Should Patients See Doctor Notes

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Patients have become used to emailing with their doctors and obtaining certain information from their medical records online eliminating a tedious process of requests for medical records. This has helped in the continuity of care as patients may want to bring their CAT scan reports from one doctor to a specialist and not want to wait weeks while the staff of a medical records office processes the request.

However, traditionally, not included in those records available online have been doctor’s notes. These notes are written any time a patient visits the office. They provide a written record of symptoms present that day and the vitals. It also can cover possible diagnoses that need ruling out or treatment plans for confirmed diagnoses.

The question will be answered during this study titled “Open Notes” in which for 12 months, 100 doctors and about 25,000 patients will participate in a system that allows patients access to the doctor’s notes in their medical file. The participating facilities include Beth Israel Deaconess Medical Center, Geisinger Health System in Pennsylvania and Harborview Medical Center in Seattle, Washington.

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Possible outcomes of the study can already be seen in the results of a pre-assessment. Doctors worry about how patients will react to possible diagnoses or the acronyms commonly used in medicine (i.e. SOB standing for shortness of breath and not an insult). Patients worry about finding out how the doctor “really feels” about them. One major concern is that doctors will waste time correcting “trivial errors of fact” in the patient’s medical record once the patient views them.
However, there are also possible benefits which include greater patient involvement in health management, and improved communication between doctors and patients resulting in increased health prognoses.

The study will only use notes written during the trial period and will seek to find out if patients and doctors will want to keep the Open Notes system in place after the study is concluded. The authors foresee a possible future of patients and doctors signing notes that “reflect their perspectives on the individual patient’s circumstance and plans for the future.”

Another concern is also that patients will develop cyberchondria. This is where since a lot of medical information is available online, patients become convinced that he or she has a certain disorder. He or she, having access to their medical records, can pick and pull from them to show another physician how he or she has a disorder or disease. Many disorders and syndromes have similar manifestations. It should be left up to a doctor to determine whether or not a patient has one or another disorder, as they have been trained in differential diagnostics.

Another benefit would be the government's plans for medical records. By 2014, with incentives from the American Recovery and Reinvestment Act of 2009, doctors and hospitals could theoretically have a system where 100% of a patient's medical records would be online and accessible to all. Right now, unless the hospital and doctor's offices are connected via an intranet, the doctor cannot access a patient's medical record, such as those at the specialist's office. If OpenNotes were to happen in conjunction with the planned integration of electronic medical records, patients will definitely benefit with time savings and cost savings.

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