Sunday, July 28, 2013

You need to take control of your personal health record now

You need to take control of your personal health record now (before it gets/especially if it's complicated).

Yes, it is a total pain to track down records from providers, and some of them won't have the records you need because they moved and lost them or there was a fire or they just toss them after a certain period of time.  And if you don't have any chronic medical problems, you may not really need to, but if you do have some chronic medical problems or a history of injuries and illnesses, it might really be good to gather things while you are still relatively healthy.  (Age will likely not make you healthier.)  If you do have chronic conditions or a long history, it will be even more nightmarish to track down and organize all this information, but it is such a good idea to have it collected and tabbed and available electronically.  In case of emergency, you don't want to be given a med you have a bad reaction to.  In case of regular life happening unexpectedly, you don't want to have to be hunting this stuff down when you are hurting and not at your mental best. 

My advice: Just bite the bullet and do it now.  It can't hurt, and it CAN help.

Your medical records are wrong

Your medical records are wrong, and you can('t) change them.

This is a sad truth.  And a frustrating one especially if you are dealing with any kind of Worker's Compensation claim because then the lies are embedded, and zealous adjudicators will haul them out and use them against you, but I should stop now).  It's also only partially true.  In theory, you can change your medical records.  You just have to do the following:
  1. see the records (why it's important to get the records).
  2. notice the problem.
  3. bring the problem to the attention of your provider within the time limit and in the manner your provider requires (why it's important to get the records quickly).
  4. follow up politely, fervently, and regularly even if you can tell they think you are a huge pain (because they don't have to deal with the fallout from the incorrect records, but you do, and it could be worse than just having some medical records people get huffy with you).
  5. have that response be approved/agreed with.
  6. follow up to make sure the change gets made (and pay any fees associated with getting another copy of the records). 
Correcting records is (understandably?) not something your provider prioritizes.  It's hard to appeal because the time limit can expire, and it is a huge hassle to follow up over and over and over again to be sure it's moving.  And the whole process can even tick your medical provider off, frankly.  I mean, you are challenging their records, and some of them take it personally because they think it is a slur on their competence as wise doctors, when really it's just a reminder of something they may have written down wrong or something you didn't have time to fully cover in the short appointment you are usually granted, a gentle acknowledgement that we know our doctors are not omniscient, and we don't hold that against them, as long as they correct their mistakes.  We just want the records left behind to be correct since they are, technically, our records.

But it really is a hassle, so you may only want to address the potentially life-threatening mistakes, especially if this provider is the one linked to the hospital system you would most likely get admitted to.  If the hospital system and associated docs use the same health information system, the emergency room docs can see that cortisone allergy in the records.  If you end up at a totally different hospital, they have no records at all since the health information systems are all designed as silos that don't play well with other health information systems because standardization in this realm prevents them from making any money.

(That was cynical.  Sorry.  But also true.  Standardization of electronic health records would save hospitals, clinics, the government, and patients tons of money at the expense of the health information system development companies, so you can see that it is unlikely to ever occur.)

My advice: If your doctor is not afraid of you providing paperwork, try to hand over copies of what you say during the appointment (much easier with your handy PHR binder!).  This could increase their chances of typing up accurate notes and save everybody time.  Otherwise, just request the records a week later, and determine if it's worth the hassle to correct the mistakes.  (If this is a worker's comp claim, IT IS ALWAYS WORTH THE HASSLE NOW TO CORRECT THE ERRORS TO SAVE YOURSELF SO MUCH STRESS, TIME, AND RAGE LATER, EVEN IF YOU JUST DON'T HAVE THE ENERGY TO DO ANYTHING RIGHT NOW.)

What your doctor tells you

What your doctor tells you and what s/he means to tell you are often not the same thing.

The most fascinating lessons I've learned have been about what doctors tell you in the office and what they put in their notes.  Sometimes these things are . . . at least similar.  Sometimes they are not.  Not even vaguely.  And I'm not just talking about all the times when they get basic information wrong (my job, my exercise frequency, other medical conditions, allergies, medical history).  I mean like when they tell me: "if PT makes this flare up, we'll do a steroid injection; there's no need for an MRI" and their notes say the next step is definitely an MRI.  (This is one of the reasons it's a good idea to get copies of your medical records every year, though it won't help you in the shorter term.)

I don't think they're being willfully deceptive or anything.  They just have such a limited time with you in the office, and they can't review everything, and they don't always cover everything, and maybe they just don't realize that we patients don't automatically get the benefit of the more thorough notes they write up afterward.  I suspect it never occurs to them that there is a difference.

My recommendation?  A week after the appointment, call and ask to have the doctor's notes from the visit sent to you.  Not all the time, just any time they tell you anything about next steps, medications, treatments, or what they think might be wrong with you.

I have now been to one clinic where they do this automatically. (!!!!)  And when I compliment them for this genius way for them to make sure patients heard what they really meant to say (patient compliance is much easier this way, docs), they tell me, "If we ever forget, just call and remind us."  Needless to say, I am liking this clinic.

I am a spreadsheet nerd

I am a spreadsheet nerd.  And I like it.  

Love it, actually.  Practical application of skills!  I looked at PHR templates and options.  (Not for long, because I didn't have time for that.)  I saved and printed some out to look at.  I wanted something electronic and easily printable.  I ended up finding these two things to be mutually exclusive.  I wanted something flexible, and nothing I found really met my needs as a not-actually-elderly person.  So I made my own.

Lots of trial and error.  Some combining and recombining, a few views, and voila!  After only 60+ hours I had gathered and boiled down a box full of medical records into something convenient, filterable, sortable, printable, copyable, and able to be shaded and updated at my whim.  Not that anyone has really wanted to look at it, but that's not its fault . . .

My advice: Make a PHR and commit to keeping it updated.  Do it using whatever programs, pre-existing forms, and storage methods make the most sense to you.  Do it now, before your life and the lives of your loved ones get complicated.  It's kind of a spiritual exercise to get it ready.  And you probably won't have as many records to deal with, so it won't take you as long as it took me . . .

If you'd like a blank version of the one I use, let me know.  I can certainly send it to you if you use Microsoft Excel or compatible things.