Can Patients Handle the Truth? Getting Access to Doctors Notes

The last time you were at the doctor’s office, and your physician scribbled or typed something into your chart, did you wonder what it said? If so, you’re in the majority: according to a new survey, more than 90% of patients said they would want to know.
Not surprisingly, most doctors were less than willing to share. In the OpenNotes trial, conducted at three primary care practices in Boston, Seattle and rural Pennsylvania, 254 physicians were asked whether they would be willing to make their office visit notes freely available to patients in their electronic health records for one year: 114 agreed, and 140 declined.
Office visit notes constitute include not only patients’ medical history, but also a record of what was discussed with the physician in the privacy of the exam room and in some cases, the doctors’ insights into patients’ prognoses and guesses about what might be ailing them. Of the doctors who agreed to participate, 69% to 81% said they thought the transparency was a good idea and beneficial for patients. Among the patients, 92% to 97% said having access to the notes would be helpful.
The difference in opinion is hardly surprising. After all, the U.S. health-care system is built on the paternalistic view that doctor-knows-best — the physician is the gatekeeper for providing and interpreting any information related to our medical care. Increasingly, however, patients are demanding transparency and taking back control of their health and their health records.
“The patient has been out of the loop until now,” says Dr. Tom Delbanco, professor of medicine at Harvard Medical School and senior author of the paper, published in the Annals of the Internal Medicine. “The basic notion of our trial is, ‘What right do you have to keep the patient out of the loop?’ Patients are legally allowed to see doctors’ notes, but we make it as hard as possible for them to get them. So what we are doing now is saying to patients, ‘This is all about you, this is your health and your record and we want to involve you more actively in your care.’”