Mistakes
and omissions can lead to the wrong treatment
by Judith Graham /
Kaiser Health News |April 18, 2019
When Liz Tidyman’s
elderly parents moved across the country to be closer to their children and
grandchildren years ago, they carried their medical records with them in a
couple of brown cardboard folders tied with string.
Two days after their
arrival, Tidyman’s father fell, which hadn’t happened before, and went to a
hospital for an evaluation.
In the waiting room,
Tidyman opened the folder. “Very soon I saw that there were pages and pages of
notes that referred to a different person with the same name—a person whose
medical conditions were much more complicated and numerous than my father’s,”
she said.
Tidyman pulled out
sheets with mistaken information and made a mental note to always check records
in the future. “That was a wake-up call,” she said.
Older adults have
cause to be careful about what’s in their medical records. Although definitive
data aren’t available, the Office of the National
Coordinator for Health Information Technology estimates that nearly
1 in 10 people who access records online end up requesting that they be
corrected for a variety of reasons.
In the worst-case
scenario, an incorrect diagnosis, scan, or lab result may have been inserted
into a record, raising the possibility of inappropriate medical evaluation or
treatment. This, too, is something that Tidyman’s father encountered soon after
moving from Massachusetts to Washington. (Her parents have since passed away.)
When both his new
primary care physician and cardiologist asked about kidney cancer—a condition
he didn’t have—Tidyman reviewed materials from her father’s emergency room
visit. There, she saw that “renal cell carcinoma” (kidney cancer) was listed
instead of “basal cell carcinoma” (skin cancer)—an illness her father had
mentioned while describing his medical history.
“It was a
transcription error; something we clearly had to fix,” Tidyman said.
Omissions from
medical records—allergies that aren’t noted, lab results that aren’t recorded,
medications that aren’t listed—can be equally devastating.
In
the worst-case scenario, an incorrect diagnosis, scan, or lab result may have
been inserted into a record.
Susan Sheridan
discovered this nearly 20 years ago after her husband, Pat, had surgery to
remove a mass in his neck. A hospital pathology report identified synovial cell
sarcoma, a type of cancer, but somehow the report didn’t reach his
neurosurgeon. Instead, the surgeon reassured the couple that the tumor was
benign.
Six months later,
when Pat returned to the hospital in distress, this error of omission was
discovered. By then, Pat’s untreated cancer had metastasized to his spinal
canal. He died 2½ years later.
“I tell people,
‘Collect all your medical records, no matter what’ so you can ask all kinds of
questions and be on the alert for errors,” said Sheridan, director of patient
engagement with the Society to Improve Diagnosis in Medicine.
In less dire
scenarios, a patient’s name, address, phone number or personal contacts may be
incorrect, making it difficult to reach someone in the event of an emergency or
causing a bill to be sent to the wrong location. Or, your family history may
not be conveyed accurately. Or, you may not have received a service recorded in
your record—for instance, a stress test—and want to contest the bill.
“It’s
important for people to realize how easy it is for mistakes to get into the
system and for nobody to know it.”
Dave
deBronkart Cancer
survivor and patient advocate
Dave deBronkart, a
68-year-old cancer survivor and patient activist, recounts mistakes he and his
family have experienced. Once, he checked a radiology report through a Boston
hospital’s patient portal. It had his name on it but identified him as a
53-year-old woman.
In another instance,
the records that accompanied deBronkart’s mother to a rehabilitation center
after a hip replacement incorrectly identified her as having an underactive
thyroid when in fact she had an overactive thyroid. DeBronkart’s sisters, who
asked to look at their mother’s chart, discovered the mistake and had it fixed
on the spot, so she wouldn’t get potentially harmful medications.
“It’s important for
people to realize how easy it is for mistakes to get into the system and for
nobody to know it. And that can cause downstream harm,” deBronkart said.
The law that
guarantees your right to review your medical record, the Health
Insurance Portability and Accountability Act of 1996, offers some
recourse: If you think you’ve discovered an error in your medical record, you
have the right to ask for a correction. (For more information about how to
obtain your record, see my earlier column here.)
Start by asking your
doctor or hospital if they have a form (either a paper or electronic version)
you should use to submit a suggested change.
A simple error such
as a wrong phone number can be corrected by drawing a thin line through the
material and writing a suggested change in the margins or making an electronic
note. A more complicated error such as incorrect description of your symptoms or
a diagnosis that you’re contesting may require a brief statement from you
explaining what material in the record is wrong, why and how it should be
altered.
If you think you’ve
discovered an error in your medical record, you have the right to ask for a correction.
Physicians and
hospitals are required to respond in writing within 60 days, with the
possibility of a 30-day extension. (Some states set shorter deadlines.) But
medical providers are not obligated to accept your request. If you receive a
rejection, you have the right to add another statement contesting this decision
to your medical record. You can also file a complaint with the government
office that oversees HIPAA or a state agency that licenses
physicians.
Devin O’Brien, senior
counsel with The Doctors Company, the largest physician-owned medical
malpractice firm in the U.S., notes that rejections can be warranted when facts
or medical judgments are in question. An example might be a patient who wants a
doctor’s notes about potentially excessive opioid use eliminated from the
record. “The patient may say I don’t have a problem, I don’t know what you’re
talking about, but the physician may think the patient has an issue,” O’Brien
said.
Another example might
be a patient who wants a diagnosis eliminated from a medical record, because it
might compromise her ability to get insurance coverage. That wouldn’t be an
acceptable reason for making a change, experts said.
For more information
about correcting errors in medical records, see this guide to
getting and using your medical record from the Office of the
National Coordinator for Health Information Technology, this explainer
from patient advocate Trisha Torrey, and these descriptions of your HIPAA
rights from the Privacy Rights
Clearinghouse and the Center for
Democracy & Technology.
Kaiser Health News is a nonprofit
news service covering health issues. It is an editorially independent program
of the Kaiser Family Foundation, which is not affiliated with Kaiser
Permanente.
KHN’s coverage
related to aging and improving care of older adults is supported in part by The John A. Hartford Foundation.
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