To Your Good Health: Who Owns Medical Records: Patient or Physician?

  • Keith Roach

Saturday, March 03, 2018

Dear Dr. Roach: On three different occasions, I have had to change doctors: once when I moved out of state, once when my doctor moved out of state and just recently when my doctor sold his private practice. The two first times, I asked for my personal medical records and received a complete file, including notes the doctor had written as to possible reasons for ordering some of my tests.

This last instance was different. The doctor sold his practice to another group of doctors. It was only by luck that I saw a small notice in a local newspaper that informed his patients that he was no longer in business and that records could be obtained at his old address. The office was closed for a week, but reopened with new doctors. When I asked for my records, I received a small package consisting of copies of forms and tests. It was much smaller and obviously a sanitized version of the originals.

Who owns my personal medical records, and who is authorized to see those records? I had assumed that payment for an office visit entitled me to ownership. Only I, other than doctor and staff, could decide who might view my medical information. When talking to insurance companies or a hospital, I have to sign a form in order to let even my wife hear or see my medical information.

But now I know that my medical file is also with a group of doctors I do not know. I do understand that it might not be practicable to ship patient files between doctors, but what is the destination of original files? Is there a time limit in limbo before they are destroyed? — A.T.

Answer: In some states, the physician’s practice owns the actual medical record, but in most the law is not clear. In one state (New Hampshire), the patient owns the content of the medical record.

What is clear is that the authority to access your medical record is covered federally in the U.S. by the Health Insurance Portability and Accountability Act of 1996, which protects the privacy and security of your information. According to this act (called “HIPAA”), a patient is entitled to “inspect, review and receive a copy of his or her own medical records and billing records.” Also, you can have your entire record sent to another physician.

In most states, the practice or hospital MUST keep those records for a period of time: at least six years, in my state. For pediatrics, it’s six years after turning 18. According to the law, “A covered entity [such as the medical practice] may use and disclose protected health information for its own treatment, payment and health care operations activities.” Your information may not be disclosed outside of the very specific circumstances allowed by law, and the penalties for failing to keep your record private are severe.

You can learn more about your HIPAA rights at http://bit.ly/2lEDEF8.

Dear Dr. Roach: Recently, a physician in my area lost his license for having an intimate relationship with several of his patients. I'm just curious why this is considered so unethical if both parties are adults who are sound of mind. Are physicians not allowed to have relationships with patients outside of their practice? If I want to see my physician for personal reasons and not medical ones, should I find a different provider first? — N.E.

Answer: The reason it is unethical for physicians to have intimate relationships with their own patients is that they are in a position of trust and responsibility, so any sexual relationship with a patient is misconduct. For former patients, the ethical boundary is blurred; it depends on the type of relationship that the physician had. If you saw someone in the emergency room who ordered an ankle X-ray, that's a very different situation from one in which there was an ongoing therapeutic relationship. In the first case, a relationship may not be inappropriate, but in the second one, I feel a relationship is never appropriate: There is too much potential for the physician to exploit the trust that derives from the patient-physician relationship. A smaller but significant consideration is that physicians who treat people they are emotionally close to have difficulty being objective as physicians.

Experienced therapists recognize the issue of transference: a patient (or client) develops romantic feelings for the therapist, whose professional role is to be a careful and attentive listener as well as try to use his or her expertise to help the patient. It is not uncommon, and is part of the goal of some types of psychotherapy.

However, the patient is not seeing the therapist as a person, but as an ideal. Thus, development of strong positive feelings is understandable.

Countertransference, when the therapist develops strong feelings for the patient, may be useful to a therapist for understanding his or her patient. I suspect the physician who lost his license had difficulty understanding countertransference. The American Psychiatric Association's ethical guidelines prohibit sexual relationships with current or former patients due to the inherent inequality in the relationship and patients' vulnerability to their therapists.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or at 628 Virginia Dr., Orlando, FL 32803.