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Comment & Response |

Transparency in the Delivery of Mental Health Care—Reply

Jan Walker, RN, MBA1; Michael W. Kahn, MD2; Tom Delbanco, MD1
[+] Author Affiliations
1Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
2Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA. 2014;312(6):650-651. doi:10.1001/jama.2014.7610.
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In Reply Dr Ritter raises difficult questions. Adults are increasingly reviewing clinicians’ notes, and we expect that adolescents and younger children, raised with ever-evolving social media, will be interested in what is being written about them in medical records. Even though some clinicians are beginning to offer adults access to their mental health notes, we are not familiar with institutions doing so for young people.

Much needs to be learned as fully transparent practice evolves. Methods granting proxy access to family members and informal caregivers of patients with chronic illness are proliferating, always with permission granted by the patient or a legal guardian. When it comes to adolescents, parents generally have the right to view the medical records of minors, although this is a complex issue that depends on the circumstances, type of care, and state law. And when abuse may be present, clinician discretion and institutional guidelines should influence what is recorded in a medical record.


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August 13, 2014
Jared T. Ritter, MD
1Department of Psychiatry, University of Hawaii John A. Burns School of Medicine, Honolulu2Dr Ritter is now with Florida Health Care Plans.
JAMA. 2014;312(6):650. doi:10.1001/jama.2014.7601.
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