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Old 16.05.2019, 10:07
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Releasing medical notes

Is this normal? Want to change doctor but they will only release my file if I sign:
Da den Arzt in Zukunft die vollständigen Unterlagen nicht mehr zu Verfügung stehen, verzichte ich auf sämtliche Ansprüche aus dem Behandlungsverhältnis, insbesondere auch auf Schadensersatz- und Genugtuungsansprüche wegen allfälliger Behandlungsfehler.
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Old 16.05.2019, 10:39
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Re: Releasing medical notes

Wow Wouldn't sign that sh!t. Even if it were limited to treatments in the future it would be way beyond what is reasonable.
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Old 16.05.2019, 11:11
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Re: Releasing medical notes

That makes no sense. At all.

Based on the data protection act you have the right to request all data about you the doc keeps. It isn't clear if you have the right to the originals in all cases when you leave, but IMO any and all 3rd party products have been paid for by you and are indeed yours so that part should be unambiguous.

Perhaps contact the administration and ask for guidance and support, certainly you're neither the first nor the last with this kind of issue:

Gesundheitsdirektion Kanton Zürich
Administration Medizin
Stampfenbachstrasse 30
8090 Zürich

Phone 043 259 24 09

kantonsarzt.sekretariat@gd.zh.ch
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Old 16.05.2019, 12:26
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Re: Releasing medical notes

I caused a bit of a ruckus when I refused to sign it! I did ask them to clarify what it meant, but neither of the people at the desk could explain what it actually meant (one because she's French-speaking).

I'm switching doctors because a specialist (referred after a second opinion) said that it was an error of judgement on the part of my GP for not investigating something further. So, my issue is if they find something after tests, can the health insurance kick up a fuss and say that it should have been investigated earlier? Which would mean if I sign the forms that the health insurance could refuse to pay and that I then would be liable for all costs? What caught my attention is that the specialist used the word "behandlungsfehler", else I would have taken the notes and signed.
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Old 16.05.2019, 13:57
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Re: Releasing medical notes

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I'm switching doctors because a specialist (referred after a second opinion) said that it was an error of judgement on the part of my GP for not investigating something further. So, my issue is if they find something after tests, can the health insurance kick up a fuss and say that it should have been investigated earlier?
I'm a bit confused... did your original doctor not refer to you a specialist and just do noting? If the situation is still on going and you just switched doctor I don't see how the insurance can say anything....
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Old 16.05.2019, 14:13
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Re: Releasing medical notes

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I'm a bit confused... did your original doctor not refer to you a specialist and just do noting? If the situation is still on going and you just switched doctor I don't see how the insurance can say anything....
No, no referral and ascribed it to a side effect of a procedure. I went to see another GP for something else as mine was away and asked what she thought as I'd always thought to get a second opinion. GP2 then sent me to the specialist who said that GP1 was remiss in not referring me for further investigations as the side effect is so rare that there is a much higher chance of it being caused by something else.

Edit to add: So would you sign the form then?

Last edited by dragoneiric; 16.05.2019 at 14:33.
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Old 16.05.2019, 14:38
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Re: Releasing medical notes

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Edit to add: So would you sign the form then?
No, for me a clear indication something stinks..... Never had to sign anything like that when transfering to another doctor
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Old 16.05.2019, 17:11
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Re: Releasing medical notes

The more I think about this the more outraged I get.

I've sent an enquiry to the Gesundheitsdirektion asking what OP's rights are, what can be done, and what the supervising body will do to stop this egregious abuse of power.
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Old 16.05.2019, 17:43
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Re: Releasing medical notes

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Edit to add: So would you sign the form then?
Nope
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Old 16.05.2019, 20:35
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Re: Releasing medical notes

Deepl translate of the text for those that don't read German:

Quote:
Since the physician will no longer have the complete documents available to him in the future, I waive all claims arising from the treatment relationship, in particular also claims for damages and satisfaction due to possible treatment errors.
Wow.
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Old 16.05.2019, 21:17
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Re: Releasing medical notes

Have a look at this: https://www.beobachter.ch/dienstleis...aben-patienten

Quote:
Herausgabe
Patienten haben Anspruch auf die Herausgabe der Krankengeschichte als Kopie (Art. 8 Abs. 5 DSG). Diese muss vollständig und gut leserlich sein. Ob auch ein Anspruch auf die Herausgabe im Original besteht, ist umstritten. Klarheit besteht hier nur bei Röntgenbildern: Diese sind dem Patienten im Original auszuhändigen.
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Old 19.05.2019, 07:06
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Re: Releasing medical notes

Thanks. GP2 has said she doesn't need the notes immediately so we will wait and see what happens. If I get the all clear, I can go ahead and get them.
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Old 19.05.2019, 12:16
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Re: Releasing medical notes

Whether or not the new GP thinks she needs your medical file from any previous doctor, that file is still YOURS to have.

If your new doctor is helpful, would she perhaps do you the favour of writing to the previous doctor asking for the file (and then give it to you)? Sometimes that does the trick, because the outgoing doctor feels better about handing over the file to a colleague than to a patient (even though the patient does have the right to it).
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Old 22.05.2019, 17:32
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Re: Releasing medical notes

So, I got an answer by the Gesundheitsdirektion.

What I paraphrase from the answer is bolded
whereas my comments are marked by italics

According to §13 of Zürich's Gesundheitsgesetz, Zürich's Law on Health, every medical professional must keep a dossier on every patient and keep it up to date. The dossier must be stored for ten years after the last treatment. According to §13 section 4 the patient has the right to a copy of their dossier. Alternatively the doc may hand over the originals, in which case they must keep a copy for ten years.

Furthermore the handover must happen unconditionally. In particular it must not be conditional to paying some bill or signing some waiver of rights.

OP is advised to request a copy of their dossier once again, referencing "§13 Gesundheitsgesetz des Kantons Zürich". If unsuccesful, OP is invited to contact the Gesundheitsdirektion and submit the doc's name and address, they'll admonish the doc of their professional obligations.


I had sent my enquiry to kantonsarzt.sekretariat@gd.zh.ch

This request should also provide some reasonable timeframe for the copy to arrive. I imagine making one for a standard case (whatever that means) shouldn't take that much effort yet they can't be expected to jump through loops, so 30 days seems reasonable. Attaching a copy of some form of ID seems useful to avoid further delays. Request explicit confirmation that the dossier is correct and complete. Registered mail is recommended.

Unfortunately Zürich's Law on Health is Cantonal law so the particular situation in other Cantons may well differ. However every Kanton has the equivalent of Zürich's Gesundheitsdirektion, see for instance this list for their current contact details. At the very least the federal law on data protection should apply, which is what Der Beobachter references in the link above. Data protection law mandates that the collector must provide the data being collected upon the subject's request. In medical cases this case it should also mean a copy of the patient dossier.


As for medical maltreatment, patients of health services professionals in Zürich are welcome to contact the Kantonale Patientenstelle (zh.patientenstelle.ch) or the OmbudsStelle of the Doctors Association of Zürich, aerzte-zh.ch/dienstleistungen/ombudsstelle.html

This appears to not be relevant (yet) but I had mentioned it in the mail anyways. It looks like there are Zürich's plus 5 others that cover all of CH, see patientenstelle.ch

A pre-emptive waiver of patient rights seems unlikely to hold before a court of law. However, just like potential damages this is a matter of civil law.

When it comes to restricting a health professional's work or admonishing them, the supervising body reacts primarily to judicial verdicts indicating or proving that professional duties are no longer met, or that they violate their professional duties in a "systematic" manner. Such a regulatory process can also be initiated by multiple tips or complaints.

I take "systematic"(sic) to mean that the (in)action is intentional and likely to be repeated. Whatever the reaction to the 2nd request may be, this seems to be given so I think OP should inform the Gesundheitsdirektion and complain about the doc anyway. The doc clearly abuses their position of power and trust - certainly some patients will be easily impressed or assume that the doc knows what they're doing and have the right to.

Certainly a complaint in English is fine, otherwise I'll be glad to assist.
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Old 22.05.2019, 17:34
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Re: Releasing medical notes

Here's the reply in German:

Quote:
Sehr geehrter Herr Urs Max

Ich beziehe mich auf Ihre Anfrage betreffend Patientendossier vom 16. Mai 2019.

Gemäss § 13 Gesundheitsgesetz, hat, wer einen Beruf des Gesundheitswesens ausübt, über jeden Patienten eine Patientendokumentation anzulegen und diese laufend nachzuführen. Diese gibt Auskunft über die Aufklärung und Behandlung. Als Behandlung gelten insbesondere Untersuchungen, Diagnosen, Therapie und Pflege. Die Urheberschaft der Einträge muss unmittelbar ersichtlich sein. Die Patientendokumentation kann in schriftlicher oder elektronischer Form geführt werden. Die Patientendokumentation wird während zehn Jahren nach Abschluss der letzten Behandlung aufbewahrt. Patienten haben Anspruch auf Herausgabe der Patientendokumentation in Kopie (Abs. 4).

Es besteht auch die Möglichkeit, die Originale der Krankengeschichte herauszugeben. Dann ist der Arzt aber verpflichtet, während zehn Jahren gleichwertige Kopien aufzubewahren. Weiter hat die Herausgabe der Patientendokumentation bedingungslos zu erfolgen. Sie darf insbesondere nicht mit der Bedingung, dass eine Rechnung bezahlt werde oder eine Verzichtserklärung unterschrieben werde, verbunden werden.

Ein umfassender Verzicht auf die Geltendmachung von Schadenersatz hat rechtlich wohl kaum Bestand; dies müsste wohl aber letztendlich durch eine gerichtliche Instanz beurteilt werden. In jedem Fall darf ein solcher Verzicht aber nicht mit dem Anspruch auf Herausgabe der Patientendokumentation verbunden werden. Diese hat bedingungslos zu erfolgen.

Was das weitere Vorgehen betrifft, so empfehlen wir Ihnen, den Arzt schriftlich und unter Hinweis auf die geltenden Vorschriften um Herausgabe der Patientendokumentation zu ersuchen. Sollten Sie keinen Erfolg haben, können Sie uns gerne Name und Adresse des Arztes mitteilen. Die Gesundheitsdirektion wird den Arzt dann mit einem Schreiben auf seine Berufspflichten aufmerksam machen.

In Bezug auf allfällige Behandlungsfehler weisen wir zudem auf Folgendes hin:
Das gesundheitspolizeiliche Aufsichtsverfahren zielt nicht darauf ab, im Einzelfall allfällige Behandlungsfehler festzustellen und zu ahnden (Schadenersatz oder Genugtuung zuzusprechen oder Strafen wegen allfälliger Körperverletzung auszusprechen). Es verfügt auch nicht über die dazu erforderlichen verfahrensrechtlichen Mittel wie beispielsweise Beweisabnahmeverfahren, inklusive Zeugenbefragung. Entsprechende Sachverhaltsabklärungen und deren rechtliche Würdigung wären vielmehr Gegenstand eines zivilrechtlichen Verfahrens (Voraussetzung bildet eine Klage beim zuständigen Zivilgericht) oder allenfalls eines strafrechtlichen Verfahrens (Strafanzeige bei der Polizei und anschliessende Eröffnung eines Strafverfahrens durch die Staatsanwaltschaft).

Das Aufsichtsverfahren zielt darauf, die Berufstätigkeit einer fehlbaren Medizinalperson einzuschränken oder zu verbieten, oder die Person an ihre Berufspflichten zu mahnen, sofern sich dies als notwendig erweist. Es kommt vor allem dann in Betracht, wenn bereits ein Urteil eines Zivilgerichts oder eines Strafgerichts vorliegt, das der Medizinalperson die Vertrauenswürdigkeit abspricht oder darauf schliessen lässt, dass diese wiederholt und in gewissem Sinne "systematisch" Berufspflichten verletzt und eine sorgfältige Berufsausübung als nicht mehr gewährleistet erscheint. Die Eröffnung eines Aufsichtsverfahrens steht auch dann im Raum, wenn sich ein entsprechender Verdacht aufgrund mehrerer Hinweise bzw. eingegangener Beschwerden ergibt. Die entscheidenden Gerichtsbehörden werden auch die gesundheitspolizeiliche Relevanz des Sachverhalts prüfen und über eine Mitteilung an die Gesundheitsdirektion entscheiden. Auf Grund einer solchen Mitteilung würde die Gesundheitsdirektion dann ebenfalls prüfen, ob gegenüber dem behandelnden Arzt aufsichtsrechtliche Massnahmen zu ergreifen sind.

Zur Unterstützung bei einem Behandlungsfehler können Sie sich an die Patientenstelle in Zürich (http://zh.patientenstelle.ch/) oder die Ombudsstelle der Ärztegesellschaft des Kantons Zürich (http://aerzte-zh.ch/dienstleistungen/ombudsstelle.html) wenden.

Freundliche Grüsse
B. Zürrer

Kanton Zürich
Gesundheitsdirektion
Recht Medizin

RA lic. iur. Béatrice Zürrer
Stampfenbachstrasse 30
8090 Zürich
Telefon +41 43 259 24 22
Fax +41 43 259 51 51
Mo, Di, Do vorm.
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Old 23.05.2019, 17:12
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Re: Releasing medical notes

Thank you very much! I shall take a look through.

I know my dossier is ready because when I first requested it they said it would take a day to prepare. I was to go with a USB stick and they would copy my file over. Once they'd done this, they gave me the paper to sign.
I refused and asked for my stick back.
They said no, they would keep it until I signed.
I said no, I wasn't leaving it, as it had other documents on it.
They grumbled and eventually removed my file off the stick and gave it back to me.
Said they would check about the form with the doctor who was not in at the time.
I've not heard anything from them since.

So I'm not sure asking them to send it direct to my new doctor would work as they were adamant I had to turn up with a USB stick.
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Old 23.05.2019, 17:17
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Re: Releasing medical notes

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So I'm not sure asking them to send it direct to my new doctor would work as they were adamant I had to turn up with a USB stick.
One time my new doctor asked me to sign a document that allowed him to ask my old doctor for the notes. Probably the easiest way for you now?
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Old 23.05.2019, 18:23
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Re: Releasing medical notes

I doubt that their insistence on your bringing a usb stick is right, either. As I see it, they should be giving it to you on paper. Unless of course you requested it digitally. But it just doesn't sound right to me.... "Swissly",
since it is a formal transaction.
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Old 23.05.2019, 18:32
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Re: Releasing medical notes

Ok since you got your USB stick back, can you just unerase the files? As long as you didnt copy anything else in there its doable. I think ive done it once
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Old 23.05.2019, 18:38
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Re: Releasing medical notes

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One time my new doctor asked me to sign a document that allowed him to ask my old doctor for the notes. Probably the easiest way for you now?
The personnel are instructed to not hand out the dossier before the waiver is signed, that won't change all by itself.

OP needs to communicate with the doc directly, or ask the Gesundheitsdirektion for help (I got the impression that they won't mind even though they say to contact the doc first).
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