Originally published March 2017
When patients ask for a copy of their medical record so they can give it to a provider of complementary or alternative medicine, some physicians may be taken aback or feel uncertain how to respond.
Conventional medicine and alternative (or complementary) medicine continue to evolve, and the boundaries between the two are neither fixed nor absolute. Some alternative treatments have become part of conventional medical practice, while others do not have the necessary scientific support and are consequently considered unproven.1
Some patients may be reluctant to inform their doctor of their intention to seek alternative medicine, sometimes fearing how their physician might react. Others may not consider it necessary to let their physician know.
Regardless, a patient request for the medical record for the purpose of sharing with an alternative medicine provider can raise professional, ethical, and legal concerns. Doctors may ask themselves questions such as: Should I give them the medical record if the other healthcare professional will be basing treatment on my notes? Should a copy of the record be transferred directly to the other healthcare professional? Will honouring this request expose me to liability? How can I speak with patients about the alternative treatment they’re considering and the potential risks?
Having the answers to these questions can equip physicians to react confidently to such requests and give patients good advice and guidance.
Providing access to medical records
When patients ask for their record, physicians should keep the original, providing patients with copies of the contents including clinical notes, investigation reports or results, and consultation reports. The courts have ruled that physicians own the physical medical record and patients have a right to access the information in the record. Physicians who deny access or delay in responding to the request could be the subject of a medical regulatory authority (College) complaint or a legal action.2
There is an exception to patients’ right of access to their medical information. If physicians reasonably believe there is a significant likelihood of a substantial adverse effect on a patient’s physical, mental, or emotional health, or harm to a third party, they can deny access. In those cases, the information or specific part of the medical record would not be disclosed to patients. However, such exceptions are rare and the onus is on the physician to justify denying access.2
It is good practice for physicians to ask patients to make a written request. A signed letter documents a patient’s request, helps confirm the scope of the request, and documents a physician’s authorization for the information. In some provinces and territories, such as British Columbia, the College instructs physicians to ask for a written request.3
When providing copies, physicians can charge a reasonable fee to cover copying and administrative expenses. Physicians should check with their medical association and College for guidelines on charging fees in these circumstances, including what constitutes a reasonable charge.2
When physicians discover their patient is considering an alternative treatment, the practitioner should consider speaking with the patient. This provides the opportunity to learn more about the treatment, discuss the implications, and consider potential interactions with the patients’ conventional treatments. In fact, if the physician is aware that there is a possibility the two treatments may result in negative interactions or an adverse outcome, the physician should discuss this with the patient.
Although physicians may be concerned that speaking about an alternative treatment may expose them to liability and complaints, taking no action may place them at greater risk. The courts and Colleges may expect physicians in some circumstances to make reasonable attempts to become aware of other treatments their patients are using, and if needed talk to them about possible interactions. The Canadian Medical Association Code of Ethics instructs physicians to "Consider first the well-being of the patient," and "Take all reasonable steps to prevent harm to patients…." 4 In Québec, the Code of Ethics of Physicians states, "A physician's paramount duty is to protect and promote the health and well-being of the persons he [/she] attends to, both individually and collectively."5
Starting the conversation
When speaking with patients about alternative therapies, physicians should keep a few things in mind. First, physicians should be mindful that they are communicating in a professional manner. Second, they should respect patients’ right to make health decisions independently, based on their values and preferences. Finally, any advice physicians give should stay within the limits of their medical knowledge, skill, and judgment.1
Physicians might consider beginning the conversation by explaining that the "alternative treatment may affect the treatments we’re doing together." Practitioners should make it clear that their concern is for the well-being of the patient and their interest in the treatment is to protect patients’ safety. The discussion may also provide an opportunity for physicians to review the medical record with the patient and the consent to the conventional treatment they're currently receiving.
After confirming with patients what treatment they're considering, physicians should decide what information, if any, they could give that would help patients to make informed choices. Knowledge of unconventional treatments varies from practitioner to practitioner. While some have concentrated on conventional medicine alone, others have explored alternative therapies, and yet others practise it themselves.1
If a physician believes that an alternative therapy may be harmful, the patient should be informed. If a doctor doesn't have the knowledge to comment on the therapy, including the potential for adverse reactions, the physician should let the patient know.
In some cases, it may be appropriate for doctors to consider consulting with or referring patients to others who may be more knowledgeable; for example, a physician colleague, when it’s in the best interests of the patient and where there is reason to believe that the patient would be exposed to harm.1 Giving information to a patient does not mean that a particular therapy is being endorsed or ordered.
Documenting the patient encounters
All pertinent encounters with patients should be documented in the medical record, from the request for copies of the record itself, to discussions about the alternative therapy, and any advice provided. Accurate documentation that is made as close to the time of the encounters as possible contributes to the delivery of high-quality care and may help physicians recall details when needed in the future. Documentation can also serve as important evidence in a legal action or College complaint.6
Taking action is in the best interests of patients and physicians
Physicians who become aware they have a patient considering alternative medicine should consider taking appropriate action to act in the patient’s best interests and to protect the patient’s health. To the best of their ability, doctors should speak with the patient about the alternative treatment and, if reasonably possible, advise them of potential interactions with conventional medicine treatments.
- Canadian Medical Protective Association. Alternative medicine — What are the medical-legal concerns? [Internet]. Ottawa: CMPA; 2012 March [cited 2016 Feb 10]. Available from: https://www.cmpa-acpm.ca/en/safety/-/asset_publisher/N6oEDMrzRbCC/content/alternative-medicine-what-are-the-medico-legal-concerns-
- Canadian Medical Protective Association. When law and medicine intersect: Influential court decision still relevant to patients’ access to medical records [Internet]. Ottawa: CMPA; 2011 Dec [cited 2016 Feb 10]. Available from: https://www.cmpa-acpm.ca/en/-/when-law-and-medicine-intersect-influential-court-decision-still-relevant-to-patients-access-to-medical-records
- FAQs [Internet]. Vancouver (BC): College of Physicians and Surgeons of British Columbia, For the Public [cited 2016 Feb 10]. Available from: https://www.cpsbc.ca/for-public/faqs
- CMA Code of Ethics, #1, 14. Ottawa (ON); Canadian Medical Association; 2004 [cited 2016 Feb. 10]. Available from: https://www.cma.ca/En/Pages/code-of-ethics.aspx
- Collège des médecins du Québec [Internet]. "Code of ethics of physicians," Article 3. [cited 2016 Feb 18]. Available from http://aldo.cmq.org/en/Partie%201/AspecDeonto/DevoirObligations/~/media/Files/ReglementsANG/cmqcodedeontoan.pdf
- Canadian Medical Protective Association. Why good documentation matters. [Internet]. Ottawa: CMPA; 2011 March [cited 2016 Feb 10]. Available from: https://www.cmpa-acpm.ca/en/duties-and-responsibilities/-/asset_publisher/bFaUiyQG069N/content/why-good-documentation-matters