Simon Maude peers into the world of digital communication between GPs and patients, and finds openness is not the norm
What a crock! There is really no excuse for not sharing open notes. Patients have a legally mandated right of access to their entire medical record. Free at least the first request per year. Yes...We need to maintain an awareness in writing notes that patients and various third parties may have consented access which somewhat influences our writing regardless. In 4 years offering open notes (yes with all the usual abbreviations) the only corrections or explanation or clarification requested has been in relation to smoking status and secondary care letters.
Self and team review of notes eg for Cornerstone, has resulted in raised awareness of sensitive abbreviations and slang ( 'bits on boobs' and 'FLK ' funny looking kid') are not sensible in records. We really need to get our heads out if the sand!
There is no evidence that patient access to medical records per se improves outcomes. There is evidence that there is some improved patient satisfaction. There is also evidence that it adds to work-load and costs. Perhaps the issue is not communicating clearly enough with patients at the outset and maintaining this through continuity of care. There is clear evidence that this improves outcomes significantly. Anecdote is not evidence. Patient access to medical records should not be a substitute for engaging in care.
What a bunch of ageist narrow thinking quacks we are. In my practice it is the younger doctors who are opposed to patient access to full clinical records. I'm all in favour yet I am the oldest...shows you how narrow thinking young doctors can be. :-}
I don't personally have a problem with patients being able to access their note but ManageMyHealth brings both an increased convenience for doctors and patients but an increased workload to the GPs. Of note virtually all of it we do for free. This is supported by U.K. evidence.
Geoff Vause I appreciate your point about the young doctors being reluctant adopters but perhaps they're just a bit more insightful with regards to it increasing their workload...
If a patient feels the need to access their medical record in order to seek clarification about their medical condition or their plan of management then this implies that this has not been adequately explained to them during their visit and therefore it is also not likely to be reflected in their notes. So where is the utility? All this will do is generate further questions (and not follow-on questions - which I believe are good) that will increase utilization by some means (electronic, telephone, face-to-face, etc). This then increases work-load and costs potentially both for the patient and the provider.
How many medical notes are a verbatim transcript of the interaction? We are not POTUS and there are no officials listening and no qualified stenographers creating the record. I am not against patients having access to their records - they are, after all their records - but I see this adding little value or improving outcomes. Firstly medical records will have to improve significantly in quality and they will also have to be written in a manner for a lay person to comprehend them sufficiently. This is time consuming and time is not something most of us have available in abundance. If this is to occur then there needs to be some utility. The evidence is that there isn't and as such what is the point? Sure it is nice but what is the point? Perhaps the point is we should brush up on our communication skills.
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