天博体育

We are fast entering the era of the , when it will be possible to call up our medical records on our computers and mobile devices. Medication lists, lab results, appointment schedules鈥攖hey鈥檒l all be available with clicks of your mouse or taps on the screen of your smartphone or tablet.

But one question that鈥檚 far from settled is whether the electronic health record should include the notes that doctors make about them. A doctor鈥檚 notes can be straightforward, such as a reminder that an additional test might be needed. But they can also include somewhat speculative observations and hunches about a patient and his or her medical conditions. The project is a research program designed to test the consequences of giving patients access to doctors鈥� notes. Harvard-affiliated is one of the test sites.

The Open Notes project is far from finished. But results of a survey of the expectations that doctors and patients have for note sharing are being reported in today鈥檚 .

I don鈥檛 think there are any great surprises here.  More than half of the primary care physicians participating in the project thought sharing their notes would result in greater worry among patients, and a sizable percentage (36% to 50%) anticipated more patient questions. Yet a large majority (74% to 92%) was optimistic it would improve patient communication and education.

Some doctors at the test sites who elected not to participate in the Open Notes project were also surveyed, and, not unexpectedly, they鈥檙e less enthusiastic about giving patients access to note than the participating doctors.

The patients who filled out the survey thought seeing their doctor鈥檚 notes would have a variety of good effects, like a clearer understanding of their medical condition, improved self-care, a greater sense of control, and so on.

I contacted two members of the 天博体育 Letter editorial board, Drs. Nancy Keating and Suzanne Salamon, and asked them what they thought about giving patients access to doctors鈥� notes. They鈥檙e on different sides of the issue.

鈥淚鈥檓 in the camp that thinks the benefits will probably outweigh the downsides,鈥� said , an associate professor of medicine and health care policy at Harvard Medical School and an associate physician at Brigham and Women鈥檚 Hospital.

Dr. Keating continued: 鈥淭here may be some patients where there are complex issues that could be challenging (like patients with drug seeking behavior), but for the vast majority of patients, I think this is no big deal, and likely very helpful.鈥�

鈥淧ersonally, I don鈥檛 like the idea of Open Notes,鈥� said , who is associate chief for clinical geriatrics at Beth Israel Deaconess Medical Center. 鈥淚 think that doctors will have to spend a lot of time explaining to patients what they meant if a patient misinterprets. For example, a doctor may see a patient as 鈥榓nxious鈥� or 鈥榙epressed鈥� or 鈥榦bese鈥� or 鈥榓lcohol dependent鈥� or 鈥榙rug dependent鈥� and the patient may object, perhaps because they don鈥檛 see themselves that way, or perhaps because they don鈥檛 want this description in the notes.鈥�

Dr. Salamon said doctors may alter what they say in their notes so as not to upset patients, and important pieces of information may be lost as a result.

鈥淚 believe that a good doctor-patient relationship should be based on honesty regarding diagnosis and treatment options,鈥� Dr. Salamon said. 鈥淗owever, the medical record and notes are a place where doctors should be able to describe uncertainties, subtle observations, and speculations while an evaluation is being undertaken without having to worry about needlessly upsetting patients who may not have the medical background to interpret the process.鈥�

So what do you think? Would you like to see your doctor鈥檚 notes? For what purpose? Is there a danger that they will be misinterpreted?