I think many therapists also don't like to share too much information with patients, notes, etc, because without the training you can become easily offended with what you will read. It is like reading a psychiatrist diagnostic evaluation. You can become easily intimidated and offended by reading their interpretation of us from a diagnostic and medical viewpoint.
You then have the problem with people wanting to sue their therapist under the belief of malpractice... so its not in their best interest to share information that will likely save their arse, or by itself, could burn them, if shown in the wrong context or partially.
Where I live, we've got the right to access all our medical files using Data Protection and the Freedom of Information (FOI) Act. However, in both of these Acts there's a specific provision that a request for access to your records can be denied, if in the opinion of the officer that disclosure may be detrimental to your health and well-being. I've direct experience of being denied access to my records and as a health professional myself I see it from both sides.
In the first case, I got access to all my records that was held by a public body, but in all their define wisdom, they decided not to give me access to one particular medical letter from one doc to another doc. Their reason was that this letter if it were disclosed was likely to be "detrimental to my well-being".
But at the same time in denying me access they also had to comply with another provision of FOI, where if access is denied because its considered likely to be detrimental, the organisatin must also offer you the right to have that record disclosed to a third party which would be your General Practitioner (GP), if you so choose.
While I understand the need for appropriate safeguards in any disclosure of records, when it comes to the country that I live in, I also firmly believe that we need a legislative amendment, that creates an onus on doctors, hospitals and public bodies, to put in place appropriate safeguards when deciding on requests for access to records.
Key amongst those safegaurds in my opinion, is that any decision to grant or refuse a request for access should be clinically informed, contemporaneous and up to date, and based on your current clinical status and not a past medical history, and with an obligation to establish what your current medical history is. Most important is that any decision should be proportionate to the level of risk that's actually involved.
Otherwise, what's happening is that this particular provison is being used willy nilly by clinicians, hospitals and various public bodies to refuse access without showing good cause,. So in essence, its being abused.
In my own case involving the public body, I ended up having to take the case to the Office of the Information Commissioner (OIC) for an independent review. Part of my own case, was that this organisation including the in-house doctor that formed this opinion, who never ever met me, let alone assessed me, was basing his opinion on one historic record that wasnt relevant to the present day. More disturbingly, was that while a doctor is duty bound to make informed decisions in all other areas of practice, it is somehow ok for them to form quite arbitrary and uninformed opinions on what my current MH status is, and what is was likely to be detrimental to my own well-being. Thankfully, the OIC ruled in my favour and overturned the decision of the public body.
The second case involved a psychiatrist, although he did give me the option of either having supervised access to the records with himself, or to nominate disclosure to a third party which would have been my GP.
At this stage I had enough! The records were historic in nature, and to put this in context this guy hadn't seen me since he discharged me from his OPD clinic when I complained about a practitioner he had referred me to, some ten years ago. Eventually, I did manage get access to get full access to the med file, after taking it to internal review in the organisation.
To cut a long story short, when I did get unrestricted access, this med file showed that he failed to undertake a proper clinical assessment and that many of the symptoms were present in those early years, but he failed to pick up on them!
So yes, Anthony sometimes when doctors refuse to grant access to your medical records, its less to do with what they may consider likely to be detrimental to your own well-being, and more to do with protecting their own arse in the medico-legal sense. That's especially the case, if it involves misdiagnosis, or if the Dr's records contain prejudicial, unfounded or derogatory statements about the data subject.
It's ironic, medicine tells them to alway's think medico-legally, and to never ever admit wrong-doing for fear of being sued. But some of the research on some of the reasons behind why people do sue, has also found that people are least likely to sue, if only the doctors were completely open and transparent and said sorry once in a while, rather than adopt the approach of that's coined Defensive Medical Practice.
My own opinion is that some of these kind of opinions to refuse access can often be grounded in quite paternalistic behaviour....like doctor know's best!
More to the point, decisions to grant or withhold access to records, can also tell us alot about the nature of the therapeutic relationship that did or does exist between the Patient/Dr/Therapist, including the level of respect and trust that may or may not exist.
What is often highlighted in these sort of cases, is the negative attitudes that some Dr/T's have themselves towards mental health and the very idea of recovery. That also raises the very important question about how do we as a society deconstruct many of the myths that surround mental health, if those who are involved in the treatment of people with MH difficulties, are the very people who are perpetuating and reinforcing those very same myths.
What bug boiled me, was that I may have PTSD, but I have not lost the capacity to decide what's in my own best interests!
