Public Health Law Map - Beta 5 - Medical and Public Health Law Site

physician, just as the records of clothes cleaned belong to the dry cleaner and the
inventory records belonged to the general store owner. The patient's interest in the
information in the records was not recognized until much later.
Privacy depended on the physician's professional ethics. Physicians were expected to
keep their patient's confidences. A physician with a reputation for violating his
patient's privacy could expect to lose business, but patients had little legal recourse.
This expectation of privacy was not absolute. Physicians were required to report
persons with communicable diseases to the public health authorities, who would
investigate cases and might quarantine the reported individuals. Privacy was not an
important issue because medical records were so limited (outside of psychiatry) and
because there were few pressures to release records. Since the records were paper in
file cabinets, there was little chance for inadvertent rerelease. While the Eagleton affair
showed that record privacy could be breached in extreme cases, there was little risk to
most patients.
C. Why Have Medical Records Changed?
Two trends have transformed the medical record from simple physician's office notes
to complex records. First, medical care became much more technologically complex.
Patients will see specialists for different problems so there is no longer a single
physician who oversees all their care. There are also many more non- physician care
providers such as physical therapists and laboratory personnel who participate in
patient care. Medical records are the vehicle for communication between these
different members of the medical care team and the medical record is, at least in
theory, the common storehouse for all of the information about the patient's care and
condition. These medical care team members must have access to the medical record to
care for the patient and to record what they have done and observed. Records, or
copies of the records, must move between different providers and institutions if the
patient is to receive quality care.
Second, the growth of medical insurance and government paid care, such as Medicare
and Medicaid, fundamentally changed the relationship between patients and medical
care providers. Patients select physicians based on their health plan, and often change
physicians when the health plans change. Many patients have no family physician and
seek care as needed from emergency room physicians and ambulatory care clinics,
seldom seeing the same physician twice. Medical records provide the only continuity
to their care and these patients suffer because their records are not readily available.
This has led to calls for national databanks for medical records so that a patient's
medical information will be available wherever that patient seeks care.
Medical insurance inserts a third party into medical care because the insurer wants to
know what care it is paying for and whether it was necessary. Very private medical
information must be sent to the insurer if the patient wants the care paid for, and few
patients can afford to pay for care without submitting the claims for payment. Private
insurance is usually provided by employers, which leads to conflicts if the employee's
medical information is shared with other employees or managers. The government paid
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