William and Stef, thank you for your clarifying inputs. I'm not a clinician and as I said - the cancer situation isn't a good, ethical or even legal example, as you've (rightfully) pointed out.
But in general: are there situations thinkable where a health professional doesn't want to disclose her/his comments to the patient? Because if there are, it will be neccessary to put this in the EHR model. I've got the intuition that especially when psychology comes in, or when a strategy is needed to get the patient to act in the most healthful way, this might be the case. Or isn't this (having private, subjective notes) how medicine works, or should work, so that there's no need to make private notes possible? Kind regards, Josina Stef Verlinden schreef: > > Op 15-dec-2007, om 7:37 heeft Williamtfgoossen at cs.com > <mailto:Williamtfgoossen at cs.com> het volgende geschreven: > >> In een bericht met de datum 14-12-2007 21:13:21 West-Europa >> (standaardtijd), schrijft jpfreriks at gmail.com >> <mailto:jpfreriks at gmail.com>: >> >> Dear Josina, >> >> This question should perhaps be in the openEHR legal list serve :-) >> >> From the clinical point of view I understand your question. However, >> the two use cases differ 180 degrees. >> >> The cancer use case is according to Dutch law at the edge of illegality. > I would even say it's over the edge > >> A Doctor is not allowed to not enter objective patient data in the >> record. He is allowed to keep personal notes on the cancer, but the >> moment he enters this information as reason for a labtest it should >> be disclosed to the patient. Anyway, the patronazing approach with >> respect to cancer has been left for over 25 years now. > Couldn't agree more. Although I can understand the idea of protecting > the patient this is really not up to a health care provider. To give > you an example: if a doctor seriously suspect something like cancer > his/her non-verbal communication will tell. For a patient the thought, > that something is so terrible that it must be kept hidden, can be > more terrifying than knowing that there is a change that disease x is > present and this must be excluded. I've witnessed several occasions > where the patient was 'protected' and in the end the all told that > they had a terrible time (one even for 6 weeks!!) and would have loved > to know upfront what was going on. > >> >> >> The information about a relative which comes to attention of a doctor >> (health professional) must be kept confidential for the patient. Here >> it would be illegal to disclose it, aside from the medical implications. >> >> the believing a patient or not can be handled in the problem oriented >> medical record. Dutch GP's use subjective, objective, evaluation, >> plan. The easy way forward is to list the subjective things a patient >> tells and to balance that in the objective. >> using the wording like i do not believe him/her is perhaps not >> appropriate in the medical record. > These are typical thing one would like to record as a personal note, > but one should be very careful with this. These personal notes can > start living a life on it's own. What, in my opinion, is the right > thing to do, is to 'confront' the 'patient' with this suspicion and > note this and the response of the patient in the record as objectively > as possible. Even a doctor can be biased by his/her personal believes:-) > > Cheers, > > Stef > >> >> >> So if you want a technical solution, the two totally distinct use >> cases need to be addressed differently. >> >> In a functional requitement set we made a separate section for care >> professionals to keep confidential notes. This is then not attached >> to the individual patient's record, but is only accesible to this one >> person the doctor making the personal note (so not to other >> professionals). >> >> >> William >> >>> >>> Hello, >>> >>> I posted this message to the clinical mailing list, but think this >>> should be on the technical mailing list. Apologies if I'm not >>> correct (and please a further explanation about what is meant by >>> 'technical' ;-) ) >>> >>> I've got a question about Author Information Mandate. (an issue >>> also brought up under 'Archetype production: Types of Archetypes' by >>> Gerard Freriks.) >>> >>> What is determined about the access control of information >>> documented by the physician that s/he wants to keep obscured from >>> the patient? I believe that the whole care process is characterised >>> by a the subtle ?game? between physician and patient, where the >>> physician has its private thoughts and goals (which he wants to >>> document) but doesn?t want the patient to know, or only partly. For >>> instance, a GP might be quite sure the patient has cancer but >>> doesn?t want to alarm the patient right away so orders blood tests. >>> (There surely are medically more correct examples.) Others are i.e. >>> whether the physician believes the patient or not, or when the >>> physician has got extra information conveyed by a relative that the >>> patient mustn?t know about. It is harmful to the care process and >>> the physician-patient relation if the patient has access to all of this. >>> Is there a way, in the RM for instance, that everything that is >>> under EVALUATION is kept hidden from the patient? I think this >>> should be so. There should be ?according to my opinion ? two >>> separate parts in the EHR: a shared part (open to, and access >>> controlled by the patient) and a private part containing the >>> physicians evaluations and comments. This latter part should only be >>> made visible to the patient under certain (legal) circumstances, >>> where the patient can order to delete certain info. >>> My question: has this been taken care of right now? If so: how? >>> >>> Josina Freriks >> >> >> >> Sincerely yours, >> >> dr. William TF Goossen >> director >> Results 4 Care b.v. >> De Stinse 15 >> 3823 VM Amersfoort >> email: Results4Care at cs.com <mailto:Results4Care at cs.com> >> phone + 31654614458 >> fax +3133 2570169 >> Dutch Chamber of Commerce number: 32121206 >> _______________________________________________ >> openEHR-clinical mailing list >> openEHR-clinical at openehr.org <mailto:openEHR-clinical at openehr.org> >> http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical > > ------------------------------------------------------------------------ > > _______________________________________________ > openEHR-clinical mailing list > openEHR-clinical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-clinical_lists.openehr.org/attachments/20071215/b9d003f4/attachment.html>
