In the British Medical Journal this week, the lead
theme is 'patient control of records', with an editorial comment, main article
and personal view.
I have spent a significant amount of time pondering
the meaning of 'control'. There does seem to be a wide variety of views and,
surprise surprise, no easy answer.
For the most determined advocates, control has been
explained in terms of patients 'holding or posessing' the records, determining
who and and when the records are accessed and being the central 'hub' for all
who request access. The most negative sceptics articulate a very different
vision, where the existing organisational medical records are maintained and
shared for patient view only with strict technical controls and information
governance procedures, in order to ensure confidentiality.
Perhaps most are missing the point - what is it we
as patients and 'citizens' expect as control?
For very many of us this elusive ‘control’ is not
‘posession or ownership’ of the record or about asserting our ‘rights’ to see all the notes about us, but rather a ‘confidence’
and trust in those who care for us – confirmed through the routine ability to
see and understand plans and records, should we wish to do so. Most of this is
focused on the relationship between clinician and patient and ‘shared decision
making’ over all aspects of health and care.
As a clinican in a professional relationship with
my patients, I want them to feel comfortable, informed and valued in all our
contacts – in other words, ‘in-control’. I cannot always make this happen, but
I feel that control is NOT about asserting rights, but rather having the confidence that they are being
respected.
Peter S
