October 2, 2012

What Your Doctor Really Thinks About You

What happens when patients have full access to their medical records? The OpenNotes study finds it's mostly all good.

If you’ve ever wanted to sneak a peek at your medical file when your doctor leaves the room, you may soon be able to do so a little less awkwardly.

OpenNotes, a one-year experiment at three hospitals, allowed patients direct access to their primary care providers’ electronic progress notes through secure patient portals. Despite some hesitation on both sides, doctors and patients are both largely embracing the system. In fact, it may just become the wave of healthcare’s future.

In a time when healthcare can seem anything but personal, the OpenNotes system seemed to help patients feel more connected to their doctors and to their own medical care.

“Patients are enthusiastic about open access to their primary care doctors' notes,” said study author Tom Delbanco in a news release. “More than 85 percent read them, and 99 percent of those completing surveys recommended that this transparency continue.”

Most patients who took part in the study said they felt more in control of their medical care and better understood their medical issues. In a time when healthcare can seem anything but personal, the new system seemed to help patients feel more connected to their doctors and to their own medical care. Between 60 and 78% of the patients participating also said they were more likely to take medications as prescribed.

Some doctors were worried about patients being put off by their notes, but this was not the case, by and large. Coauthor Jan Walker said, “in contrast to the fears of many doctors, few patients reported being confused, worried or offended by what they read.”

Doctors’ work load did not increase as much as they may have thought would happen with the new system: About 20% of the doctors did say they spent more time writing notes, and 5% said they spent more time with patients. Some doctors said they had changed the way they wrote about sensitive subjects, like addiction, mental health issues, obesity, and malignant cancers, which is probably not a bad thing.

Patients were not obligated to read their charts and some opted not to, though most seemed to feel better for having seen the information. As Walker said, “fear or uncertainty of what's in a doctor's ‘black box’ may engender far more anxiety than what is actually written, and patients who are especially likely to react negatively to notes may self-select to not read them.”

If programs like OpenNotes become widespread, it will be interesting to see if such improved communication affects patient satisfaction and compliance with their doctor's recommendations. It may also change how doctors approach their work.

The study was led by a team at the Beth Israel Deaconess Medical Center, Harvard Medical School and published in Annals of Internal Medicine. Doctors and patients at Geisinger Health Systems of Danville, PA and Harborview Medical Center of Seattle participated in the study.

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