"Desperately Self-Centered:" Requesting My Medical Records

At work recently I was informed that mental health patients are not allowed to view their medical records while they are in the hospital. As staff we are actually prohibited from allowing mental health patients to view anything in their charts, even printing off a copy of a patient's lab results for them to keep is not allowed. They may request their medical records later, after they have been discharged, but according to the nurse I discussed it with "they charge a bunch of money for it, to discourage people from looking at their medical records." (Which is actually not true, the government assigns a limit to what hospitals can charge for copies of health records). I was actually astonished to learn this, because it goes against everything that I believe and so obviously violates patient rights to be informed about their care and treatment!

In the "Guide to patient services" that every patient receives is the Minnesota patients' bill of rights and a helpful explanation about "your right to access and protect your health record." It states that:

•  "You can see your health record for information about any diagnosis, treatment, and prognosis. 
• You can ask, in writing, for a copy or summary of your health record, which must be given to you promptly. 
• You must be given a copy or summary of your health record unless it would be detrimental to your physical or mental health, or cause you to harm another.
• You cannot be charged if you request a copy of your health record to review your current care"

Apparently this hospital (and probably most others) has a blanket approach that deems that all mental health patients should be prohibited from viewing their medical record on the grounds that it would be detrimental to their mental health. In order to make any exception to this a patient would need a signed order from a doctor that they have permission to view their medical records. As far as I know, this has never happened. Patients with "physical" medical conditions are not subject to this ridiculousness. I completely reject the notion that viewing their health records would be detrimental to most mental health patients. Most patients know what is going on, they know that they are struggling with a mental illness and the contents of their medical record should thus not be surprising or upsetting to them. Denying patients right to see their medical records sends the message that the records are not important and do not need to be factual, unbiased, or complete. Allowing patients to view their records would hold staff accountable for their contents. They would need to back up their opinions with facts, observations, and science rather than making assumptions, jumping to conclusions and stereotyping as they sometimes currently do.

As a result of these findings I decided to request my own medical records from my 6 psychiatric hospitalizations. Because I have the right to, and because I was curious what sorts of things it might contain that the hospital did not want me to see. I had requested my records in the past but didn't really know what to ask for so was only given vague discharge and intake summaries. This time I requested ALL medical records, which turned out to be a mistake, because at $1.30 per page the cost of this would be about $2,500. So I amended my request to just ask for copies of all nursing, doctor, and social work progress notes. This got me what I wanted without having to pay a fortune.

When I started reading through my records I was transported back to a time when I was deeply depressed. Some of it was very sad to read and I had to remind myself that I wasn't in that place anymore, I was better now. There were details I had forgotten, such as that time that I hatched a plan to pull the tape out of some VHS's in the hospital and use them to hang myself from a sink. Overall, I was impressed by the understanding, empathy, and accuracy with which some of the doctors and nurses described my illness and state of mind, and horrified by the complete inaccuracy and lack of sensitivity that other doctors showed. There were more than a few errors. Some of the worst things written in my chart were: 
"Presents as desperately self-centered. blames others. Tried to relabel her behaviors as symptoms of illness. Patient is not invested in getting better but would rather be ill. Patient is very good at eliciting sympathy from friends and family." None of those things are true, and at first I couldn't understand why someone would write them. Given my experience in the mental health system I have concluded that many providers can't deal with treatment resistant depression. The idea that someone would continue to suffer so much through no fault of their own is just too sad, so when they encounter a patient that has suffered so much for no reason they rationalize that the patient must deserve it. They must be at fault for their illness, they must not want to get better, they must be a bad person.

The experience of perusing my own medical records taught me an important lesson as a mental health worker: Don't believe what is written in a patients chart. Get to know them yourself. Ask the patient what is going on rather than trying to find out from their medical record.  Form your own impression.