Doctors open their notes to patients — and patients like what they see

October 2, 2012

It is, perhaps, the most infamous doctors' visit in television history: The Seinfeld episode where Elaine Benes sneaks a peak at her doctor's notes and, after finding herself described as "difficult," cooks up an elaborate plan to steal the document.

The scheme — which involved Kramer dressing up as a fake Dr. Martin van Nostrum — might not have been the best-laid plan. But some new research lends some credence to the underlying idea: Patients who spent a year with access to their doctors' notes say their quality of care improved. 

The doctors were all using OpenNotes, which gave patients access to all those notes scribbled down during various appointments. Doctors at three medical systems tested out the new system with just over 13,000 patients. After a year with the new system, researchers had patients and doctors fill out surveys about how the new system effected their health. Their results are now available in an Annals of Internal Medicine study

Overall, the ratings were positive when it came to the quality of care, with patients appearing to be significantly more enthusiastic about the program than their doctors. You can see that in this chart below, where the squares represent doctors' answers to various questions and the circles represent those of patients. The results are separated by the three health care sites where the new OpenNotes software was deployed.

 

Patients, across the board, reported feeling more prepared for their doctor appointments and better adhering to the prescription drugs they were supposed to take. As one patient put it to these researchers, "Having it written down, it's almost like there's another person telling you to take your meds.”

Doctors didn't totally, however, agree with this assessment: Usually about one-third agreed that the new system was actually changing how well patients managed their care.

Those were the positives — but there were also some drawbacks. Just as Elaine became more anxious after she saw a doctor's note describing her as "difficult," some doctors reported patients becoming more worried after seeing their charts. Here's the surveying on some of the downsides of the OpenNotes software:

Forty-two percent of doctors at Geisinger Health Systems (GHS in the chart above) said they thought the OpenNotes system meant their patient "worries more" than had she not had access to the records. Doctors sometimes changed how they described patients when they knew that description could be read, using "body mass index" in place of "obesity." 

The study does have some limitations: It was only conducted at three sites and, in studies like these, there tends to be a bias toward more positive opinions (people like to say, for example, that they're taking better care of themselves). Still, a year into the project, no doctor elected to leave the program, suggesting that some of the gains might offset any of the negatives of having patients peek at their own medical records.

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Brad Plumer · October 2, 2012