Re: Access to charts

Now that the ruling body in Canada, the Supreme Court, has decreed that patients should have access to their charts, it is appropriate that steps should be taken to ensure that the law will be upheld and the article by Durbach and Smith, BCMJ 2004;46(8):392-396, gives an excellent description of the means by which this has been implemented. It is obvious that the process has been a costly one in terms of professional time and application. It is earnestly to be hoped that other institutions, who famously love to reduplicate and reinvent policies and procedures, will take heed of and apply the lessons learned. One need merely reflect on some of the software programs which have been designed and then scrapped at huge cost in our hospitals.

It would be of interest to know how frequently patients at BC’s Children’s Hospital have, unsolicited, requested access to their own charts or charts of those of whom they are the guardians. Private practice may not be representative, but if it is, it must be relatively infrequent. In over 45 years, despite being an obstetrician, I am able to think of only two requests for this information by patients. Lawyers seeking an emolument were a different matter and were accepted with varying degrees of philosophical resignation, just as dwellers in muskeg country endure the torment of black flies and mosquitoes.

One wonders too, whether the graphology of the staff members at BCCH is superior to that of my colleagues. The hand of a number of practitioners left a good deal to be desired or to the imagination. On one occasion when asked to give an opinion as to the defensibility of a case the handwriting was so undecipherable that even an expert, i.e., a medical colleague who had formerly been a pharmacist, proved unequal to the task and in the end I suggested that a court reporter should attend the doctor’s office and have him read it into the record. Alas, in vain, for he was unable to read his own writing. He was unaware of the three tenets: if it was not in writing it didn’t happen, if it was worth recording it should be interpretable by any reasonably intelligent individual, and finally, that every letter and punctuation mark might be subject to close scrutiny by someone whose name was preceded by the title The Honourable or followed by the letters Q.C.

Should newer readers be misled into thinking this is merely the vaporing of another cantankerous obstetrician, they should be reassured that it is forwarded only to maintain the excellence of the Journal.

—H. Ewart Woolley, MD
Vancouver