Can Patients Handle the Truth? Getting Access to Doctors’ Notes

Do you want to see your doctor’s medical notes?

Doctor, What right do you have to keep the patient out of the loop?

Should Doctors Notes be open and available to the patient?

We are fast entering the era of the electronic health record, when it will be possible to call up our medical records on our computers and mobile devices. Medication lists, lab results, and appointment schedules—they’ll all be available with clicks of your mouse or taps on the screen of your smartphone, iPad or tablet. An extension and expansion of e-health, e-medicine,-e-doctor and now e-patient!

But one question that’s far from settled is whether the electronic health record should include the notes that doctors make about them. A doctor’s notes can be straightforward, such as a reminder that an additional test might be needed. But they can also include somewhat speculative observations and hunches about a patient and his or her medical conditions. The Open Notes project is a research program designed to test the consequences of giving patients access to doctors’ notes.

The last time you were at the doctor’s office, and your physician scribbled or typed something into your chart, did you wonder what it said? If so, you’re in the majority: according to a new survey, more than 90% of patients said they would want to know. Not surprisingly the doctors resist this idea.

Office visit notes constitute include not only patients’ medical history, but also a record of what was discussed with the physician in the privacy of the exam room and in some cases, the doctors’ insights into patients’ forecast of likely course of disease and guesses about what might be ailing them.

The difference in opinion is hardly surprising. After all, the Kenyan health-care system like many others around the world is built on the paternalistic view that doctor-knows-best — the physician is the gatekeeper for providing and interpreting any information related to our medical care. Increasingly, however, patients are demanding transparency and taking back control of their health and their health records.

In a recently published trial, 75% of patients said it would improve their adherence to their medications, if they could see in their chart why the doctor thought they needed the drugs and how they might help them. Most patients also said having open notes would encourage them be more in control of their care and take better care of themselves.

Such openness may pose challenges in certain cases, however. Psychiatric patients represent a sensitive population when it comes to sharing medical information, and these cases may require special protocols to ensure that patients are not exposed to undue harm by reading about how their physicians interpret their symptoms.

But the fact that patients were overwhelmingly in favor of seeing their doctors’ notes suggests that physicians may be facing a sea change in the way they deliver care They need to recognize that what they put in a chart is in fact likely available to not just patients but their families, and they should behave accordingly.

I’m in the camp that thinks the benefits of Open notes will probably outweigh the downsides

A colleague who thinks otherwise reckons, “Personally, I don’t like the idea of Open Notes,” “I think that doctors will have to spend a lot of time explaining to patients what they meant if a patient misinterprets. For example, a doctor may see a patient as ‘anxious’ or ‘depressed’ or ‘obese’ or ‘alcohol dependent’ or ‘drug dependant’ and the patient may object, perhaps because they don’t see themselves that way, or perhaps because they don’t want this description in the notes.”

Others say doctors may alter what they say in their notes so as not to upset patients, and important pieces of information may be lost as a result.

A good doctor-patient relationship should be based on honesty regarding diagnosis and treatment options, However, the medical record and notes are a place where doctors should be able to describe uncertainties, subtle observations, and speculations while an evaluation is being undertaken without having to worry about needlessly upsetting patients who may not have the medical background to interpret the process.”

So what do you think? Would you like to see your doctor’s notes? For what purpose? Is there a danger that they will be misinterpreted?

SideBar

Patients and doctors have dramatically different visions about the value of access to physicians' notes about their patients, a new survey from Harvard Medical School released recently shows.

Patients overwhelmingly favor access to doctors' records, researchers found, including:Ninety-four percent believed the records should be available.

Ninety percent said the information would give them more control.

Eighty percent said they would take better care of themselves because of the information.

More than half said the information would help them take their medication properly.

About 20% of patients said they would share the notes with friends and family, which may further increase the likelihood that they will follow their doctor’s advice and benefit from the care they receive

Doctors, on the other hand, worried access to their notes would confuse patients, that it would not benefit them because they would not change their behavior, and that it would lead to such an influx of phone calls and concerns that their practices would be overwhelmed

As many as 80% of the surveyed doctors said they were frightened by the idea of allowing the records to be accessible

Quote: "I have no idea what I'll find in my doctor's notes, but I think it may help me in the long run.”- Patient