Doctors have been keeping secrets for thousands of years. The Hippocratic Oath, which dates back to the 5th century BC, extracts a promise from physicians that they will share their knowledge only with disciples, sons or students of medicine and no one else.
For the most part, modern-day doctors still uphold that oath. But questions have been raised about the wisdom of keeping patients in the dark. A new study published in the Annals of Internal Medicine (October 2, 2012) suggests that patients who read their complete medical records, with doctors’ notes included, understand their health condition better and are more likely to follow treatment recommendations.
Many doctors find this idea heretical. They worry that patients will be confused or insulted if they read the doctor’s candid opinions about their condition. For example, a patient described as “obese” in the medical record might not appreciate that adjective.
The study, termed OpenNotes, was conducted in three large medical systems that use electronic medical records and provide patients access to them. They were Harborview Medical Center in Seattle, Geisinger Health System in Danville, PA, and Beth Israel Deaconess Medical Center in Boston. More than 100 primary care doctors and 13,500 patients participated in this research.
The proportion of patients reading the notes available to them differed between the three sites, ranging from 92 percent in Pennsylvania to 47 percent in Seattle. Across the three sites, at least three fourths of the respondents reported that reading the notes made them feel more in control of their own health care. Of those taking medications, 60 to 78 percent reported taking their drugs more conscientiously.
Doctors who are concerned that offering patients access to clinic notes will increase their workload or slow things down should be reassured. Fewer than 5 percent of the participating physicians reported longer visits to address concerns in the notes.
Some doctors found themselves making their notes more understandable by substituting English words or phrases for Latin codes or abbreviations. One web-savvy commentator likened this process to tidying up the living room before company shows up.
At the end of the study, 99 percent of the patients wanted to continue to have access to these notes. No doctor elected to drop out.
There is a growing movement in this country called “participatory medicine.” The idea behind it is that patients and their health care providers are collaborators, rather than one taking orders from the other.
To participate fully, though, people need information. Currently, the overwhelming majority of patients do not have ready access to clinic notes. Some don’t even have access to online laboratory results. The OpenNotes study shows, however, that greater access to this kind of information reduces medical errors and improves patient safety.
People who would like to learn more about participatory medicine will find detailed information at e-patients.net.
