Effective Physician-Patient Communication is a Must

Our practice just started something called "open notes." This makes all office visit notes accessible to our patients via the electronic health record (EHR) patient portal. As you may imagine, the champagne corks were not popping when this news was announced. Physicians are protective of their records – it is our opportunity to take in information and interpret for our own or other physicians' future reference. The office visit note is not intended to be a plan of care or patient education document.

Aside from initial patient concerns about being labeled a complainer "patient presents with multiple complaints" or something worse "patient is a SOB," the impact has been minor at best. What we understand from other organizations is that open notes are appreciated by both the majority of providers and the majority of patients. Patients who read their notes may be more likely to adhere to a recommended treatment plan. Contrary to physician fears, patients do not submit frequent edits to be made.

Today is the first day I've been in clinic since we went live with open notes. I saw a couple of patients who were deficient in their ability to give a coherent history. In the past, I would've documented "patient is a poor historian," but I held my figurative tongue and had the history of the present illness (HPI) reflect the circuitous and anemic history I was given.

One patient I saw recently was being seen for the exact same thing she was seen for a month prior – abdominal pain. At her last visit, she was prescribed a proton pump inhibitor but never realized and therefore never started it. Not surprisingly, her symptoms failed to improve. I wonder if having access to her office visit note would've improved the chance that she would've followed through on the medication that was prescribed.

Another patient used an over-the-counter formulation of the medication recommended at her last appointment which happened to be a lower dose than had been recommended. She wasn't sure what the physician who saw her intended, but if she had access to her note, she would've been able to read the physician's intent in black and white.

In general, I am supportive of granting patients greater access to their records and increasing their involvement in their own care. However, opening notes for the patients to view is unlikely, in my opinion, to cause significant gains in communicating with our patients. While there are theoretical examples of how access to the office visit note may improve patient comprehension, these notes are still institutions of medicine with many abbreviations and medical lingo sprinkled liberally throughout our documentation. I am still of the opinion that communication starts with a trusting patient-physician relationship.