If your family physician retires, did you know she can bill you for transferring your medical records to a new GP? And the price tag can be hefty. The fee schedule is laid out by Doctors of B.C. — the association that represents physicians. GPs are allowed to charge $33 for a record transfer, plus $92.70 for every 15 minutes they spend cleaning up the file. Photocopying is extra. You could easily get a bill of $100 or more.
Need a copy of your medical record to buy an insurance policy? That will cost you from $137 to $180. If you require a standard health-status form for legal purposes, the bill is $158. More complex summaries of your medical history are priced at $992.
There are two issues here. The first is whether, in an age of electronic record-keeping, charges like these still make sense. They originated at a time when typed or hand-written paper files remained the norm.
Given the relative ease with which digital material can be transmitted, there’s no excuse for preserving such high fees. Some GPs might still work with paper files, but that’s their choice, not the patient’s. And in any case, isn’t this just the cost of running a practice?
The second issue has to do with a patient’s right of access. While the information contained in your medical record is yours by law, the file itself, whether paper or electronic, belongs to your physician.
There are some legitimate reasons for this arrangement. A medical record might contain information that could cause unnecessary anxiety or mental anguish, if the patient saw an unedited version.
Medical jargon isn’t always easily understood. The story is told of one outraged patient who discovered his physician had called him an “SOB.” It turned out that’s a notation for “short of breath.”
There are also privacy matters to consider. A patient’s file might contain references to the health of spouses or family members. Those have to be removed before the file is released.
Then again, patient records must be preserved for 16 years after the last entry. It’s your doctor’s responsibility to ensure that is done. In short, physicians do have an important stewardship role to play.
However, there is another side to this. The idea that patients have a right to their medical information is still contentious.
A recent survey of physicians in eight countries, Canada among them, found that only a minority believe patients should have full access to their files. Two-thirds think access should be limited, with the physician deciding who sees what.
Perhaps some of this reluctance is embedded in those fee structures. In effect, the medical community might be telling us: If you want this information, we’re going to make you pay for it.
Surely it is in no one’s interest to maintain this policy. It’s well-established that patients who try to stay informed about their health status have better outcomes.
It’s also more likely that people who know their drug regime will spot a medication error in hospital or at the pharmacy: Not a small matter, when such errors are a leading cause of patient harm.
The provincial government concedes all this. The Health Ministry actively encourages patients to play a greater role in managing their care. But how is this to be done, with price barriers blocking the way?
The answer is straightforward. Patient records should be available for free.
Part of the cost can be absorbed if the province negotiates lower fees with Doctors of B.C., citing cheaper file technology.
The rest should be covered under the Medical Services Plan. The financial cost would be modest, but the benefits would surely be greater.
