From what I’ve read, there’s been LOTS of consideration of what effect this might have on what doctors put in the notes, including both the social issues and the liability issues.

I don’t know if anyone involved in the project will want to comment, but I assure you those issues haven’t been overlooked. Some smart and thoughtful people are behind this.

The whole discussion shifts if we switch to the perspective that healthcare is about the patient, and the relationship is a partnership, and the notes rightfully should be created as a shared tool for use and reference by the patient and the professional.

Yes, exactly: in the discussions I’ve heard about patient access to medical records, two things commonly cited are medical terms that mean something different to lay readers, and abbreviations that mean something different.

This has all been discussed elsewhere but we might as well catalog examples here for ready reference.

The most-cited semantics issue is, as you say, “obese.” To most people it means “grossly fat.” To a clinician and a medical record it means “outside of recommended limits.” Here’s my doctor and me – he says I’m obese, and medically I am, but most citizens wouldn’t think that.

A commonly cited abbreviation is SOB, which means Shortness Of Breath to clinicians and means something entirely different to citizens.:)

I think every patient & caregiver who’s waded into medical wording has needed to learn vocabulary. As patients become more actively engaged in their care and records this may evolve, or not … that may become part of the study: if a doc knows the pt will be referring to these notes AFTERWARD, will the vocabulary evolve??

I learned that cerumen is ear wax… is it more precise to say ceruman?

Importantly, some enterprising healthcare providers are learning to attract customers by being more user-friendly in their language.

IMO it’s a grand grand thing to be exploring.

I’m now also thinking about patients that have been offended at the use of term “obese” in their medical records and a proliferation of complicating euphanisms.

Where the patient will go to understand the thoughts entered into the notes will be another discussion. Ideally the author of the notes, but this won’t always be the case. Clinicians don’t have the resources to address all the questions adequately. Maybe they could better develop their FAQs for their regularly used treatments linked to the patient’s profile.

The explicit thought processes may also go some way towards encouraging clinicians to explore evidence (or lack of evidence) behind certain practice behaviours. This could have the flow on effect of introducing evidence based practice to their patients and showing them why they weren’t prescribed antibiotics for their sore throat.

This project only involves primary physicians, so detailed psych notes aren’t likely to be involved.

Nonetheless, in the discussions I’ve seen about open notes, psych is recognized as a special area. I can easily imagine a significant difference between a patient & physician on mental issues.

A big one that springs to my uninformed mind is alcoholism, where denial is common. Another is paranoia. Etc.

My personal opinion is that the whole idea of collaborating on notes is predicated on collaboration in the first place: if there’s no sense of partnership, it changes the whole nature of Party A looking at the work of Party B.

Hmm, I wonder if it would be useful to position each relationship in this study on a scale from strongly cooperative to strongly adversarial. Hm. Better yet, ask both partners, before and after?

Funny, I took a pre-study survey a month ago, but I don’t remember what was in it. :)