Access to good quality care and in particular primary care is important. John Tudor Hart, a GP who worked in the mining areas of Wales, formulated his famous ‘inverse care law’: the more health problems there are in a community, the less good quality care is available. Combining this with the relative importance of determinants of health, it struck me that there is also something that we may call the ‘inverse patient records law’. Most of what GPs note in their patient records relates to diagnostic and therapeutic interventions – which in terms of determinants of health are least important. As far as I can see, GPs record some information in their patient records about life style and behaviour. In the Dutch situation, this is largely restricted to patients who participate in disease management programmes. I think we can say that GPs do not have a good overview of the life style and health behaviours of their patient population as a whole. And still, as we saw, this is the second important determinant of differences in health outcomes. Finally, the structural circumstances, such as education, health literacy, income, work circumstances. These are not routinely in the patient records at all.

Of course it is not easy to change this situation. Recording information about health behaviour and structural circumstances takes time of health care providers who are already burdened with administrative tasks; health behaviours change and data must be accurate to act upon them; recording this kind of information may be in conflict with data protection and privacy regulation. However, it may be worthwhile to look for practical solutions. On the technical side there may be possibilities of data linkage (with informed consent of patients). On the patients’ side there may be willingness to provide life style and structural information and update it regularly if patients have direct access to a personal digital health environment, containing also their electronical medical record. However, we still have to be aware of John Tudor Hart’s wise observation: it will be easy to get this life style and structural information of the patients whose information we need least.