Can practitioners charge for accessing a patient's records?
Yes. Hospitals and practitioners can impose reasonable fees for retrieval of records and photocopying expenses. From time to time a practitioner may be asked to provide the record electronically; if so you should ensure that it is appropriately protected so that the record cannot be altered. Again, it is appropriate to charge the reasonable costs of providing this service.
For a Worksafe injury, can the insurance company request the entire patients file?
Yes, insurers can and often do. It is up to the claimant/patient to authorise the release of their information. This request does need to be carefully assessed for relevance/proximity to the injury/illness currently being considered. You will usually be provided with a copy of the claim form that has the patient’s authority attached. If you have not received the patient’s authority, please request it before responding.
What happens if the patient requests to not put something on the notes?
Ultimately, the patient owns the notes however you must accurately record the patient’s history to ensure appropriate care as well as continuity of care by other practitioners. In regard to the My Health Care record, patients do have the option of excluding some information if they choose.
A patient admitted in USA for Supraventricular tachycardia. Travel insurer requested "all relevant notes from X date to Y date". During this period, the patient also consulted for a chlamydia infection. I wonder if this should be included? As to my understanding chlamydia infection is not relevant. Also, could I provide cardiologist notes or does the insurance company have to contact the cardiologist separately?
Firstly it’s important to be aware that your patient is in a US hospital for a cardiac condition. This involves extremely high costs and you need to be cognisant that whatever relevant information you supply may result in their insurance being covered or denied, so you need to be comfortable that you have read and understood the patients authority to release medical information carefully. The chlamydia results would not be deemed relevant unless she is currently taking medication and the hospital needs to know her current medication regime, in regard to the cardiologists notes if they are relevant clinical notes that you hold on your patient file then they should be supplied with your response.
I am caring for a psychiatric patient in a public hospital under a treatment authority. We have family meetings to get collateral information and understand expectations and share thoughts about the plan of management. The patient's mother was unhappy with a medication due to weight gain. We discussed, and I agreed to change that medication but the patient became unwell, so reverted to the original medication. Now her mother is unhappy and wanted to issue a complaint. What's your advice and what are her rights in that regard?
Ultimately, you are the medical practitioner responsible for the patient and must exercise your clinical judgement in the best interest of the patients by weighing up the pros and cons of various treatments and medications. You are engaging the family in discussions and decision making. The mother can complain but providing your treatment and prescribing is assessed as reasonable and appropriate by your peers, the complaint is unlikely to be investigated. In a public hospital setting the hospital would assist you in responding to any complaint. You should also be aware that just because the patient is in hospital he/she may still be competent and it is he/she who can make decisions.
In group practice, patients are likely seen by number of GPs including locum or by a GP who has left the group. Is the current doctor responsible to provide the medical record if requested by the patient? Should it include all the other GPs or just those created by myself?
The practice is likely to have in place some policies around this and who maintains copies of records. Careful attention needs to be given to the specific request of the patient as to purpose, timeframes etc. In general, the whole record should be provided (but see Q1 above)
S-8 Permit is different in each of the States, e.g. NSW, Vic, ???
That is correct. Check your local jurisdiction for specific requirements. If in doubt, ask
It's much more challenging for doctors who work in rural or remote areas to avoid seeing patients socially. What is your advice for doctors who live and work in these places?
Agreed. Whilst you should have an appropriate work/life balance including a social life and be an active community member, you need to ensure you do not blur the boundaries with any present or past patients. In the event someone who you have had a relationship with approaches you as a patient, we advise that you disengage and arrange alternative care. AHPRA have strict guidelines in place and being a rural or remote practitioner is unlikely to be a mitigating factor in their eyes. As a general rule always avoid off the cuff advice (it can come back and bite you), get the person to see you in the practice even if you know them socially and make sure you bill them.
Does the patient have the right to refuse a chaperone? If yes, then can the practitioner refuse to go ahead with the examination in such scenarios?
Assuming there are no registration practice conditions in place, then yes, the patient could refuse a chaperone. Can the practitioner refuse to treat – yes, but we suggest your offer a chaperone, the patient’s decision and or your refusal to treat should be witnessed by another health practitioner and documented accordingly. You would need to ensure continuity of care in such circumstances.