[ Friday, June 22, 2012 ]


Mental Health Records are Health Records: There is a lot of push for "mental health parity," with the argument made that mental health should be treated the same as physical health in perception and care. Unfortunately, that's just not really the case in many instances. Mental health is different, certainly in most people's opinion.

In this story in the Boston Globe, a patient was upset that the notes from her visits to her psychiatrist at a particular hospital ended up in the hospital's medical record for her. I'm not sure why she thought the Mass General psychiatrist wouldn't treat medical records just like a Mass General surgeon or ENT, but apparently she did, and was upset to find out that those records ended up in her general medical record.

The Globe story contains a lot of HIPAA inaccuracies, unfortunately (patients don't need to sign a "permission slip" for doctors to share their information for treatment or payment). HIPAA does provide special treatment for "psychotherapy notes." However, what constitutes "psychotherapy notes" isn't what you probably think it is. It's intended to cover notes the psychotherapist makes to himself that aren't supposed to go to the patient. Also, for the records to be considered "psychotherapy notes," they must be segregated from the rest of the medical records. When they are combined with other records, they're no different than any other medical record.

If there's a lesson to be learned, it's this: if there's something in your healthcare situation that you want to be treated differently than the rest, be it mental health, sexual issues, whatever, ask your provider if special protections can be placed on that information. They don't have to do so, but you have the right to request special protection for some information, and many providers have methods to provide such extra protections. Or, pick a different provider for the sensitive stuff. Of course, that can backfire, if you have multiple doctors treating you and none of them know the whole story. Which, coincidentally, reinforces a point I've made a million times: perfect care and perfect privacy are opposite ends of a continuum, and any increase in privacy will erode the quality of your medical care.

Jeff [4:35 PM]

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