An opinion piece published in the Journal of the American Academy of Dermatology examines the legal and ethical concerns surrounding medical students’ continued access to patient electronic health records (EHRs) after the conclusion of a student’s rotation.
Evidence suggests that as many as 96% of medical students access EHRs to monitor the outcomes of patients after these individuals have left the students’ care. Although this may constitute a violation of the right to privacy of these patients, 93% of these students reported that this practice was of educational benefit.
In the presented case study, a medical student has a 1-week dermatology rotation, during which he performs a skin biopsy on a male patient with suspected basal cell carcinoma. When the pathology results are available a week after his rotation ends, the student accesses the patient’s EHR to review the histologic results and then continues to follow the patient’s progress by viewing postoperative photos.
The authors review a number of issues, including ethical and legal concerns regarding a patient’s right to privacy and the societal benefits of educating medical students more fully. They offer 4 different options for dealing with the situation, including reporting the student to the dean, informing the patient of the student’s continued access to his health record, doing nothing further as no harm has come to the patient as a result of the breach of privacy, and commending the student for his interest in patients and their outcomes.
The authors recommend the second option: informing the patient of the privacy breach and giving him the opportunity to provide consent for further student access to the records for educational purposes. However, the authors acknowledge that the patient may end up taking legal action against the physician or the institution.
Ultimately, the best solution to problems posed by EHR access is to obtain permission from patients during standard consent for care. In this way, medical students can benefit from additional learning and patients are aware that trainees may access their records. In addition, teaching institutions should educate trainees about the ethical and legal issues involved in accessing patient records without consent. In this way, patients’ right to privacy can be preserved while the societal goal of better-educated medical students is achieved as well.
Baranowski MLH, Stoff BK. Should medical students follow up on skin biopsy results? When education conflicts with patient privacy. J Am Acad Dermatol. 2018;78:1229-1231.