Physicians in this country seem so confident of their group strength that they can afford to ignore public opinion. So, at least, say critics of the powerful medical establishment in the wake of this week’s failure by a subcommittee of the government’s medical reform council to agree on a proposal to seek new legislation to require the disclosure of a patient’s medical records upon request. Exactly one year ago, a private advisory group to the Health and Welfare Ministry proposed that such disclosure should be made obligatory, but the council then failed to come up with any recommendations, mainly due to the disapproval of the Japan Medical Association.
Now, a special subcommittee of the Council on Medical Service Facilities has issued a draft report reflecting this continuing deep division among its members on the controversial issue. The question that occurs to many observers, in particular to patients and their families, is why something they feel should be a matter of medical routine is still the subject of so much professional dispute. Why should specific details about their illness and its treatment be kept from them? At a time when serious cases of medical malpractice and hospital error are much in the news, the public’s image of the medical profession would seem badly in need of improvement.
Yet, the influential JAMA remains adamantly opposed to any revision in the Medical Service Law that would require its members to provide patients with copies of their medical charts and other records on demand. Despite this opposition, the prospect for a heightened awareness of patients’ rights by the medical profession is not as bleak as some commentary on the council’s report would suggest. Although the report failed to produce any firm recommendations on the disclosure question, it did indicate that some of the council’s 14 members supported the proposal for new legislation. Others, mainly those representing the JAMA, insisted that disclosure should be voluntary on the part of individual physicians.
It is a sign of progress, if only a limited one, that the advisory panel’s draft report urges such voluntary compliance with patients’ requests under the principle of informed consent, while arguing that it is “too early” to require such disclosure by law. It is a fact that some more forward-looking medical practitioners already provide patients with their records and discuss their ailments and prescribed therapies in detail. It is because their number has been so slow to grow, however, that calls from citizens’ groups for legislation to make disclosure mandatory have continued to mount.
Representatives on the council of the Japanese Nursing Association and the Japan Hospital Association are reported to have favored the proposal for new legislation at the start of deliberations, but to have changed their stance after being persuaded by its opponents that voluntary disclosure would increase if regulations governing hospital advertising are relaxed to allow them to promote their disclosure policy to the public. That is a change many patients and their supporters hope to see implemented quickly.
While JAMA officials say that the group’s official stance is for disclosure on a voluntary basis “to ensure trust between physicians and patients,” many doctors claim that their opposition to a policy of openness stems from fears that their patients will not be prepared to fully understand what they are being told or shown, or how to deal with the information. That attitude is a major part of the wall of arrogance that the proposal for new legislation was intended to break down. Proponents of disclosure have said all along that it should be at the request of the patient. There will always be some people who prefer not to know the exact nature of their illness and its treatment, and their wishes should be respected.
But so should the wishes of those who want to know. The report recognizes the need for greater transparency by urging the medical profession to develop standardized document formats and terms for use on medical charts within three years. The purpose, of course, is to make them more comprehensible to patients, as well as to doctors and nursing staff. Yet while promoting voluntary disclosure to patents, the report apparently accepts the highly dubious policy of not sharing medical records with family members in cases of suspected negligence that results in a patient’s death. Why? To protect the hospital and medical staff involved? There is still time to change that before the council submits its report to health and welfare minister.
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