What's he writing anyway?
Have you ever been tempted to sneak a peek at those notes your doctor is scribbling about you? If you have, you’re like most patients, new Harvard research shows.
But chances are, your doctor would rather you keep your nose out of his notes. A poll of 100 primary care doctors nationwide conducted by Truth On Call for msnbc.com found that 68 percent of physicians have written something in a patient's chart they wouldn't want that person to see.
Wendie Howland took a look at her chart while she waited alone in an exam room. The notes revealed that years earlier a doctor had stitched her up in the wrong place during surgery, and that’s why she developed an infection that was so bad it landed her back in the hospital for 10 days.
“The nurse left it, and I picked it up and started reading it,” says the 60-year-old nurse from Cape Cod, Mass. “I went through it because I didn’t have anything better to do. It angered me because I was pretty uncomfortable for a couple months. God knows I was.”
Deciding it was time to allow patients access to written notes in their charts, researchers at the Harvard University Medical School and the Beth Israel Deaconess Medical Center in Boston created a new system called Open Notes, and invited patients to take a look.
“You’re allowed legally to get ahold of those notes, but we make it as difficult as possible,” says Dr. Tom Delbanco, a professor of medicine at the Harvard University Medical School and senior author of the report published Monday in the Annals of Internal Medicine.
“Legally to do that, you may have to pay for it; you’ve got to see it with a nurse sitting next to you. There are all kinds of impediments. We say that’s a lot of nonsense. We want to open the black box. It’s your body; therefore we invite you to read what we wrote.”
When they asked nearly 40,000 patients in Boston, Seattle and rural Pennsylvania what they thought about seeing their charts, the team of researchers led by Jan Walker, a nurse at Harvard and Beth Israel Deaconess, found that 90 percent wanted to see their primary doctor’s written notes.
More than half thought they would take their medications better if they were taking any, and 90 percent felt they would be in more control of their care. At least 80 percent of patients also felt they would take better care of themselves if given the opportunity to read their notes and gain greater understanding about their medical situations, and half thought they would share their notes with others.
Doctors, however, didn’t like the idea at all.
What are they hiding in there anyway? In a famous “Seinfeld” episode, Elaine peeked at her chart and discovered her doctor called her a “difficult” patient. When she asked about his note, he pretended to erase it, and failed to treat her rash. The “difficult patient” note followed her to a second doctor, so she hatched a plan for Kramer steal her chart.
In this study, doctors were divided into two groups: 114 doctors who participated in the study and 140 who were surveyed, but didn’t participate. Across the three study sites, about 84 percent of doctors who didn’t participate in the study said they were concerned that if patients saw their notes, they would bombard them with questions between visits, researchers said.
“We tend to sell patients short, and we don’t realize how resourceful patients are; we are still learning about that,” Delbanco says. “As far as confusing or worrying you, we are going to scare some patients. But if something is going to scare you, we should be talking to you about it anyway.”
Next year, the researchers will report back on what happens when doctors and patients get on the same page.
The health care practitioner polling firm Truth On Call contributed to this report.