Forbidden Fruit!

When you go to visit a physician, do you ever crane your head around to catch a glimpse at what he or she is writing in your chart?  Perhaps colored by paranoid thoughts like, 'is he thinking I'm a hypochondriac?' or 'she can't wait for me to get out of here?' Now results from an Annals of Internal Medicine study may encourage all physicians to grant full access to their notes to patients, as Rick and I discuss on this week's PodMed.

So what did they do in this study? One hundred and five primary care physicians in three locations in the United States and almost 14,000 patients participated in the intervention, called OpenNotes, which took place over a year. The sites included an academic medical center, an urban center and a rural center. Physicians who volunteered for the study invited their patients to read notes they had written during an office visit after the notes were signed by the physician.  These were available electronically.

Depending on the site where patients were seen, up to 92% accessed at least one doctor's note during the study period. Patients and physicians were surveyed both before and after the study was performed.  About 80% of the patients said open access to physician notes made them feel more in control of their own care, with about 70% reporting better medication adherence as a result. About a quarter of the patients shared their notes with others, and contrary to concerns cited before the study began that access to physician notes would increase patient worry and confusion, a mere 1 to 8% reported such an outcome.

What about the physicians? Concerns before the study began included potential increased volume of email from patients relative to the notes, longer visits, more time spent addressing patient concerns outside of visits, and more time spent writing notes.  Afterward, none of these concerns proved onerous, and a whopping 99% of patients wanted open notes to continue, and no physician elected to cease participation.

One thing that did change on the part of physicians was they were a bit more careful regarding what they actually wrote down in notes, for example, instead of reporting a patient as obese they cited bmi.  It should also be pointed out that physicians volunteered for this study and were also accomplished electronics users, as were the patients.  Such a strategy is likely to become ever more practical as means to access electronic communication permeate even more of our society.

Rick  and I agree in the podcast that the results of this study are encouraging, and also recall historically when resistance on the part of physicians to use of email was prominent- a situation that has certainly changed!  As the electronic medical record becomes a reality, and patient involvement in their own care an expectation, no doubt even more dissemination of such strategies as OpenNotes will take place.

Other topics this week include a look at C-reactive protein and fibrinogen as markers for predicting cardiovascular risk in NEJM, the impact of screening for diabetes on mortality in the Lancet, and vitamin D and the common cold in JAMA.  Until next week, y'all live well.

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