Chris Lancelot: Allowing patients to access their medical records is risky

Patients will soon be able to view their medical records online, if the NHS Future Forum's recent suggestion is adopted by the government. You may feel this is a step forward for openness and improved human rights: I can't think of a more effective way to destroy the value of the medical record.

For most patients immediate access to their electronic notes poses no problems: patients and doctors will benefit if patients are able to point out errors and omissions.

But this proposal falls down significantly at the uncomfortable edges of medicine: where the diagnosis is tentative; or where the patient is unstable, vulnerable or violent.

We have to remember the prime purpose of medical notes: they are our records about our patients, our observations and our suspicions. Primary care often deals in uncertainties: the same set of symptoms may emanate from a self-limiting disease - or be the tip of a nasty iceberg. Faced with an already anxious hypochondriac, how can we note down '??cancer' without alarming them unnecessarily when they view their record? Dare we write 'paranoid' or 'psychopath' on the notes of a violent patient? How do we record our suspicions of child abuse without alerting the perpetrator?

If our notes are available online then we will no longer type in anything potentially risky or uncertain. Instead we will try to remember it (dangerous because memories are fallible) or else write separate notes which we keep in a drawer. In neither case will this important information be available to our colleagues for continuity of care. The 'official' notes will become dangerously empty of detail at precisely the point where they need to be subtle and information-rich.

And if you don't believe me, look what happened within government departments after the Freedom of Information Act was introduced. Far less is now written down: many 'sensitive' intra-office communications are deliberately conducted by telephone, thus going unrecorded.

So my message to the government and the NHS Future Forum is simple: think again, because you've got it appallingly wrong. Your intentions are laudable, but letting patients view their notes online risks undermining the medical care of the very people you are trying to assist.

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