When you’re in the hospital you probably want the medical pros treating you to have all the information possible to ensure you get the best care, right? But if you have a history of psychiatric issues, chances are good that your medical record is not only separate from your psychiatric record, but also that the doctors caring for you won’t have access to your psychiatric background, including any medication you may be taking.
That can be dangerous. According to new research, when hospitals block doctors from having full access to a patient’s psychiatric records—primarily to maintain a patient’s privacy—hospitals may not be able to offer the highest quality of care.
The study, published in the International Journal of Medical Informatics, is one of the few to examine how psychiatric care may be affected by policies regarding medical records. Dr. Adam I. Kaplin, the lead author of the study, and his colleagues looked at how medical records were stored (electronically or on paper) and whether they were accessible to non-psychiatric physicians. Finally, they examined how often psychiatric patients had to be readmitted to the hospital, a marker of care quality and successful treatment.
The researchers found that half of the hospitals surveyed had all their inpatient psychiatric records in an electronic medical records (EMR) system. However, less than 30 percent of hospitals gave non-psychiatric doctors access to all four types of psychiatric records (admission summaries, discharge summaries, emergency room notes, and consult notes). And less than one-quarter had full psychiatric electronic medical records as well as a policy allowing for full access of those records by non-psychiatric doctors.
But the hospitals with electronic records that were made available to non-psychiatric physicians had lower readmission rates for psychiatric patients—a sign of better care.
Traditionally, psychiatric records in hospitals have been restricted to protect patient privacy. Because of the stigma surrounding mental illness, some patients treated for mental illness fear a breach of confidentiality if their records are shared among healthcare professionals. "We're doing our patients no favors by treating their illnesses differently than other illnesses," says Kaplin, an assistant professor of psychiatry and behavioral sciences and neurology at the Johns Hopkins University School of Medicine. "Doctors cannot make informed decisions on what are the right treatments for the patient without the full record."
For example, he says, when psychiatric records aren't shared, a doctor who referred a patient for a psychiatric evaluation (such as a primary care or ER doctor) may not be able to find out what the consulting psychiatric concluded. "The absurdity is that many of these patients get sent to the psychiatrist by their primary care doctors and the psychiatrist then says [to the primary care doctor], 'I can't tell you what is going on,'" Kaplin says.
There are many potential pitfalls from not sharing records, he adds. If an ER doctor doesn't know a patient is on a psychiatric medication—because the patient's records are blocked—other drugs could be prescribed that interfere with those meds. Similarly, people with depression have much higher rates of dying in the year following a heart attack. But if a doctor doesn't know her patient is depressed, she can’t address that risk factor.
While hospitals and clinics set their own policies regarding the sharing of psychiatric records, patients are left out of the decision loop. And there may be an assumption among doctors, Kaplin notes, that patients want their records closely guarded. In one study, patients stated that a breach of confidentiality was their primary fear regarding electronic medical records. And yet in the same study only 5 percent of patients refused to transfer their records from paper to an electronic system.
Patients would likely endorse a full sharing of medical records among healthcare professionals if they knew it would promote better care, Kaplin says. "To protect people from themselves without giving them an option is absurd," he says. "I see hundreds of patients a year and they never tell me, 'Don't tell the person who sent me here what happened.'"
Should medical and psychiatric records be linked? Would you want your record to include both and be shared with your medical providers?
Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.