MD’s tips on retail-clinic care offer a reminder of medical records’ importance

med-records-300x200In the best of all worlds, none of us will need any time soon to race to a nearby urgent care center or to pop by the retail, walk-in clinics that have sprouted in neighborhood drug stores across the country. But if you do find yourself at one of these “doc-in-a-box” clinics, here is some good advice. A lot of this applies to regular doctor visits, too.

A tip of the hat to Dr. Peter Ubel, who posted recently at Forbes and KevinMD.com, the physician information-sharing site, his suggestions of a half dozen “essentials” that patient-consumers might need to know before a retail clinic visit. He based these on positions taken by the American College of Physicians and published in the peer reviewed  Annals of Internal Medicine.

Ubel says “doc in a box” operations (retail clinics, often staffed with physician assistants or nurses) are suitable for low-level, ordinary treatment for things like poison ivy or sore throat. When patients go to these clinics, they need later to fully inform their doctors about the care they got (see the next paragraph). They shouldn’t take referrals to specialists from staff at walk-in clinics. The facilities are OK for patients who are “relatively healthy,” and who don’t have a “complex medical history,” meaning they lack chronic or difficult conditions. Patients with greater challenges need to see their own doctors, regularly if need be. Ubel calls out his colleagues, noting that if they were more responsive to their patients, or figured out alternatives when they can’t, docs in boxes wouldn’t be flourishing as they are.

This all seems like good advice to me.  I would note that patients can get many retail clinics to transmit electronic records of their visit to their regular MD. They need at least to take this step, and I’d say they should request that they be given a copy of the “encounter note” to take with them. They then can bring that document to their primary doctor’s office.

Many patients assume that the information-advice sheet they get at the end of a clinic visit is all they need. Wrong! They and their primary doctor need the actual encounter notes, which include information such as history and physical exam, and lab values.

Am I being too fussy? Not. I’ve written how critical it can be for patients to get all their own health records. This should be Task 1 for informed consumers, as I made clear in my book,  The Life You Save: Nine Steps to Getting the Best Medical Care, and Avoiding the Worst. Reading your own records makes you an informed patient, helps doctors correct misunderstandings about your history, and ensures that you don’t get expensive duplicative tests because providers don’t know results of  each others’ testing.

Hospitals and doctors can sometimes make it difficult, even costly to get these vital records. I’ve written on our firm’s site about best practices to legally pry loose your medical records, and I’ve noted recently on the blog on how Uncle Sam has stepped in and tried to help lower the charges that providers can ding you for your own records. I’ve also discussed the contemporary challenges in ensuring that your highly personal and confidential health information doesn’t get compromised.

I read with great interest an Op-Ed in the New York Times by Kathryn Haun, a federal prosecutor, and Eric J. Topol, a doctor and professor at the Scripps Research Institute. They made the point in their piece that cyber hackers, through the millions of breaches that already have occurred, may have greater access to many Americans’ health records than do their rightful owners, the actual patient-consumers.

They also say that we all need not only to protect this important data from illicit and criminal use but also to ensure that giant health corporations don’t come to think the information is theirs and not ours. They argue, rightly I think, that systems must be developed so patients, not institutions or corporations, hold electronic health records. They would provide these to caregivers on a need to know basis. They note that researchers need not fear that enlightened consumers would balk at sharing information, say for important medical science studies.

Lest their concerns about corporate behemoths and Big Brother-ism sound too futuristic or far-fetched, it’s worth reading a recent Wall Street Journal story on how, in the name of improved care, doctors and hospitals are digging deeper into patient and other records, mining and analyzing information with increasingly sophisticated and powerful algorithms to predict not only patients’ wellness but also related concerns, such as their capacity to care for themselves after major illness, surgery, or other life-changing events. I’ve written about another initiative that employs patient data and an algorithm to predict who soon might be ill, dying, and in need of end of life counseling and palliative care.

So if you find yourself needing, or even thinking about retail clinics — which, by the way, can be valuable for their convenience and faster access but which also haven’t proven to be quite the cost-cutting option that some reformers hoped — be modest in your demands and expectations for care. Get those key documents. (By the way, the author of a well-read, long-running Washington Post news feature also advises coincidentally that to stay out of her column on medical mysteries, it can be important to gain possession of your own medical records.) As with any setting where medical services are delivered, take a companion with you, if possible. It’s always helpful to have a second set of ears, eyes, and thinking about any medical care.

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