The question of patient access to health records is often lumped in with the
debate over medical privacy. Access and privacy are quite different concepts.
To illustrate this point, consider whether health records encased in concrete,
welded into a metal drum, and dropped into deep ocean waters will be kept private.
Chances are very good that they will. The information in those records would tend
to be very securely kept from public view. The subject of the records could be
confident that those records would not be revealed to others. The subject of those
records would not have access to them either.
This absurd example illustrates the huge conceptual difference between
privacy and access. While patient access is probably appropriate in most cases,
there may be some where it is not. A medical practitioner may need to make very
frank notes in order to best serve the patient. Mandating that patients should
be able to review their files may undermine security by giving wrongdoers a path
to access that may open medical files to a variety of threats including invasion
Access to patient files should be treated as a separate issue from privacy. It
involves many important and difficult value judgments. At times, access and privacy may