Should doctors share their office notes with patients?

 

[caption id="attachment_10642" align="alignleft" width="225" caption="Doctors office"][/caption]

Carol Forsloff - "Tell me really, doctor, what is going on?"  How much should a doctor tell a patient about what is truly going on if the news is bad or moving in that direction or the doctor just wants to make notes of concern?    It isn't an easy question as surveys reveal.

“Opening documents that are often both highly personal and highly technical is anything but simple,” declares 10 investigators, led by Tom Delbanco MD and Jan Walker RN, MBA of Beth Israel Deaconess Medical Center. 

Technology provides opportunities for people to have vast amounts of information but certain areas have been off-limits for the most part, like a doctor's notes.  New research is taking a look at whether these notes should continue to remain confidential in a study entitled, "Open Notes: Doctors and Patients Signing On," recently published in the Annals of Internal Medicine.

They document what was learned from the participation of 100 doctors in primary care who had 25,000 patients reading their notes.  The doctors were associated with Beth Israel Deaconess Medical Center, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle.

Previous information on the subject has shown that when a patient is actively involved in his/her care, communication and clinical outcomes are improved.  But having the notes is a different step with a different outcome.

The initial concerns on transparency of doctor notes are mixed.  The dialogue taking place between doctor and patient as reflected in the notes has some appeal.  But some patients are clearly uncomfortable reading their care outlines, as the doctors have found in their surveys prior to the anticipated research study itself,   Some patients clearly did not want to read what their doctors wrote because they were worried about discovering something they would rather not know, finding potential diagnoses that might make them anxious, or reading what their doctors really thought of them.

As for sharing medical information with others, outside of doctor and patient, but with employers and other parties of interest, the guidelines are stringent; and it is here that most people are very concerned about privacy.  The information specifically can be found at Privacy Clearinghouse on this subject.

The study will use secure Internet portals and only include notes written during the trial period. The centers involved represent a variety of medical settings, from urban and suburban practices in Boston to a rural Pennsylvania health system and a county hospital in Washington state that serves many poor patients.

While they are gathering considerable data from the patient and doctors’ experiences during the study period, Delbanco and Walker, two of the researchers involved in this study,  say their ultimate question is whether the participants will want to “leave the OpenNotes switch on” after 12 months.

“Open notes pose many questions and probably represents the Model-T stage of the future. Can a single note serve many different audiences, and can the push toward structure and template preserve the unique attributes of each person?” And, in the future, will doctors and patients generate and sign notes together that reflect their perspectives on the individual patient’s circumstance and plans for the future?