Peter Wehrwein

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

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, appointment schedules—they’ll all be available with clicks of your mouse or taps on the screen of your smartphone or tablet.

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. Harvard-affiliated Beth Israel Deaconess Medical Center is one of the test sites.

The Open Notes project is far from finished. But results of a survey of the expectations that doctors and patients have for note sharing are being reported in today’s Annals of Internal Medicine.

I don’t think there are any great surprises here.  More than half of the primary care physicians participating in the project thought sharing their notes would result in greater worry among patients, and a sizable percentage (36% to 50%) anticipated more patient questions. Yet a large majority (74% to 92%) was optimistic it would improve patient communication and education.

Some doctors at the test sites who elected not to participate in the Open Notes project were also surveyed, and, not unexpectedly, they’re less enthusiastic about giving patients access to note than the participating doctors.

The patients who filled out the survey thought seeing their doctor’s notes would have a variety of good effects, like a clearer understanding of their medical condition, improved self-care, a greater sense of control, and so on.

I contacted two members of the Harvard Health Letter editorial board, Drs. Nancy Keating and Suzanne Salamon, and asked them what they thought about giving patients access to doctors’ notes. They’re on different sides of the issue.

“I’m in the camp that thinks the benefits will probably outweigh the downsides,” said Dr. Nancy Keating, an associate professor of medicine and health care policy at Harvard Medical School and an associate physician at Brigham and Women’s Hospital.

Dr. Keating continued: “There may be some patients where there are complex issues that could be challenging (like patients with drug seeking behavior), but for the vast majority of patients, I think this is no big deal, and likely very helpful.”

“Personally, I don’t like the idea of Open Notes,” said Dr. Suzanne Salamon, who is associate chief for clinical geriatrics at Beth Israel Deaconess Medical Center. “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.”

Dr. Salamon said 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.

“I believe that a good doctor-patient relationship should be based on honesty regarding diagnosis and treatment options,” Dr. Salamon said. “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?

Related Information: Harvard Health Letter

Comments:

  1. Staci Perry

    I came across this article while researching cellulite for a project I’m doing. I never really thought about it before but you bring up some valid points. With the technology today it is very possible and I could see it actually make me feel lime I have more of personal relationship with my doctor instead of him just being my “doctor”. Either way it was an interesting read and I wanted to let you know I appreciated it.

  2. Sonu

    i think that its a great idea but some screening procedure should also be kept in place which willnot allow patients to see those notes about them which are likely to make them upset…like commenting on alcohol dependence…

  3. Heather Smith

    It is right for doctors not to open their notes to their patients so that it will not complicate their unhealthy state of mind and body and let the doctors treatment make them recover. This is an intriguing post, but thanks anyway.

  4. jake

    Yes share the notes.
    I just had surgery a few weeks ago, and when I was meeting with my family DR for a follow up… I took the time to explain to him some of the pains and challenges I have been having over the last little while. He examined me, and while he was doing so, I looked at the screen at the notes that he had taken- and the notes did not reflect what I had just said- but clearly he had a hard time listening, digesting what I was saying, and summarizing what I had said in a manner that was clear and concise.

  5. Carey Achee

    Thanks for the article, it was interesting and compelling. I found my way here through Google, I will come back another time :)

  6. Timothy

    Talking about the open notes and Dr. Suzanne Salamon’s suggestion on this I have something or you may say one experience to share here. I have seen one patient who is regular to a neuro-psychiatrist and her doctor has written on the prescription – “personality disorder” which is a very common problem. What her problem is that she is feeling more depressed because of this and as she is of 25 years this word is creating some problems for her suitors also.
    Our problem is we understand that we are sick and we need medicine but hardly try to come out of the shell and accept the names of the problems that we are suffering from.
    This happens because of the lack of knowledge that the common people have about the medical conditions. We need to educate the patients on this as open notes are very useful also. Everybody should be aware of the medical problems they are having. This also helps in the cure and the prevention procedure also.
    Thanks for this valuable post!