2001 Volume 41 Issue 7 Pages 517-527
To examine factors related to health care professionals' attitudes towards patients' access to medical records in the field of psychosomatic medicine and psychotherapy, a self-administered questionnaire was sent to 482 members of the board of trustees of the Japanese Society of Psychosomatic Medicine. The survey was conducted in March 2000, and the recovery rate was 62% with 86% of the respondents being male and 91% physicians. About half of them specialize in internal medicine(including psychosomatic medicine)and 30% in psychiatry. More than 90% of the respondents are interested in the issue of medical record disclosure, while about half of them were familiar with the content of the Ministry of Health and Welfare's recent report in detail. The majority(69%)answered that they preferred partial disclosure of medical record in the field of psychosomatic medicine, while 29% answered that all the medical record should be disclosed. Only 2% of them said that no disclosure at all is better. Among those who agreed with partial disclosure, more than 90% would be comfortable with disclosing drug prescription, physiological test data, and results of self-administered psychological tests. However, only half of them agreed with disclosure of the results of psychological tests using projective methods, and less than 20% agreed with patients' direct access to nursing records and medical charts that include interview records and assessments by health care professionals. When the situation is limited to cases involving psychotherapy, their answers were split. Sixty-four percents of the respondents were against and 35% for patients' direct access to medical charts. The reasons against included that direct access would have a negative effect on patients, medical records contain information provided by third parties such as family and colleagues, and it would interfere with health care professionals freely writing down necessary information. The reasons for included that all treatment should be provided only with the patient's consent, patients have the right to know, and patients and therapists should be equals even in the case of psychotherapy, etc. As to the question of their experience, about 40% of the respondents reported experiencing some distress when explaining diagnosis to their patients or obtaining consent for treatment from their patients. A multiple regression analysis demonstrated that in the case of psychotherapy the experience and use of psychoanalytic psychotherapy showed significant correlation with negative attitudes towards patients' direct access to medical charts. This suggests that these issues should be discussed in relation to the specific characteristics of each psychotherapeutic mode, and of each disease and condition under treatment.
