Should Patients Have Access To Doctors’ Post-Visit Notes?

Who owns your medical chart? Well, you (as the patient) do of course, and since 1996 as part of the federal Health Insurance Portability and Accountability Act, patients have been able to legally access their medical records at any time upon written request.

However, this is done through the medical record department of most medical centers, and long wait times and fees often discourage people from taking the time to do it.

With electronic medical records and the advent of the “patient portal,” people can now schedule appointments, look at lab results, even email their doctors with questions instantaneously. But one area is not currently accessible. Medical notes for each visit.

Why not? Well in a recent article in the Journal of the American Medical Association, three major centers on the mainland, Geisinger Health System in Pennsylvania, Beth Israel Deaconess Medical Center in Boston, and Harborview Medical Center in Seattle talked about their participation in a pilot study using OpenNotes, a proprietary software that allowed patients to access their specific visit notes from their doctors.

All reported that patients were very satisfied with their ability to read doctors’ notes.

Prior to participating in the pilot, a survey noted that although 92-97 percent of patients thought this was a good idea, only 69-81 percent of doctors though so too. However, at the end of the trial, 99 percent of patients supported continued access, and 85-91 percent of doctors were now in favor.

Would you want access to see your doctor’s notes? Not just the instructions, but the actual notes?

Well, I thought I would ask my office staff. Five people work in my office pod. All five of them wanted access to their notes, but interestingly enough, none of them wanted patients to have it. The most common reason: having to field phone calls from people not understanding what was in the chart.

Does that actually happen? Well, according to the pilot study from OpenNotes, less than 10 percent of physicians reported an increase in length of visits or time spent responding to patient questions.

To be fair, I asked my next five patients, same number as the staff, and all of them said they would want to have access to the notes.

I also inquired what they might do if they didn’t understand the notes. Three said they would email me directly, which actually goes through my staff first, one said he would wait until his next appointment to ask, unless it seemed very important, and one said she would just figure that I knew what it meant and that was enough.

I did offer each of the five patients the opportunity to have their medical notes from that visit given to them when they left. Curiously, none of them wanted to wait.

Charting is done at the end of the day, and I usually don’t make people wait while I dictate, just to be efficient. But as it stands right now, none of my notes from the visit are available electronically for patients to view. So, unless they call back and request it from the medical record department, they missed their chance to have their notes from that visit.

I asked two of my colleagues how they felt. One, an internist like myself, said he already spends hours each day returning phone calls and going over things in the chart. If it would cut down on that, he said he would be on board. But not if it generated more questions and then even more phone calls.

The other doctor, an oncologist, said he gives his patients a copy of their notes whenever they ask, even encouraging them to review the information.

Often, patients will bring in their own internet research about their condition and look up a lot of the words he has in his notes, just for clarification.

“Oncology requires teamwork with my patients, and the more they feel in control the better they do,” he said.

He doesn’t filter the notes or change anything about them before handing a copy to patients. I’ve seen his notes and I have to really focus on understanding what is documented. I can only imagine a patient trying to read it.

So, if patients did have easy access to notes, would that change how I write them? Absolutely.

I honestly think our current note system has been overrun by documentation requirements, needing to meet certain elements in the history and the physical exam, which can make the current medical notes several pages of information that are irrelevant to the reason patients come in to be seen.

However, there is a golden part of every note. It’s the assessment and plan. Therein lies the diagnoses and the details of what patients should do next and this is the part that patients should have immediate access to.

Important facts, like when to come back, when to do labs, what testing was ordered, what medication was given and for what condition — that should be available for all patients to see immediately, regardless of how much of the rest of medical notes they can see.

For those of my colleagues who protest full access to view notes, this is the one area that should be made for patients to read and not for billing departments to code.

Given concerns about medical errors, one way to address the problem would be to have patients able be to read this most important part of their medical record and have doctors tailor this section to make it patient-friendly, with easy-to-understand directions about what they need to know to take charge of their health.

The days of doctors keeping their medical notes to themselves are over. Yes, the notes are a way to keep track of someone’s health problems, but it doesn’t do anyone any good to have this accessible to medical professionals only, or written in such medical jargon that no one else can understand.

It’s time to make systems like OpenNotes the standard of care for all electronic medical record systems and let patients truly own all of their medical information in an easy-to-read format so they can be in charge of their health.