Late last month, the Los Angeles Times published a story whose news hook was a development taking place at Beth Israel Deaconess Medical Center in Boston. There, leaders have launched a pilot program this summer involving about 100 primary care physicians, and called the OpenNotes Initiative, in which about 25,000 patients will soon be able to read their doctors’ notes on a secure Web portal. Patients and their doctors will then fill out questionnaires on whether the experience of allowing patients to see their doctors’ notes ended up improving physician-patient communication.
As the LA Times reporter Shari Roan asked in her July 20 article, “If doctors know their patients are reading the notes, will they write as candidly as they might otherwise? After all,” she went on, “doctors and nurses use their notes to remind themselves about a patient’s unique characteristics and medical histories. This can mean something like, ‘Mr. Smith is typically in a foul mood and is convinced he’s going to die.’” Precisely.
So it will be fascinating to see what happens in Boston. I think the fact of some patients eventually seeing their physicians’ notes will have been an inevitable development, given the forward march of automation, and the (gradually) increasing transparency of patient care delivery and clinician-patient communications.
That having been said, there are inevitably unforeseen consequences to every step forward of clinical IT progress. In this case, we’re confronted with the potential conflict between two “goods”: the right of patients, as healthcare consumers, to know as much as possible about their care, and to be as involved as possible as participants in their own care management, versus the value that physicians and other clinicians derive from being able to communicate clearly with one another, as clinically appropriate, and even more fundamentally, to be able to recall precisely their individual patients’ stories in order to deliver optimal care. So the fact that “Mr. Smith is typically in a foul mood and is convinced he’s going to die,” though perhaps quite an outlier in terms of what is typically notated by doctors in the patient record, might very well be extremely helpful to Mr. Smith’s doctor, at a moment when s/he needs to recall key elements of Mr. Smith’s story, in order to assess his condition and make critical decisions about his care.
Ultimately, the path that healthcare is going down, and must go down, is one towards greater clarity, transparency, accountability, service, and collaboration between clinicians and their patients, for patients’ good. It will be fascinating to see how the countless “wrinkles” that will emerge as we move down that path end up getting worked out and resolved. I think that if everyone agrees that improving the care of patients and better serving patients and their families are the most important goals, we will collectively get to where we need to go; but no one should believe for a nanosecond that there won’t be multitudinous bumps along the road.
