The biggest change in doctor-patient relations since Dr. Rush

For doctors to become trusted advisers, they have to stop acting like high priests and let patients in on what they're thinking.

The OpenNotes project may start the biggest rethink of doctor-patient relations since the profession began.

(Picture from Myopennotes.org.)

In the two centuries since Dr. Benjamin Rush tried a mastectomy on John Adams' daughter, the relationship between a patient and doctor has been transformed.

Where once doctors advised, now they order. Their authority may be subject to questioning, but in the end it is unquestioned.

Opening up doctors' notes may lead those orders to being rigorously questioned.

That's one reason OpenNotes is moving cautiously, with a survey and a one-year trial with 115 doctors in two states starting this summer.

Ironically, as The Wall Street Journal notes, current medical practice flies in the face of the law, which gives patients a legal right to see all but psychiatric notes. In practice notes are not even included when patients access their medical records.

In the test reactions from both patients and doctors will be monitored, but I suspect the truth is much simpler.

There are three kinds of notes.

  1. There are notes doctors exchange among themselves, filled with acronyms like NERD (No Evidence of Recurrent Disease) and SOB (Shortness Of Breath), which patients could misinterpret.
  2. There are notes doctors make for other doctors, which may relate to patient behaviors, as in the 1996 Seinfeld episode The Package. Such notes may also be speculative, hinting at what a doctor thinks another doctor should look at, but offering no conclusions.
  3. There are notes detailing what the patient has and what they should be doing about it, things many patients quickly forget, but which are important to maintaining health. It's these notes whose power the OpenNotes test is aiming to unleash.

This last category of notes are supposed to be part of the Continuing Care Record, which whether printed or sent electronically is an integral part of any health reform, public or private, liberal or conservative.

Patients tend to forget what the doctor says in that brief meeting. Whether we're sick or well, the ongoing hints of what to do and watch out for tend to fly out the mental window in our rush to get out the door.

The CCR gives you this information, in plain English, so you and your family can follow-up and participate in your wellness. It makes health care a partnership between patient and providers. It gives every other professional who sees you an overview of what's happening so they can provide better, more personal care, and not do the same tests over-and-over-and-over as they do now.

But some doctors even fear the CCR. They fear lawyers could use it against them, that it's a legal document. And if their whole note file is also treated as a document the patient has a right to, then the patient's lawyer may also misinterpret that and make their life a living hell as a result.

Well, there are reasonable fears and unreasonable ones. I can see doctors wanting to protect the data they exchange among themselves, thinking it's in confidence. But patients have a right to the CCR, and an obligation to become active participants in their own health.

For doctors to become trusted advisers, they have to stop acting like high priests and let patients in on what they're thinking. The CCR, developed by a collection of doctors, vendors, and standards groups, is a good compromise.

Give me that and you can keep your notes, doc.

This post was originally published on Smartplanet.com

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