My assault casts a long shadow over my medical record...
October 13, 2014 9:40 PM   Subscribe

My history of sexual assault is in my medical record. My electronic medical record. This is driving me nuts and becoming a mental roadblock for me when I seek further healthcare.

I want to be seen for various health concerns-- for example, I am concerned about my longstanding complete and utter lack of libido. But because my mental health records make note of my history of sexual assault, I feel like the general response will be, "Oh, of course you're not interested in sex given your history of assault; here's a referral to a psychiatrist."

Even if this were indeed the thought process my healthcare provider followed (and I'm not saying that it will be), I know that it would be easy for me to insist on a blood test to get my hormones checked. Furthermore, I could very well be unnecessarily wary that she'd make those sorts of assumptions-- after all, a good clinician wouldn't, right?

But the fact that this part of my medical history is visible to my healthcare providers is driving me crazy. Not only is the fact that I was assaulted in my medical record, but snippets of my personal life and response to the assault are in there because I was in therapy for a while. I am in healthcare myself and I know that once it gets buried deep enough in my record, people won't read that part of my record if I'm being treated for, say, something in nephrology or cardiology. But still! It's there and I feel like there's such stigma and I don't know why it bothers me so much, but it does. It's keeping me from scheduling medical appointments I should have no issues scheduling.

I am frustrated with how inarticulate I'm being in writing this question, and maybe it's not clear what I'm asking here,... but I just feel like many of my medical concerns are not legitimate anymore because everything can be chalked up to my history of assault. This might be all in my head, but it has also been compounded by the fact that my PCP is frequently unavailable to see me (month-long waits...), by having a bad experience or two within the same healthcare system I'm currently seen in, and by generally disliking the homogenous, super-conservative environment I am currently living in.

What is it exactly that I am experiencing here? Am I making this all up? How can I get over this mental block? How can I talk to my healthcare providers comfortably? Any other tips? Thank you!
posted by gemutlichkeit to Health & Fitness (41 answers total) 7 users marked this as a favorite
Hopefully a medical professional will chime in here. A couple thoughts -- I recently read an article where a doctor discussed his own tendency (and everyone's) to take the closest matching symptoms and feel fairly conclusive about it. He discussed a particular patient who had pain in the muscular area of his back and he offered the patient cortisone injection. The patient refused this treatment, the issue got worse and the patient came back for more testing. Turns out: pancreatic cancer. The doctor was not aware of organ problems presenting as muscle pain so it had not occurred to him to investigate further. But, the most important point is that he said doctors would do well to ask themselves, "What else could this be?" I decided that was a great thing for me to keep in my back pocket to ask my doctor as well. So, if you go to your care provider and they bring up your sexual assault you have this at the ready, "What else could this be?" I think that phrase could be really empowering to lots of folks who feel like the doctor is not digging deep enough.

I have actually found that regular doctors don't care much about sexual health, anyway. Your best bet is to get a referral to a specialist as quickly as possible from your PCP. If they suggest it is your sexual assault history that is the cause you can simply say, "I know that seems like it might be the answer but I strongly feel that it is not. What else could this be?"

I would kind of be surprised if the assault came up actually. The docs generally don't research you. If you volunteer the info on the intake form then they will ask. But, of course, I have no idea how your practice works or what kind of intake form they might request you fill out if you request an appointment to discuss libido. Also, you don't have to fill out that form completely if it makes you uncomfortable, in my opinion.

Good luck -- this sounds pretty awful for you.
posted by amanda at 10:10 PM on October 13, 2014 [30 favorites]

Maybe you could start by explaining the problem/the symptoms to your doctor. Maybe emphasise any other things that are happening that could also be caused by hormones (changes in menstrual cycle? migraines? energy levels? etc) and then mention the libido as well, but as an aside.

If your doctor notices the notes in your record, then it would be best to be forthcoming about it: "Yes, I was sexually assaulted in the past. I have dealt with it extensively in therapy. The low libido has come up recently, so I don't think that it's related. Could we please check that all my levels are in the normal range to see if the cause is something physiological?"

Edited to add: I don't think the doctor will notice the notes in your file until during your appointment, so I think that you have at least a few minutes to make your case for getting your hormone levels checked before it even comes up.
posted by kinddieserzeit at 10:11 PM on October 13, 2014

Find new providers, don't ask for your records to be transferred. Request a copy of your file (you don't have to explain why) and give the new providers a selective version. Or, just give them a verbal history - you don't need to share your entire medical history with them, and I think it would be entirely reasonable for you to redact bits.

You're not making this up. What you're feeling is fine, and real.
posted by arnicae at 10:11 PM on October 13, 2014 [16 favorites]

Ugh I hate this. I have a somewhat unusual assault/trauma from 14 years ago now that's in my medical record and every. single. doctor. flips through my file, notices it, and asks about it (and I've moved a lot so I've had a lot of doctors). Here about your chronic joint problems? Let's talk about this non-physically-damaging trauma you experienced a decade and a half ago! That seems relevant!

I try to be a little dismissive about it (oh, that was a long time ago, I'm over it now), but it still comes up. I'm more commenting in solidarity that it is a problem, and it is something that doctors do, but don't be afraid to advocate for yourself and push for the results you want.
posted by brainmouse at 10:22 PM on October 13, 2014 [3 favorites]

You know... I have never gotten the impression that ANY new doctor I have ever seen had access to my previous medical records, unless I gave it to them on the intake form that day. There isn't a big database that every doctor has access to- you have to ASK for your records to be sent from one doctor to another, right?
posted by showbiz_liz at 10:22 PM on October 13, 2014 [13 favorites]

I can't even get doctors to pay attention to my moderately serious drug allergy, even when I fill out their individual medical history form and write SULFA across it several times.

Even if it somehow came up, you clearly know what to advocate for. Just do it, the worst that can happen is you have to complain and go somewhere else.
posted by Lyn Never at 10:27 PM on October 13, 2014 [5 favorites]

Seconding arnicae's advice. I recently moved cross-country and got all new doctors as a result; I filled out intake forms, but none of them seemed particularly concerned about getting my previous medical records.
posted by serelliya at 10:42 PM on October 13, 2014

There isn't a big database that every doctor has access to- you have to ASK for your records to be sent from one doctor to another, right?

In the US, this is changing now (countries with single payer, like the UK, already have linked electronic records).

That's why the OP mentions specifically that this is on her *electronic* medical record. It's not all streamlined/"all systems go" yet, but part of the ACA is a push to get medical records set up into an electronic database. So far, that push is still at the stage of offering rewards to providers who are setting up EMR systems, but already in 2015 (iIrc), it's shifting over to penalties for those who are setting them up too slowly . If she's part of an HMO, all doctors in that HMO (which is going to include any PCPs *and* any specialists she can see in-network) probably already have ready access to her EMR. Anyway, the point is, once something is in your EMR nowadays, getting rid of a part of your medical record you don't want to share really is often not as simple as just dropping your doctor and getting another, like it was back in the days of paper files.

What is it exactly that I am experiencing here? Am I making this all up? How can I get over this mental block? How can I talk to my healthcare providers comfortably? Any other tips? Thank you!

FWIW, how I would feel about it is that I'd be afraid that after seeing this in my record, providers would see me "differently" than they did before (which would make me feel humiliated/ashamed), and that they'd dismiss or disrespect me because of seeing me "differently." Does that sound like it could plausibly be what you're experiencing? Ime, it's a perfectly valid and rational fear, not something made-up. BUT. At least give your PCP a *chance* to do right by you? One thing at a time. You've got some solid Plan B ideas floating around, like asking to get some hormone levels tested, changing to another practice, etc. But right now you don't even know that you need a Plan B at all. So at least find out whether you do. Make the PCP appointment, talk about your health concerns, and then figure out the second step based on what happens with that, not based on what you fear could happen with that.
posted by rue72 at 10:57 PM on October 13, 2014 [6 favorites]

I see a Pulmonologist who's part of the Providence Health Care system. My PCP's private practice joined the Providence team, which is how I got referred to the Pulmonologist. Then my PCP quit practicing and I had to choose another physician. Since I'd also been hospitalized in the Providence Group's hospital twice and been to their ER several times, I chose another doctor in their group. Now everything I say or do to any doctor in the system goes into my electronic record and if I were to walk into a new doctor's office - say a surgeon or psychiatrist - they have my entire medical record instantly available on their computer - which they scan while I'm sitting in the room.

The first item up on the medical record is a list of my diagnoses - twelve of them, if you can believe it - and they're listed right there on Page 1 for God and everybody to see. My own list is mostly physical stuff - Parkinson's, COPD/Pulmonary Fibrosis, osteoporosis, GERD, obesity, etc - and Major Depression is also there. If I were a victim of sexual assault, my record would probably read Post-Traumatic Stress Disorder instead of, or along with, Major Depression. If I'd been treated for gonorrhea as a result of that sexual assault, it would say Sexually Transmitted Disease - or something similar. IOW, every diagnosis for which you've ever been treated that they know about, including diagnoses that were transferred into their group when you first went to one of their physicians, every diagnosis that was ever billed with a Code - is on your electronic record, right up front - IF the records are up to date.

Secondly, your list of medications shows what you're being currently treated for, which helps to exclude old diagnoses from the physician's interest. My doc told me it would take forever to read everyone's record - she just wants to know what I'm dealing with now, not 20+ years ago - but not all docs are like that. The idiot I had for my (repetitive) sleep studies wanted every detail of my life going back to birth - all of which he wanted to treat with Ambien - but that's another story.

Yes, the electronic medical record tells all; it's only up to the doc to read the first page or so and your medication list. Insurance companies also have this information BTW - and it has nothing to do with the ACA or Obama.
posted by aryma at 11:25 PM on October 13, 2014 [3 favorites]

Insurance companies also have this information BTW - and it has nothing to do with the ACA or Obama.

You're incorrect, the ACA includes a timeline for the phase-in of universal use of EHRs (as opposed to paper records). It's part of its regulations for improving quality of care. (BTW, EMR = EHR. Technically, there *is* a difference between EMRs and EHRs, in that EHRs are meant to be more comprehensive, but in practice the distinction is basically too esoteric to matter and ime people use the terms as synonyms).

Right now, EHR phase-in is transitioning from being an incentive program for early adopters to a penalty program for late adopters. Providers are still trying to get this stuff in place and lots of practices are still using different EMR/EHR software, so it's not at all streamlined yet, but it's getting there. The reason for the push toward EHRs is that they're meant to increase quality of care by increasing coordination of care between providers and decreasing admin costs/responsibilities in the long run. From the page on HHS's site, "Key Features of the Affordable Care Act Year by Year":

Reducing Paperwork and Administrative Costs. Health care remains one of the few industries that relies on paper records. The new law will institute a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information. Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care. First regulation effective October 1, 2012.

The ACA regulations w/r/t EHRs are targeting all providers, but those regulations are building on the incentive program for Medicare and Medicaid providers that was part of the American Recovery and Reinvestment Act (2009). The health regulations in ARRA are called the HITECH Act, which instituted an incentive program that gave money to Medicare/Medicaid providers who got EHR systems in place and could prove "meaningful use" of them (i.e., could prove that they were using the systems to inform their care decisions). HITECH is an extension of HIPAA. It's basically gone: HIPAA to HITECH to ACA, in terms of federal regulation of medical records (though obviously that's not entirely inclusive, there are always tons of things going on, the US health care system has a pretty much infinite number of working parts).

The point is, if something is in your EMR, it's accessible to your providers and literally very visible to them. There *is* a database of everyone's medical records being created right now in the US, and there's a phase-in timeline that we're in the middle of. (Which in this context does sound very Big Brother, but it's actually something most other countries with nationalized health care/insurance already have in place, and the reason for the "rush" to put EHRs in place in the US is that instituting universal use of EHRs is meant to address the shitty coordination of care and huge admin costs that the US has relative to other economically comparable countries). So if you've got an EMR, you probably can't just get a new doctor and leave the info on your medical record behind anymore. Which is again why the OP brings up specifically that this is her EMR and not a paper record that she's talking about here.

On the other hand, the advice to find a new doctor if your current doctor is dismissive or lazy is still good, imo. EMRs are a tool for better care, they're not a tool for disqualifying you from receiving medical help -- and if your doctor is shitty enough to use yours to justify handwaving away your concerns and limiting your access, you need to find someone else. (And there *are* doctors out there who won't use your EMR to justify dismissing you and refusing to help you. I've found that out from personal experience and you can, too, OP).
posted by rue72 at 1:26 AM on October 14, 2014 [4 favorites]

"Electronic medical/health record" only means, strictly speaking, that it's being kept electronically. The term by itself does not indicate that it's something like the mythical "permanent record" of your childhood. I see multiple providers right now, on Medicaid which you would think would have the most likelihood of doing some kind of universal tracking, and the best anybody knows what anybody else is doing is that it doesn't matter what pharmacy I visit, they won't pay for the prescription more often than they're supposed to. I still have to keep telling them to send information to each other, they still don't know when my prescriptions from elsewhere have changed. Storing the data electronically does make it easier to share; it doesn't make it inherently shared. Your insurance company may store things based on information that was submitted to them, but that doesn't mean the doctor is actually pulling down this information from the insurance company.

In my situation it would be quite frankly easier if my various providers with electronic records were all looking at the same record, but they aren't. If you aren't sure, you should absolutely ask your providers what information about you they actually have.

Even in the UK, shared information is not a given. Records kept by the payer are not the same thing as records that providers have access to.
posted by Sequence at 2:16 AM on October 14, 2014 [1 favorite]

In case that was unclear, on re-reading--it's still POSSIBLE for stuff to be shared under various circumstances, particularly if you're with an HMO or seeing multiple providers who work under the same organization, it is just not a GIVEN that it is. It's more like: I have a Word document, and it's digital, and you have a system that can (possibly) read this Word document, and I could send it to you for you to do that, and we might even have sharing set up to do that automatically. But there's no system by which everybody's files from everywhere are all on one central bank of servers. Making everybody go electronic was not about putting everything on centralized servers, it was about guaranteeing that all of your records aren't going to be in a physical file in the basement wherein nobody can get it to your new doctor in a timely manner in the middle of an emergency. The improved ease of sharing does mean that sharing's happening more than it used to, but--check, don't assume.
posted by Sequence at 2:33 AM on October 14, 2014 [2 favorites]

This is only anecdote obviously, but I was sexually assaulted 15yrs ago, had psychiatric treatment etc, and haven't switched doctors, and nobody has ever mentioned it. Not at Pill checks, not at smear tests, just never mentioned. Even when I went to see my GP about something gynae-related, and mentioned my assault (because it was relevant) she was like "oh really? Didn't know about that, it's dropped off the front page by now". I had assumed she wasn't mentioning it out of politeness, but no it wasn't even on there anymore.

When I see patients with traumatic histories, I might privately think "gosh how awful", but if it isn't relevant to the problem they're seeing me about I don't bring it up, because I'm polite enough not to rubberneck at other people's misfortune, ffs. Maybe that is being British, but if it's none of my business then it's none of my business.

I'm not going to say that no doctor is ever going to harp on about it inappropriately because I've read too many insane stories on here about crazily inappropriate American gynaecologists. But it will not remain on the front page of the EPR for ever - you could try having a lot of phone consults about rashes or fungal nail infections or sore throats to add some extra noise if you haven't seen your doctor for a while. If somebody does bring it up inappropriately, I would say something like "actually that was quite a while ago and I'm over it now. Can we get back to the problem at hand?" If they don't respect that then switch doctors, because most doctors do actually have professional boundaries.

The other thing you could do if you are worried about people accidentally triggering you, is to speak to somebody in advance and get it moved somewhere else in the EPR, or get a note put on there to stop talking about it unless you bring it up. I have had patients ask me to stop talking about dialysis, and even though that is the whole point of them coming to my clinic I just put a little note on the system that we will talk about other things until the egfr is below 12 or whatever we agree on. And then we stick to that.
posted by tinkletown at 3:09 AM on October 14, 2014 [4 favorites]

As I get older, I find that amazing things can sometimes happen if you are totally honest about difficult subjects. Blunt, but not rude. It can really shock people and turn an everyday, routine encounter into something deeper.

In a case like this, you could say something like, "Yes, I was assaulted, and it was horrible. But to be honest, I think doctors have been much too quick to say the problems with my libido are psychological and related to the assault. I think something may be wrong with me physically, and I'm really worried about that. I think I need some tests to rule out physical causes. Can you help me with that, or can you refer me to somebody who will?"

That sort of thing can be enormously difficult. But if you prepare yourself for it, and go in knowing you are going to give that little speech with your head held high, I'm betting it will get you through this.

If you say something like that, and your doctor still doesn't want to run some tests, get the hell out of there. That's just a crappy doctor, no matter how many diplomas they have on the wall.
posted by Ursula Hitler at 3:22 AM on October 14, 2014 [10 favorites]

Sorry, I posted my comment under the impression doctors had already been dismissive of your problems. I see now that it seems to be something you're worried about, not that it's happened yet. In that case I'd say you should still go in knowing you may have to make that speech, but don't assume you will. In my experience doctors don't pay a lot of attention to your old records, they mostly focus on what you tell them right now. I wouldn't be surprised if they have no clue you were assaulted.
posted by Ursula Hitler at 3:26 AM on October 14, 2014 [2 favorites]

Best answer: The other thing that I might be hearing from your question, reading between the lines, is that you still feel a lot of shame about your assault, and that maybe it is not so much the fact that your healthcare providers are actually bringing it up as the fact that they even know about it at all, or potentially could find out about it if they wanted to. It is not nice to have no control over who knows about it either.

I'm not sure how long ago your assault was, but although that feeling of stigma never goes away completely, it does get better. I still don't tell people at work because I do not want to be pitied as a "rape survivor" when it happened half a lifetime ago, but I can talk about it in the abstract with friends now without feeling any particular emotion - it's just a sad part of my history now, like my father dying or like my awful undergrad research project or something. It probably took me 5-8 years to get to that state though.
posted by tinkletown at 3:26 AM on October 14, 2014 [1 favorite]

I think what you're experiencing is a kind of shame reflex.

And I think that one way to confront your fear of what you're afraid of is to look at it dispassionately. The rate of sexual assault are so high that having a patient who's been assaulted is commonplace for care providers.

Thus, I don't think it will be the wailing siren it is for your healthcare providers that your (understandable) anxiety fears it will be.
posted by DarlingBri at 4:37 AM on October 14, 2014 [2 favorites]

I would also have a hard time with this. I understand why you would be sensitive to this, and frustrated that you have to re-live that experience every time you see a doctor.

Practically speaking, I think you could work on finding a new PCP who isn't so hard to schedule with, and someone who you trust to not ask you about this every time you come in for an appointment.
posted by deathpanels at 4:57 AM on October 14, 2014 [2 favorites]

I run into this problem. But my doctors are super respectful. I set boundaries. I have a asexual abuse history 8 years long. I have PTSD. I have to let my providers know because touch can flip me out and I make it clear that I need doctors to explain what they are doing. When they ask I tell them I'm in therapy and that is that.
My doctors focus on my symptoms. And it is possible I've got some psychosomatic stuff going on. But I just say something like it might be but let's rule or everything you can. And we move on.
There are doctors who will respect and believe you . If you are having trouble you can call them out on it or you can find a new doctor. It is okay.
posted by AlexiaSky at 5:12 AM on October 14, 2014

Oh and when possible I bring my wife with me to report my my symptoms. It just is a defense again the you are crazy.
Some doctors are just hit or miss sometimes. I had a nurse tell me I was pretending to wheeze in the ER. I've had asthma since I was 2 and my O2 levels were low. I But you know what? The doctor treated me just fine and I got the treatment I needed anyway.
posted by AlexiaSky at 5:21 AM on October 14, 2014 [1 favorite]

Like AlexiaSky above could you bring a close trusted family member or friend with you? Someone who could remind you of everything you wanted to ask about, someone who would stand up to doctors for you in the (Ihope unlikely) event that they treat you dismissively?
posted by mareli at 5:52 AM on October 14, 2014 [1 favorite]

It's time to ask what is in your electronic health record, and where. It's not necessarily true that therapy info, beyond maybe a diagnosis, would be in there. Was your therapist in the same health system as your primary care doc? Did you sign a consent form telling your therapist he/she could share info with your doc?

There are two steps I'd take to deal with this anxiety: 1) ask the medical office what is in your record and where -- info in EMRs does not magically pop up every time someone opens the record (especially older info) and 2) say something like the following to your doc "there's sexual trauma in my past - but I know trauma survivors can have enjoyable sex lives. My libido seems low and I'd like to rule out physical causes. Everyone seems to assume that it HAS to be trauma-related. But I've already done my emotional work around it. I want to rule out physical causes."
posted by vitabellosi at 5:55 AM on October 14, 2014 [1 favorite]

Best answer: There's lots of good advice above on handling this at a practical level. But there is still the emotional issue.

What you're experiencing may be a loss of identity and agency through the sexual assault. You feel that the doctors aren't seeing you they are seeing "nameless sexual assault victim 37".

As others have pointed out, this can happen with any preexisting medical condition: "Oh, here's someone with a history of high blood pressure. Their current symptoms must be related." It's always annoying, but in your case it's easy to see why it would be particularly annoying.

Sexual assault is in many ways an attack on identity and agency. Recovery from sexual assault involves rebuilding / reclaiming / asserting identity distinct from the assault, and agency drawn from your own core identity. Having a doctor equate you with your sexual assault is a terrible terrible thing. I could imagine how it would make it difficult to seek health care.

I don't have any particular advice for handling this. But perhaps just having clarity on the issue will help you be strong through it. Ultimately the doctors are there for you, and in my experience most doctors do understand that.
posted by alms at 6:02 AM on October 14, 2014 [1 favorite]

Response by poster: Oh, to specify:

I have full access to my medical record (probably even more than the average patient would) because I am a medical student and I'm technically working "in" the healthcare system -- I'm given the same privileges to medical records as any healthcare provider would be. So yes, it has all my diagnoses spelled out on the front page. Since I am a generally healthy, young person who doesn't see the doctor often, my medical record is basically therapy session after therapy session after therapy session interspersed by, oh, a note of an annual flu shot or TB test. I can read what my therapist writes, etcetera, practically immediately after my appointment. I feel ambivalently towards that.

I think I also have issues (anxiety?) with my general sense of privacy. After going through a judicial process for my assault... and having to think about the sorts of defenses that my rapist's attorney used... and the records they requested... I feel like nothing is truly "private" anymore. Obviously people have far better things to do with their time than poke around in my medical records, but some days, I think to myself, "Wow, everything I do/think/say is technically on record, in the most organized, browsable format possible." (Okay, maybe that's giving too much credit to the EMR system we currently have, and would probably be true given the fact that I use Google and Gmail and Amazon regardless of what I say in therapy, and yes, HIPAA and all that jazz-- but you get the idea...)
posted by gemutlichkeit at 6:10 AM on October 14, 2014

I think it's completely understandable to have concerns about your privacy. I have been in a similar situation, where what I thought were completely private medical issues were brought up in court by lawyers for someone who assaulted me.

If your therapist's notes in your medical records concern you (and well they should for the reasons you give and also in light of the recent medical records data breaches that I can only assume are going to become more common), ask your therapist to refrain from making notes of your sessions. I had a therapist who explained to me that she would take minimal notes during our sessions precisely because of what you list as a concern, that insurance companies and lawyers could subpoena her records and she was loathe to potentially have her notes undermine her patients in such situations. If your therapist is reluctant to do this, find another therapist.

As far as doctors are concerned, sometimes what happens in those little exam rooms between you and the doctor is uncomfortable. It just is. I've found that bringing my SO (or any witness who I don't mind letting hear the details of my treatment) into doctors appointments with me helps tremendously. Not only do I feel better having support, but having someone to take notes or ask questions when I'm freaked out about what is going on is really better for me in the long run. If there's someone in your life that you trust this way--best friend, relative, SO--consider bringing them to the doctor with you.
posted by GoLikeHellMachine at 6:53 AM on October 14, 2014 [1 favorite]

Therapists are usually legally required to keep notes, and an ethical therapist will not agree to stop keeping notes. Additionally, many EHRs require notes in order for the therapist or provider to bill insurance for the session (not that the notes go to the insurance company, just that the database tracks the insurance coding that way).

I do think it's worth remembering that, as DarlingBri said, so many women have been sexually assaulted that it's unlikely to be branding you with a giant scarlet S in the minds of your providers. It might be helpful to think about how you would treat a patient who disclosed (or whose records disclosed) sexual trauma -- what would be your "doctor thought process" about treating or diagnosing her? Would it affect your perception of her so much that you couldn't do your job? Or would you consider it just one more variable to take into account, or not, as the situation warranted?

If you're up for more of a policy push (which I realize, as a student, you may not be able to do), I would start looking into why patients' therapy records are being held as part of their physical health records. In my state, at least, those parts of the chart need to be separate -- the diagnoses and medications would carry over, since providers need to know what you're dealing with to treat you effectively and avoid medication interactions, but I can't imagine doctors even wanting to see a patient's therapy notes.
posted by jaguar at 7:11 AM on October 14, 2014 [3 favorites]

Wow, um... OP, first of all, I think you've gotten good advice here on your main question.

Second of all, accessing your own medical record through access that you have in your capacity as a student/medical worker is a HIPAA violation. You are entitled to access to your own records through the same avenues as everyone else, but your EMR access as a medical student is limited to what is required for you to complete your job. Since you don't treat yourself, it is a HIPAA violation to access your own record. This is well documented and should have been covered in HIPAA training when you gained access to the hospital EMR system. You might want to anonymize this question. You should definitely stop reading your therapist's notes.
posted by telegraph at 7:41 AM on October 14, 2014 [18 favorites]

You should look up what rights you have to issue "consent directives" with regard to sharing your personal health information in your jurisdiction's electronic health record. Depending on your local legislation and regulations, and the technological sophistication of the local EHR, you may be able to block certain information from being readily accessible. There should be a privacy officer associated with your health providers' institutions who could help you with this.
posted by sevenyearlurk at 8:26 AM on October 14, 2014

Depending on the institution I've worked at, some have said that they do not want me checking my own EHR due to HIPAA issues, but others have not. I do believe that looking in your own EHR is a HIPAA violation technically, but I don't think it's for good reason (EHRs have the ability to track who's looking in a record so this access will be recorded, every medical record should be written with the expectation that the patient is going to be able to see what is written there because patients do have the right to get copies of their own records whether they are healthcare personnel or not, what does "treating yourself" mean in this context - it's your body, of course you're treating yourself, no one else can treat you without your consent and participation).

Anyway, that's a side issue. Many EHRs do put mental health records into a separate category from other health records, and you may want to look into whether that's possible at your institution - ask your therapist. No, I would NOT want my physicians to be reading notes written by a therapist I was seeing, and I think it's completely understandable that you're freaked out by all those notes being there. Is it an option to start seeing a therapist outside your healthcare system if having the notes made more private is not possible?

I think trying to find a new doctor and not giving them a copy of your prior records is a bad idea. As a medical student, you know that there is a lot of information in medical records that can be helpful to future physicians aside from just a problem list. I suggest that if sexual assault is listed on your main problem list (and most EHRs do feature a 'problem list' now which is prominent every time the chart is accessed, because having diagnoses that 'drop off the front page' or become more difficult to find in the record over time is something that really should not happen with an electronic record), you could ask for it to be removed - ask your therapist to remove it, if so, so you don't have to have this conversation with your primary care doc if you don't want to. I've never heard of this being done, but I personally would be happy to remove a patient's sexual assault history from their problem list if they requested it.

Obviously, the assault will still be documented in historical records, but most of the time doctors have about 5 minutes or less to look at your chart, and so if the problems aren't listed front and center, they are unlikely to have the time or the energy to go searching for them. You can mention it if it's relevant.

There will be no incident where you arrive at the hospital in a coma and unable to communicate for yourself where your providers will need to know about your sexual assault.
posted by treehorn+bunny at 9:12 AM on October 14, 2014 [1 favorite]

Speaking as a layperson here (and also a rape victim): I think the fact that you are in the healthcare profession yourself might give you an edge in being treated. I can relate in how this piece of info in your records feels like yet another assault (I have different things in MY record I feel prickly/uncomfortable about fwiw) but you have an edge that many of us do not. You WiLL be taken more seriously than most of us will. Just sayin'.

Let me also state for the record that you will probably be an excellent and compassionate doctor because YOU will understand better how some of us patients feel. Just wanted to throw that out there for you.
posted by St. Alia of the Bunnies at 9:29 AM on October 14, 2014 [2 favorites]

every medical record should be written with the expectation that the patient is going to be able to see what is written there because patients do have the right to get copies of their own records whether they are healthcare personnel or not

That's not necessarily true of mental health records, though. In my state, at least, clients have the right to request their records, but therapists or other mental-health providers have several options in how complete a record (if any) they feel is appropriate to provide the client, and in what context (e.g., the client needs to read the records in the therapist's presence so that the therapist can explain anything that seems weird).

OP, does your therapist know you can read those records? And have you talked to your therapist about any of this? It seems like there's an element of anxiety here that's probably making the problem (which is certainly a real problem) seem worse than it is, or is making you feel more helpless than you are. If your therapist is using the same EHR, they might also have more practical ideas for restructuring your records.
posted by jaguar at 9:39 AM on October 14, 2014

Removing the record won't rewrite history. I am concerned that this is more about your feelings than (legitimate) concerns that clinicians might treat you according to stereotype rather than addressing your current problem.

Having someone with you in exams is probably the best short-term solution.
posted by Lesser Shrew at 10:02 AM on October 14, 2014

Something I haven't seen mentioned here: what, if any provisions exist to review / amend / edit / correct electronic healthcare records?
posted by doctor tough love at 10:30 AM on October 14, 2014

HIPAA provides the right for a patient to request an amendment to their medical record:
If you think the information in your medical or billing record is incorrect, you can request that the health care provider or health plan amend the record. The health care provider or health plan must respond to your request. If it created the information, it must amend the information if it is inaccurate or incomplete. If the provider or plan does not agree to your request, you have the right to submit a statement of disagreement that the provider or plan must add to your record.

I think the key here is that OP doesn't dispute the accuracy of the information. AFAIK there is no provision to remove accurate information from your medical record just because you don't want it to be there. The "best" way to do that is probably what's been described above (establishing yourself as a patient in a new system).
posted by telegraph at 10:55 AM on October 14, 2014

Therapists are usually legally required to keep notes, and an ethical therapist will not agree to stop keeping notes.

It is not remotely true in the state that I live in that therapists must legally keep notes from sessions. I've had this conversation with several therapists. Furthermore, their beliefs have uniformly been that helping their patients is more important than complying with insurance company regulations. Some of the therapists I know refuse to work with insurance companies for this very reason. If you cannot trust that your therapist doesn't have your best interests in mind, in this or other matters, then you need to find another therapist.
posted by GoLikeHellMachine at 12:01 PM on October 14, 2014

This isn't a HIPAA violation at all, (it may violate your organization's rules). And no, you should not "definitely" stop reading your therapist's notes. You have a right to read them. But in any case, that's not at all the point of this question.

I agree with the advice above: be explicit about it and that you are confident the assault is not the issue here. Every time I have a negative interaction with a doctor (which, excluding the ER is 100% of the time) I realize it's because I wasn't forceful enough, because it's weird to argue with a doctor about medical stuff. But like any job, they going for the easy answer, because it's right most of the time. You have to explain why it's not.
posted by spaltavian at 3:22 PM on October 14, 2014

Having had some negative responses from doctors related to sexual health (but admittedly not compounded by sexual assault), the best advice I can suggest is keep switching doctors until you find someone sex-friendly that you are comfortable with.

(my particular anecdote is that what turned out to be chronic pain was ascribed to frigidity and tension, and I just needed to relax for sex not to be painful. I found a GYN who thought painful sex was 100% unacceptable and took a proactive approach to deal with it. One possible solution that was constructively raised that may be helpful to your situation was physical therapy. Memail me for more information if you like.)
posted by mchorn at 3:29 PM on October 14, 2014

Some EMRs allow certain notes to be "locked", so that anyone trying to access them is subject to inquiry. I'm a physician, and I wouldn't access a locked patient note unless it was related to what I was treating the patient for. (Ie, I don't have to see therapy notes for a patient with a hernia).
In that case your providers would see that you had been to therapy, but not necessarily the content of those sessions. If you have/had any formal diagnoses those may be visible on a problem list.

Also, I do recommend you review your institution's policies re:accessing your own medical record. My employer just sent us all an FYI email that they consider it a big no-go to do that.
posted by maryrussell at 4:42 PM on October 14, 2014 [2 favorites]

Part of my job as a nurse care manager involves talking to lots of different providers. Let's face it, some are good, and some suck. You know this better than anyone (as a med student). Some will blow off your concerns for whatever reason they care to. In this case, they might in fact blow of your concerns because of your assault history. That clinician sucks and you should not keep seeing them. Other providers will be interested in your experience and priorities and will never make a decision or recommendation based only on a chart. That is the provider you want to see.

Let's face it, both these providers, the shitty and the great, are overworked and have little time to read your chart. They are mostly, the good and the bad, basing their work on the first few moments of conversation they have with you. Be assertive about what you want when you see a provider. Write it down. Bring a friend to advocate for you if it helps. If your provider blows you off, find someone else.
posted by latkes at 4:55 PM on October 14, 2014 [1 favorite]

It is not remotely true in the state that I live in that therapists must legally keep notes from sessions.

Fine, but that's not true in all states, so it's not responsible to suggest that any good therapist is going to comply with such a request.
posted by jaguar at 6:08 PM on October 14, 2014 [1 favorite]

I sort of wonder if having access to your own medical records and seeing EXACTLY WHAT THEY SEE is making you a little ah, extra sensitive about this.
posted by jenfullmoon at 6:10 PM on October 14, 2014 [1 favorite]

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