There are many excellent Migraine and headache specialists in practice today, but with 12% of the population suffering from Migraine disease, it can be hard to find competent Migraine care. Just this week a friend told me about a neurologist who provided no treatment or suggestions for her two-week-long Migraine, but told her she should see a psychologist. Imagine that doctor's comments being what would control your Migraine care in the future!
"My doctor put negative comments about me and my Migraines into my medical record; what if he bad-mouths me to other doctors?" I see this or similar questions frequently on this site. Patients worry that their current doctor could make it hard for them to get the medical care they need. I don't know how often this happens in real life. As Teri Robert likes to say, "Optimal health care can be achieved only when patients are educated about their health and patients and physicians work together as treatment partners in an atmosphere of mutual respect." Your first and best strategy is always to have open and honest communication with your doctor. Let him or her know what your concerns are.
In "Fundamental Elements of the Patient-Physician Relationship," the American Medical Association (AMA) Code of Ethics states:
The patient has the right to confidentiality. The physician should not reveal confidential communications or information without the consent of the patient, unless provided for by law or by the need to protect the welfare of the individual or the public interest.1
I believe most doctors are truly interested in caring for patients, and they take their code of ethics seriously. Doctors are not likely to be talking behind your back about you and your care. Even if a particular doctor isn't as caring as I'm assuming, practicing medicine is very difficult these days in light of rising medical malpractice insurance rates and claims against doctors. Most doctors aren't likely to risk their professional standing by chatting about you and your Migraines.
Remember that there could be statements that sound negative to you, that don't show a deep level of understanding of your medical problems or concerns, or are just plain ignorant about Migraines, but which won't really be harmful. Just for example: A statement that your Migraines are psychosomatic will be dismissed by any knowledgeable Migraine specialist. A statement that you abused medications will be real cause for concern to any doctor. So check carefully whether your disagreement is over tone or understanding, or over something of more substance.
What if you have a real reason for concern - you got a look at something negative a doctor put in your chart, or you had a conversation with your doctor where he or she said something negative about you? What can you do? Under the Health Insurance Portability and Accountability Act (HIPAA) you have a right to correct errors or place rebuttals of statements in your medical records. You might want to look at your medical records from time to time. You won't know if there's something you disagree with unless you look. It's best to be polite and non-confrontational about it. Let your doctor know what you disagree with; he or she may correct the file. If not, you can write a rebuttal and have it placed in the file. Read more about the rules in Teri Robert's article: Your Rights to Your Medical Records; and in my earlier sharepost: HIPAA and the Privacy of your Medical Information. You can also get more information and FAQs on HIPAA directly from the US Department of Health and Human Services at Health Information Privacy.
It's always your right to go elsewhere for your health care. How do you keep the doctor you disagreed with from discussing you with the next doctor? Just don't authorize him or her to talk to the next doctor! Although HIPAA allows two physicians who are treating you currently to discuss your care without permission, when you leave a doctor's care he or she can only reveal what you allow, to whomever you authorize. Read that HIPAA release carefully before you sign it! You can have the records sent to you and bring them to your new doctor yourself; that way you have not authorized any contact between the two doctors.
Meet your new doctor and establish the relationship first before you hand the records over. This way, you can share your concerns about the records with your new doctor. If you are moving from a less knowledgeable doctor to a Migraine or headache specialist, your new doctor will be familiar with the lack of knowledge of Migraine in the general medical community.
If all else fails, you can file a complaint with the Department Of Health and Human Services, Office of Civil Rights. There is no right of private action under HIPAA; in other words you can't start a lawsuit. You can get the government to take it up for you, however. Or you could report the doctor to your state's medical licensing board.
1 AMA Code of Ethics Opinion 10.1, paragraph 4.
*** This sharepost is legal education, not legal advice. No attorney-client relationship is created. ***
© 2010 Megan Oltman
Last updated 4/25/2010