Diagnosis: Difficult?
Most Seinfeld fans certainly remember "The Package" episode, involving a subplot in which Elaine Benes is unable to find a doctor willing to treat her troublesome rash. Branded a "difficult" patient by her primary care physician, Benes scours New York City doctors' offices in search of treatment, even plotting to steal her medical records with hopes of altering her doctor's comments. She eventually recruits fellow miscreant Cosmo Kramer -- posing as a physician from a fictitious clinic, no less -- to aid her in absconding with the file containing the damaging remark. Naturally, their efforts are thwarted, and the inept pair was sternly reprimanded for their attempted thievery.
This uniquely Seinfeld scenario was far flung, of course -- except perhaps by Seinfeld standards -- and a physician withholding a patient's medical records would be committing an egregious violation of the medical profession's code of ethics, not to mention breaking the law. Many states, including New York, require all health care practitioners and facilities to grant patients access to their own medical records upon request.
In reality, physicians may be compelled to share medical information with patients, but that doesn't mean that all doctors are eager to make their notes available to them. Many large hospitals with electronic health records (EHRs) allow patients to see their medical history, allergies and so on, but not notes made by their physician. Doctors commonly jot down comments after each patient's visit, which are read by other physicians treating these patients as well. Some doctors and health care facilities are hesitant to share those comments with patients, who may misinterpret medical jargon, take offense to a doctor's observation -- as in Ms. Benes' case -- or worry unnecessarily, for instance.
A group of researchers at Beth Israel Deaconess Medical Center in Boston is undertaking a project they hope will foster improved, clearer communication between physicians and their patients.
By the end of this year, thousands of patients at Beth Israel will have free and easy access to their physicians' notes as part of their online medical record, according to a recent Boston Globe article.
The "open notes" project will involve about 100 physicians and between 25,000 and 35,000 patients at Beth Israel and two other medical sites, according to the Globe article.
The Robert Wood Johnson Foundation gave Tom Delbanco, MD, an internist at Beth Israel, and colleagues $1.5 million to fund the project, because physicians have "strong differences of opinion" on the usefulness of physicians' notes to patients, said Stephen Downs, an assistant vice president at the foundation, in the article. Dr. Delbanco and nurse Jan Walker are developing detailed surveys to give patients, including whether they read the notes and found them useful, and whether they discovered errors.
One question for doctors will be whether they kept private "shadow notes" that patients couldn't see. The ultimate measure of success will be whether doctors and patients want to keep sharing notes at the end of the study, the article noted.
As the move toward electronic health records continues, so too does the debate surrounding whether doctors' notes should be made available to patients online. According to Downs, Beth Israel is conducting the largest study yet on this issue, and we're curious if other facilities have considered similar projects. Has your hospital weighed the possibility of sharing doctors' notes with patients online? Is it a smart move to do so, and why or why not? Let us know what you think.