Your patients want to see their medical records, but not everything in those files is fit for their eyes. How do you know where to draw the line? "Each College has its recommendations to practitioners with regards to patient access to their records," says Dr Robert Rivington, senior medical officer at the Canadian Medical Protective Association (CMPA). Here are 10 things you need to know before you pull those files.

1 Do patients have a right to the original records? No. By law, the patient has the right to have their records out of respect for their autonomy. But this right is limited to a copy of the records — not the original — since those are legally yours.

2 Can they see everything? "No," says Dr Rivington. "They have access to the vast majority of the information in their files, but there are exceptions." Those exceptions that might harm the patient physically or mentally — such as sensitive psychiatric records — or bring harm to someone else can be withheld. However, if they ask, you'll have to justify why you felt the patient shouldn't see some parts of their records, adds Dr Rivington.

3 If you made a non-medical comment, should you censor it? It's best not to write it in the first place, says Dr Rivington. The Royal College of Physicians and Surgeons of Canada cites a case where a radiologist had trouble getting a patient's co-operation with a test because he was "a bit of a wimp." Lucky for the radiologist, it's ok to expunge inflammatory statements that are medically irrelevant from the copy you give to patients. But Dr Rivington emphasizes: "Physicians should avoid inappropriate comments, and be factual and professional."

4 What about reports from other carers or providers? "Basically, any information in the health records that arises from care provided through the provincially-funded system is accessible," says Dr Rivington. For other reports, like the ones from insurance companies for instance, different provinces have different rules. When in doubt, contact the CMPA, Dr Rivington recommends.

5 Can you charge a fee for copying records? Absolutely, says Dr Rivington. "It costs the physicians for use of their secretary's time and photocopier, so it is their right to charge for this service." In fact, each provincial College has a statement about charging and many even propose a fee for the service, he adds.

6 Are patients allowed to make changes to their records? "They're permitted to propose corrections or modifications to the information in their records," Dr Rivington says. But physicians are encouraged not to alter the original record. Instead, Dr Rivington suggests the doctor add a note that "on X date, the patient corrected the piece of information Y in the record."

7 Should the patient put their request in writing? "Most physicians should request something in writing," Dr Rivington recommends.

8 Can anyone else request records on behalf of a patient? "If the patient is incapable of speaking for themselves, then whoever has the power of attorney for personal care can request the records on their behalf," says Dr Rivington. If it's a child, then the parents have access. But there's a caveat, he warns. "If there's a matrimonial dispute, physicians must be cautious about allowing a non-custodial parent access to the records." You could seek legal advice to determine who gets to see what, adds Dr Rivington.

9 What if the patient wants the records sent to a third party? There's nothing to stop docs from complying with that wish. But sometimes there's very sensitive information in the files that the patient might not even know is there. For example, if there's mention of childhood sexual abuse, and the patient asks you to send the records to their employer — this puts you in a delicate position. "We suggest that the physician have the patient come in and show them the information in the file, then decide what to do," says Dr Rivington.

In some cases, it's not even necessary to send all the medical records, according to Dr Rivington. "If the patient has a condition and they're travelling to another country, then a simple letter might help introduce them to a doctor in that country, rather than the entire file."

10 Should you make access to the records easier for your patients? "I'm not sure it's in the best interest of patients to always have a copy of their records," he says. "The records are not always in plain English. Most physicians are uncomfortable providing the health information directly to the patients and would prefer to give it to another physician."

Keep in mind, the whole point of giving patients access to their records is to help them make informed decisions about their health. There's nothing to stop you from having an informal session with them, going over the records and explaining the medical terms, says Dr Rivington.

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