Who Exactly Has Access to our Medical Files?

[bravejordy]

I have a valid reason for asking this question. My dentist, for example, seems to know everything about me, right down to the fact I had kidney stones in 2009, even though I personally have never disclosed this information and there's nothing in my list of medication to indicate me ever having a problem with my kidneys. Don't get me wrong, I'm not complaining that my dentist apparently has access to my medical history, but it seems that sometimes those who should have access, don't.

For instance, I have to see the Urologist every year and in between those appointments I do tend to suffer from recurring Urinary Tract Infections for which I visit my GP for the usual course of antibiotics (for all the good they do, but that's another story). Everytime I see my GP I always ask him will he keep the Urologist informed as regards to my latest UTI and he promises he will. I asked the same of the nurse that does my diabetic review (at my doctor's surgery) when a recent blood test showed my PSA (Prostate-Specific Antigen) to be slightly raised. She said she wouldn't actually notify my Urologist (whom I was due to see a week later) but assured me that he would have access to my files.

However, here's the thing, when I saw the Urologist last Friday (I didn't see my usual Urologist but a young female doctor instead) she seemed to know absolutely nothing about the ongoing water infection I've had since January, nor was she aware of my recent PSA results. The only files she accessed on her computer were the ones held by the hospital themselves, where there was nothing relating to PSA tests. I explained to her that the blood test had been carried out at my GP's surgery, as had previous tests involving PSAs, and she just said, "That explains it then" but I'm baffled as to why someone as important as a Urologist cannot access the medical files held by my GP yet my dentist evidently can. It also seems my GP is not sticking to his promise to keep the Urologist informed. To be honest, I have every intention of writing to both the hospital and my GP to find out why there seems to be a lack of communication between the two.

One final note, I recently found out about something called EMIS access, where patients can access their medical records online (the ones held by their GP, that is). I believe you have to visit the practice before they'll allow you to register and create an account. I'm hoping to do this next week but would I be right in thinking once I've created an account and can access my medical records, it would be ok for me to print out those records to take with me next time I go to see the Urologist? I'd appreciate any help with this.

[karenmac60]

Mr mac has various doctors and they do keep each other informed, but it does seem to be a slow process. He is cc'd in on each letter they send between themselves, but they come in months after the appointment concerned. I don't know that his dentist is kept up to speed though...

[China Doll]

I can't answer about the dentist but with regards to hospital and GP communication, unless they write to update each other then they wouldn't know basically. If a consultant at my hospital does blood tests for a patient then they follow them up either by appointment or phone to give those results, they may also write to the GP is anything is abnormal for either information or because they are asking them to prescribe something (vitamin D supplements say). I have had many times when the patients have told my consultants they've had tests at the GP which the GP has not sent us (and this is for things that are actually relevent to why we're seeing the patient in the first place!) that I have had to call up and ask to have faxed over.

We have a dental hospital that is part of our hospital and they can see your medical history (in the form of clinic notes and letters on the clinical database) becase we are all the same hospital so you have the same hospital number which corresponds to the notes. (So I'm a patient at my hospital and I also am a patient at the dental hospital so they could see on the clinical database we use that I've also had a hip op and the results of any blood tests although the information is essentially useless to them unless it's related to why I'm seeing them... some of the patients my docs see have loads of other appointments in different department but unless it might have a relevance to why they're being seen by my consultants we're not actually that interested in whether you had ingrowing toe-nails or not :c)

[bravejordy]

Thanks Karen, I did show my GP the letter from the hospital with the date I had to see the Urologist (March 9th) and this was in January, so I would have thought this was adequate time for him to bring the Urologist up to speed. I know you said it can take months after the appointment concerned, but you'd think they'd pull their finger out especially seeing as patients like me only get to see the Urologist once every year.

Thanks China, I can understand a hospital dentist having access to patients files but mine is just a regular dentist. Don't get me wrong, I can understand the necessity of him being informed where my epilepsy's concerned in case I should have a seizure while in his chair (or worse still, while he's got a drill in my mouth!) Thankfully, so far that's never happened (touch wood!) but I was a little surprised when he mentioned my kidney problems.

Also I understand what you're saying about certain things having no relevance to the consultants but when I first started getting UTIs in 2009 and was eventually referred to a Urologist, one of the first things he did was to give me a rectal examination to check my prostate. This, by the way, was following a blood test involving a PSA carried out at my doctor's surgery and where my level was found to be slightly raised. Blokes over 50, such as myself, are always being encouraged to regularly have their prostate checked. With this in mind, now whenever I have a blood test in relation to by diabetic review I always request a PSA and like I mentioned in my OP, I had one done a couple of weeks ago which, just like in 2009, showed my PSA level to be slightly raised. The nurse that does my diabetic review told me I'd need to make an appointment to see my GP for a rectal examination and that was when I told her I was due to see the Urologist the following week and the chances are he'd carry out a rectal examination. I also felt having a PSA done a couple of weeks prior to my appointment with the Urologist might be of some help to him.

Unfortunately things didn't go quite according to plan. Like I said, instead of seeing my usual Urologist I saw a young lady consultant who intended to do a rectal examination but to be honest I was too embarrassed to let her (she was young enough to be my Granddaughter!). OK, I know she's probably done it hundreds of times but I just wouldn't be comfortable with it and told her I'd prefer it to be done by a male doctor. I was hoping she'd go and get my regular consultant but she said he was too busy. Although I'm a little peeved she didn't actually go and ask him. Long story short, I'm now having to wait six weeks before I can see my regular Urologist for a rectal examination. Two weeks prior to that appointment however, they've told me I'm to make an appointment at my own doctor's to have a PSA blood test done.

The thing I don't understand is why it takes so long for a GP and hospital to communicate with one another, especially in this technological age where information is literally at our fingertips and we have the ability to send an email to the other side of the world in a matter of seconds. Yet my GP can't send a fax to a hospital ten miles away! And just going back to my diabetic clinic nurse's assurance that the information she had regarding my PSA results would be accessible to my Urologist but evidently this wasn't the case. What's to say the same thing won't happen again when I have another PSA blood test done at my GP's surgery in four weeks time?

By the way, on the day of my Urology appointment I was sent to the X-ray dept to have my mid-to-lower abdomen x-rayed (as they do every year), which showed "tiny specks" in my kidneys but the consultant didn't feel they were cause for concern. She would, however, arrange for me to have an ultrasound scan, which I'm waiting for a letter from the hospital in relation to.


Thanks again Karen and China, I appreciate your input very much :)

[Ann]

I agree Jordy - its so frustrating. Last week I went to a locum (my dr was away) and wanted blood tests as I was worried that a condition I had for 14 years was coming back. I had attended outpatients at a hospital in all those 14 years to see consultants for check ups and bloods etc but on my computerised medical records last week my condition wasn't even recorded. She was amazed and said she would have to get on to the hospital to send those records over to my GP practice. How dangerous is that, that they could be missed! The reason is, the hospital was so old fashioned they never used computers much at all until just before I stopped going to the clinic, they had paper records, which were all loose in the file, often they fluttered all over the floor when the consultant picked the enormous file up! I thought to myself that is so slovenly, the tests etc should be either be filed better or put on a computer ......

[bednobs]

it's all very well saying that there is instant technology, but it depends on the doctor seeing you dictating what has happened,, then the secretary writing it up, then it being sent out, then it sitting in the pile waiting for the gp to sign it off, then it being scanned into your file. Then it relies on the next person seeing you actually reading it. They just don't have time usually

[bravejordy]

I couldn't agree more, Ann, as I said before in my response to Karen and China, why, in this technological age of computers, can't they just hit a key and instantly send any relevant information to the appropriate consultants and/or patient's hospital files? For instance, in my case, any latest Urinary Tract Infections and subsequent treatment by my GP should be sent to my Urologist so that he's immediately aware of any changes since I last saw him. It amazes me that even in this day and age, in hospitals they're still lugging around huge folders of paper files. It's little surprising when case notes go missing. I wonder how many mix ups there's been over the years due to hospitals relying on paper files?

In 2009 after I'd had my kidney stones removed, they had to leave a stent in my left uterer for six weeks. On the day I was to have my stent removed, my appointment was for 12.45PM. I was standing at the bus stop a little after 11.00AM when I got a call from the hospital on my mobile, wanting to know where I was. The lady on the phone was quite abrupt and insisted my appointment was for 10.15AM and that I was late! I told her I had the letter in my hand and it clearly stated 12.45PM. Anyway, still adamant I was late she said can you get here as soon as possible. I repeated I was standing at the bus stop waiting for the bus that would take me to the hospital but I couldn't make the bus arrive any faster!

Anyway, I arrived at the hospital at 12.15PM and handed the Receptionist my letter and told her about the phone call I'd received. She knew nothing about the phone call and then announced that she was unable to find my case notes! She waltzed off somewhere taking my letter with her (which she also succeeded in losing!) and basically left me standing around for the best part of an hour and wondering what the heck was going on. If I'd told them once I must have told them a dozen times I was there to have a stent removed - a procedure, by the way, that takes all of 30 seconds (if that) to perform. Next thing I know is some nurse came along and asked me to confirm my name and date of birth. She then asked me had I brought any pyjamas with me (which I hadn't of course) and then showed me to a bed in an Oncology ward! I kept insisting that I was only there to have a stent removed but the staff were treating me like I was the village idiot. I started getting paranoid and wondering if they knew something I didn't. The guy in the bed next to mine had testicular cancer while the one opposite had kidney cancer and was being taken to the operating theatre. I kept pleading with the nurses to find out what was going on but it was like banging my head against a brick wall. Eventually, and after having waited three and half hours, I was taken to have my stent removed. I asked the Urologist did I have to remain in hospital and he looked quite surprised when I asked this. In hindsight I really don't think he knew anything about the nurse placing me in an Oncology ward and I suppose I should have sent a letter of complaint to the Administrator. The one(s) responsible for such incompetence should have been brought to task but it's water under the bridge now. Nonetheless this lends support to the lack of communication that exists within the medical profession. And I mean, how on Earth could they lose my case notes? Surely a copy is kept on computer?

Thanks again for your views, Ann. :)

[Ann]

At my usual 4 monthly hospital checkups that I used to have over the 14 years I was attending Out Patients, I always had an ECG heart tracing for which I got the results the next time I went. On one occasion there was quite a panic on, as obviously there was cause for concern, my heart rhythm taken from the ECG taken last time, was all over the place it said on the report, they asked "was I aware of this?" No I said by now quite worried as AF does run in the family..... they could not find the ECG tracing corresponding to this result, they searched all over the place and left me sitting waiting for ages in the consultants office. The consultant and nurse came back and said "well we have found it, it WAS actually tucked in your file - got caught between other tests from way back in 2000 (this was 2005!) She was obviously annoyed at whoever should have read the result and filed the result, as she was shaking her head in despair and told me not to worry as the test was absolutely fine, and .... wait for it ....... "those abnormal test results must have been someone elses!!!!"

[China Doll]

Our hospital is trialing an email process with a couple of GP practices in which once the letter is signed off on the clinical database we get an option to email the letter directly to the GP. I think this is a brilliant idea but it will be a while before it becomes the norm. Also it's only the letter and not full copies of blood tests etc. Personally, whenever I sign up with a new GP, I take all the copies of any medical letters I have to put directly in my file rather than wait for the two GP practices to get all my documents to each other. I just find it more practical to do things that way, and if I have the information and/or know that I am going to have tests done that are relevant to an appointment may have then I will ask for a printed copy so that I can take them to any appointments with me.

[ummmm]

The first appointment I had with my new doctors she said 'healthy lady, lot's of A&E visits but hardly any GP visits'

She obviously took the time to read my notes...

(A&E visits were all childhood accidents/broken bones)