Should Doctors Share Notes with Patients?
To hear Delbanco and Walker tell it, the potential impact of note-sharing is similar to the use of checklists–step-by-step procedures performed by hospitals that were initiated several years ago by Peter Pronovost, MD, a Johns Hopkins clinical care specialist. Pronovost identified a rudimentary checklist of basic procedures to improve hand-washing routines and proper skin evaluation that has helped to reduce hospital infections.
The study on doctors' notes involved patients and physicians from Beth Israel Deaconess, the Geisinger Health System in Danville, PA and the Harborview Medical Center in Seattle, WA. The project, OpenNotes, is supported by grants from the Robert Wood Johnson Foundation and other foundations.
"We believe that patients get a better understanding about their care," Walker told HealthLeaders Media. "They take better care of themselves and take their medicine."
Delbanco says he has been sharing notes with patients and it has been illuminating to them as well as to him. Writing notes has clarified his thoughts about patients' conditions, Delbanco says. As for patients, some say they are more inclined to take their medication, or lose weight, for instance, after reviewing physician notes.
"We've had several patients who say to us, 'My doc's been telling me for a year to lose weight, but when you see it in the notes, that the doctor is worried, it's a different ballgame and you want to do it,'" he says.
Although note-sharing is relatively uncommon, it has been tried in certain health systems with some degree of success. The University of Texas M.D. Anderson Cancer Center in Austin, TX implemented an electronic medical records system for patients in May 2009. Few physicians have voiced concerns since the system went into effect, despite worries that it would increase workload and anxiety, wrote Thomas Feeley, MD, vice president of operations at the Texas hospital in an editorial published in the Annals of Internal Medicine. "There have been no adverse consequences and generally positive feedback."
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