whether considered "blacklisting" or not I think is
unprofessional. ..Maurice.-
Agreed.Kim M Robinson commented Jan 15, 2011 at 11:50AM
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0Votes
answered Jan 16, 2011 at 03:32PMThe patient has the right to request copies of their medical record. This should be an objective account of all medical encounters between the practice and that particular patient. Extraneous information, unrelated to medical care, does not belong in the record. That being said, it is easy for a patient to misinterpret the information in a medical record. The simplest example of that being SOB (shortness of breath).
However if a new physician calls the prior physician and asks probing questions regarding the patient discharge, it is difficult not to be candid. This is essential to protect patient health in instances of psychiatric disease, or with the violent, disruptive, or drug seeking patient. -
0Votesanswered Jan 16, 2011 at 05:35PMThomas, you write "objective account of all medical encounters", would that include patient behavior in communication or in actions or reactions beyond description of physical examination findings such as liver size by percussion. For example, in our medical school teaching of first and second year students, we have them report in the student's writeup of history and physical about the patient's apparent reliability as a historian, cooperation or their mood, all of which represent subjective estimations reflected by the student. Shouldn't this kind of evaluation be part of the hospital chart later on in their patient responsibilities? And what would you define as "extraneous information, unrelated to medical care" particular as I have noted the Unified Concept of Disease (biologic, social and psychologic) is an accepted guideline for evaluating the patient and his or her illness? In other words, from the perspective of the physician where should the physician stop with regard to social and psychologic when it comes to writing in the patient's chart or communicating with the next physician? Is psychiatric disease, violent, disruptive or drug seeking the main acceptable conditions to record in the chart? Shouldn't the chart (which may be inspected by others as part of a court case) contain both objective findings and subjective descriptions which are considered important by the physician to explain the patient's disease and how the the physician managed the illness? Finally, shouldn't we, realistically, look at the "patient's medical record" more as the "physician's medical record of the patient" and as such the full responsibility of what is written there falls on the physician? ..Maurice.
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The content on or accessible through Medpedia.com is for informational purposes only. Medpedia is not a substitute for professional advice or expert medical services from a qualified health professional.
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