Season's greetings (2) Patient safety and personal access to medical records

24 December, 2022


May I echo your "Season's Greetings and Happy New year to all HIFA members everywhere and special thank you to to Neil's ongoing inspiring and Participatory Leadership.

Also, in relation to patient safety, and if you have the time, it may be worth you reviewing the ongoing discussions and negotiations between doctors, governments and patient access to records devotees with special reference to patient safety and to the WHO 2021 to 2030 Patient Safety Plan.

Global Patient Safety Action Plan 2021-2030 (

The plan, which was ratified by the 74th WHA, supports patient access to their own records.

Although the British Medical Association cites patient safety as a reason for not letting patients see their records, it is known that 20 to 30 % of patients who see their records find errors or omissions - not a "safe" system, perhaps?

The reasons for patient access to records are diverse but the Institute of Medicine described a comprehensive set of procedural improvements for Care in their book "Crossing the Quality chasm" - below. The openness perhaps also reflects many of the attributes of compassion as described in the seven habits of effective people described by Steven Covey

Crossing the Quality Chasm - Building a Better Delivery System - NCBI Bookshelf (

"The report finds that the current system is unable to provide safe, high quality care in a consistent manner. It consists of 10 rules to redesign the health system and a series of recommendations, including the allocation of $1 billion by Congress to support reform efforts. Crossing the quality Chasm can be read or ordered on line at"

"Although it was thought by some that this report would not catch as much attention as the first, it has created quite a splash in the media. Headlines such as "US Health Care System said lacking" and "IT must BE used to reform US Health System" can be found in both the trade and popular press."

"New rules to redesign and improve care

1. "Care based o1. "Care based on continuing healing relationships. Patients should receive care whenever they need it and in many forms, not just face-to-face visits. This rule implies that the health care system should be responsive at all times (24 hours a day, every day) and that access to care should be provided over the internet, by telephone, and by other means in addition to face-to-face visits.

2. Customisation based on patient needs and values. The system of care should be designed to meet the most common types of needs, but have the capability to respond to individual patient choices and preferences.

3. The patient as the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over the health care decisions that affect them. The health system should be able to accommodate differences in patient preferences and encourage shared decision-making.

4. Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.

5. Evidence-based decision-making. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place.

6. Safety as a system property. Patients should be safe from injury caused by the care system. Reducing risk and ensuring safety require greater attention to systems that help prevent and mitigate errors.

7. The need for transparency. The health care system should make information available to patients and their families that allows them to make informed decisions when selecting a health plan, hospital, or clinical practice, or when choosing among alternative treatments. This should include information describing the system's performance on safety, evidence-based-practice, and patient satisfaction.

8. Anticipation of needs. The health system should anticipate patient needs, rather than simply responding to events.

9. Continuous decrease in waste. The health system should not waste resources or patient time.

10. Co-operation among clinicians. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and co-ordination of care.

The openness perhaps also reflects many of the attributes of compassion as described for "healthy families" as described by the Timberlawn project, I think

Family measurement techniques: Beavers-timberlawn family evaluation scale: The American Journal of Family Therapy: Vol 14, No 3 (

Mentally Healthy families

1) Positive in their attitude to life and other people.

2) The ‘love’ of healthy families involves closeness and distance. They are capable of great intimacy and affection, but they also feel self-sufficient and confident and free.

3) They are very clearly in charge of the lives.

4) The members of the family are always consulted very fully.

5) They communicate well. They are straightforward – direct and open and honest with each other.

6) They are very realistic and practical.

7) They have a remarkable ability to cope with change.

HIFA profile: Richard Fitton is a retired family doctor - GP. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data. Email address: richardpeterfitton7 AT