Doctor organisations have responded predictably to the ACT Government’s plan to give a patients access to their records. They did not like it. Their fear is twofold: an avalanche of litigation and a feeling that patients could easily misinterpret their records, leading to unnecessary anxiety.
The ACT legislation is prospective; it will not apply to existing records. However, a case is before the High Court about the status of existing records. If that goes in favour of patients it will affect all previous records.
The avalanche of litigation is a misguided fear; patients have had access to public-hospital records for about a decade under freedom-of-information legislation in various states and territories. There has been no avalanche.
The “”misinterpretation” argument has more merit. Most people will not be able to interpret medical records accurately. But that does not mean they should not have access to them; it merely means they should be explained when they get them. That means translating the Latin and terms derived from Latin into English, which is simple enough.
It means relating the treatment to the condition, whether biochemically for drug treatment or physically for surgery. This is a little more difficult.
It means explaining the balance between the risks of treatment and testing against the risks of not treating and testing, or treating and testing in another way. This is very difficult indeed.
The wonders of medicine are catching up on the medical profession.
Most of today’s adult population have been brought up on a diet of medical breakthroughs. At school we learnt about the conquest of the bacteria-borne diseases and the development of wonder drugs. Moreover, they were cures for things which were obvious with faily obvious results_ little diagnostic skill was required to tell if someone had smallpox or malaria and little knowledge was need to know the result.
We came to expect “”cure” as a matter of routine. High expectations have been put on the medical professions. They are black-and-white expectations _ cure and fix and make me like I was before.
Medical science is getting less like that. Part of the reason, perhaps, is that it is getting better at diagnosing _ not only actual disease and defects, but also the potential for them. Further, more choices of treatments are being devised, many of them ancilliary to, rather than substitutes for, early treatments. And further still, the treatments have different side effects.
In short, the developments in medical science in the past four decades have required far more sophisticated risk assessment than in the past. Instead of: “”You’re crook, take this pill or you will die.” We have: “”You may be ill, if you take one of these several courses of action you may get fully, partially or totally better, or worse.”
People are not very good at assessing risks. People have far greater fear of being eaten by a shark than the risk of being injured during the drive to the beach, let alone make the fine assessment of having an eye operation on XYZ syndrome that has (on past experience) a 0.1 per cent chance of leaving you blind in that eye and a 92 per cent chance of preventing a blindness in that eye which occurs in 45 per cent of XYZ syndrome cases within 10 years.
In the new environment doctors may feel under siege: sued if they do not treat (because they think too much intervention is a bad thing) and sued if they do (when intervention goes wrong).
But the answer is not to apply the earlier doctor-knows-best approach. That approach will perpetuate the expectations of that era _ to be cured by a magic pill _ without that era’s acceptance of life’s viscissitudes if it does not. If you combine the doctor-knows-best approach of the 1960s with the litigiousness of the 1990s, the medical profession will get into strife.
If more patients can be taught to understand the complex balance of risks that infuse modern medicine with a more open approach on records, less of the anger resulting from failed treatment will be visited upon doctors.
Far from causing an avalanche of litigation, access to records and fuller explanation of choices is more likely to stem it.