Patients Find Dangerous Medical Record Errors are Common
Older adults have cause to be careful about what’s in their medical records. According to the Office of the National Coordinator for Health Information Technology, roughly 1 in 10 people who access records online end up requesting that they be corrected due to some type of error. This means, record errors might be more common than expected.
An incorrect medical diagnosis or lab result may have been inserted into a patient’s file, raising the possibility of inappropriate treatment. Allergies that aren’t noted, lab results that aren’t recorded, medications that aren’t listed, and other common and blatant omissions to files can be equally detrimental.
When both his new primary care physician and cardiologist asked about kidney cancer, a condition Liz Tidyman’s father didn’t have, she reviewed records from his emergency room visit. In doing so, Liz saw that “renal cell carcinoma” (i.e., kidney cancer) was listed instead of “basal cell carcinoma” (i.e., skin cancer).
“It was a transcription error; something we clearly had to fix,” Tidyman said.
Susan Sheridan’s husband had surgery to remove a mass in his neck nearly two decades ago. A hospital pathology report listed synovial cell sarcoma, a type of cancer, but somehow the report didn’t get to his neurosurgeon and the surgeon reassured the couple that the tumor was benign. Six months later this error of omission was discovered, and it was too late. Pat’s untreated cancer had metastasized to his spinal canal and he died a couple of years later.
“I tell people, ‘Collect all your medical records, no matter what’ so you can ask all kinds of questions and be on the alert for errors,” said Sheridan, who is the director of patient engagement with the Society to Improve Diagnosis in Medicine.
It’s also common for a patient’s name and contact information to be listed incorrectly, including the person’s address, phone number, or personal contacts, which makes it particularly difficult to reach someone in the event of an emergency. Bills also get misdirected and the next time the patient is in to see the doctor, they’re hit with hefty charges, including late fees.
Dave deBronkart, a 68-year-old cancer survivor and patient activist, checked his radiology report through a Boston hospital’s patient portal. It had his name on it but identified him as a 53-year-old woman. In another case, records that accompanied deBronkart’s mother to a rehabilitation center following hip replacement surgery identified her as having an underactive thyroid when in fact she had an overactive thyroid. Likely, family members caught this in time to ensure she didn’t receive dangerous medications.
“It’s important for people to realize how easy it is for mistakes to get into the system and for nobody to know it. And that can cause downstream harm,” deBronkart said.
The law that guarantees a patient right to review his or her medical record, the Health Insurance Portability and Accountability Act of 1996, gives an individual the right to ask for a correction. One should begin the process by asking the responsible party – a physician, hospital, etc.—if they have a form to submit in order to suggest a change. Physicians and hospitals are required to respond in writing within 60 days, with the possibility of a 30-day extension.