10 ms·

When Patients Read What Their Doctors Write

281 points by mkempe 12y ago

mutatismutandis 12y ago
I think this is great; I know for a fact that when I try to describe a series of symptoms to my doctor he will be typing away, and I think there's a lot of what I'm saying that gets lost going from the ears to the fingers. I also think, having both patient and doctor "on the same side" makes it seem more like a team effort and empowers people to take more of an active role in their health.
krisgee 12y ago
As a complete outsides I don't see why anyone would be surprised, going to the doctor is quite often an expression of powerlessness, you have no idea and no control over what is going on in your own body and you need this powerful semi-stranger to do some divination on you and tell you what's wrong. Of course giving someone even a semblance of control over the proceedings helps them feel more engaged and more knowledgeable about themselves.
- hrktb 12y ago
  I think it can be pretty complex. A lot of people (especially older people) will have a preconceived idea of what they have, and come to the doctor only to get confirmation, or have a prescription. Then some will only take the drugs matching what they think they have, and just ignore everything else the doctor told them (my parents do that). Or for people with chronic issues, there isn't much mystery about what's going on, only some variations between a month and another, most of the time. What's special is that the patient will be motivated enough to do a lot of research (in the time there was no internet, go through medical documentation, even research papers), taking time to understand well enough what's happening to them. Then, a doctor might diagnose something different than their previous doctor. Or prescribe different drugs with different side effects. Or sometimes the doctor might not be as well informed on the subject as their patient is, because it's not their specialty for instance. These might be the cases where having transparency and trust between the doctor and patient are the most important and crucial to have the patient cooperate.
SoftwareMaven 12y ago
I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to a (hopefully) trusted, knowledgable advisor. That change frightens many in the medical community[1], but it will yield better outcomes. My own story is one of overcoming obesity and, at times, nearly crippling depression using that ability to gain knowledge to learn how to feed my body. In the process, I've stopped medications and have had to teach my doctor certain things (like why I'm not gong to either worry about my cholesterol or take any drugs for it). The medical community currently has an abysmal record with treating chronic health problems. There are a lot of reasons for that, but, IMO, the most glaring is people abdicating their health reonsibility to somebody else (whether doctors, pharmaceutical companies, or government guidelines). As people take control back...when they realize they have some control...they will become more healthy. 1. Source: my wife is part of that community and sees it regularly.
- chimeracoder 12y ago
  > My own story is one of overcoming obesity and, at times, nearly crippling depression using that ability to gain knowledge to learn how to feed my body. In the process, I've stopped medications and have had to teach my doctor certain things (like why I'm not gong to either worry about my cholesterol or take any drugs for it). > As people take control back...when they realize they have some control...they will become more healthy. Your story is great, and a good example of the upside of patient control and involvement in care. However, the downside also exists, and is very real. For some patients, having control over their care means demanding unnecessary tests and treatments, which leads to phenomenal increases in costs to the insurer and/or provider, as well as a reduction in compliance with medication and treatment regimens[0] - this has implications both for public health and the patient's own health. Or, worse, demanding medications that they think are helpful but are actually harmful (this happens all the time). The problem is that control isn't very meaningful without an appropriate level of knowledge to supplement it, and even when the resources are available, very few patients are willing to take the time to educate themselves to the extent necessary to make informed decisions about their own care. > Once patients become knowledgable, the doctor moves from a pillar of all knowledge to a (hopefully) trusted, knowledgable advisor. That change frightens many in the medical community[1], but it will yield better outcomes. To be blunt, it's more likely that the doctor will move towards being the person who enacts the wishes of the insurer (or whichever entity is acting as the insurer). This isn't a particularly bold prediction - it's already happened, in that doctors are increasingly beholden to the pressures of insurers. Once you take into account the massive costs that arise from mismanagement of long-term conditions (whether from the patient or the doctor), it's not hard to understand why insurers are taking increasingly active roles in patient care. [0] This isn't always bad, but think of diseases which require adherence to antibiotics (or, worse, diseases like HIV, which are chronic and for which compliance is a matter of public health) and you'll see why this can get problematic very quickly.
deleted 12y ago
[deleted]
idlewords 12y ago
One problem with this approach is patients who are making stuff up entirely. They're not a large part of the population, but since they relentlessly seek medical attention (often to the point of self-harm), every doctor is familiar with them. Giving such patients editorial power over doctors' notes gives them a further lever with which to manipulate the system. It's a weird situation in which the doctor/patient relationship is actually adversarial, and it poisons a lot of otherwise good ideas predicated on the assumption that doctors and patients want the same thing.
- skybrian 12y ago
  This could be fixed by having a section of the notes that only doctors can read. Hopefully it wouldn't be needed most of the time.
- drdeadringer 12y ago
  > patients who are making stuff up entirely I'm not sure how making notes visible, or invisible, to patients would change the adage that "patients lie". Exacerbation or reduction arguments, perhaps, but the fundamental principle I'm not sure would change. Toward the "further lever to manipulate the system", that may be something to consider in terms of who has editorial access to the records vs. simple readability access to the records... little more.
  - pyre 12y ago
    It's not about the patient editing the record directly. It's more about the patient talking to a different doctor than the one that wrote the notes, and then saying, "oh, that's wrong. This is the right information." If the doctor takes that at face-value (like in the article's example), I assume that it ends up on the notes.
    - judk 12y ago
      Ultimately anyone can lie to anyone, and misplaced trust is a separate problem from letting people know. Plenty of records are incorrect, and kill people.
dfan 12y ago
My doctor types at a computer whose screen is explicitly set up to point at both of us. I was surprised and appreciative when he first did so.
- hbosch 12y ago
  I too have seen this at a chain of clinics where I live: the doctor's laptop is hooked up to a wall-mounted screen, where I can actively watch what is being typed into my reports. It surprised me too, and makes me feel much better about the whole experience.
  - hollerith 12y ago
    Do you have any implementation details I could take to my doctor? (My doc currently uses a laptop that only she can see.)
motyar 12y ago
Doctors writes too bad (poor hand writting) that sometimes patients cant understand. In India we are talking about a rule ( law ) where doctors have to write in CAPITAL only.
- kijin 12y ago
  That's going to be a non-issue once doctors start typing instead of writing. Maybe there should be a rule that requires doctors to type their notes whenever possible. I'm not even talking about a real computer, which might be too expensive for doctors in rural India to purchase and maintain. Even a 60-year-old mechanical typewriter should be better than most people's handwriting.
  - DanBC 12y ago
    > That's going to be a non-issue once doctors start typing instead of writing. It will be a lot better, but: 35 instead of 3.5? 7.5 uG or 7.5 mG?
- kamaal 12y ago
  In 90% of the cases this is a non issue, if you visit any doctor in any India metro, the guy will never write you a prescription which isn't available with the medical shop they tie up with. These days I can more or less guess what medication the doctor where I regular go to generally writes.
davycro 12y ago
I work in a family practice every other week as a requirement for medical school. I've noticed that EMRs are very disruptive to a doctors bedside manner. For every visit the doctor types notes into a laptop while the patient speaks to her. Communication is inhibited and the doctor struggles to maintain rapport with her patient. I would love to see the patients EMR displayed on a screen so the patient could see what the doctor typed as he spoke. This would make the process collaborative instead of one sided. It would also be a great feedback mechanism where the patient could double check that his doctor understood what he just said.
- alsetmusic 12y ago
  A doctor also might theorize about possible causes of the issue while trying not to implanting ideas of symptoms in the patients head. When I did computer repair, I was very careful not to put my own words in the clients vocabulary when I was still trying to gather information, as I wanted to keep from coloring their memory / experience. Same thing would apply here. Maybe a good compromise would be for the doc to summarize their notes at the end and ask for feedback.
- mhb 12y ago
  For other readers, like me, who are not doctors, I will share that I have discovered that EMR means Electronic Medical Record.
- ensignavenger 12y ago
  At least one of my wife's doctors does not type notes during the visit, but puts them into the computer immediately following. I think she keeps notes on paper while visiting.
- baldfat 12y ago
  My doctor sits with me near him and always has the ability for me to read what he is typing.
- imroot 12y ago
  My neurologist is relatively old-school -- he uses an EMR in the room to order scripts and lab works, however, he uses his time with me talking to me, and then enters records into his EMR in between appointments. As such, I prefer visiting this guy (an older gentleman) versus a young, fresh out of school neuro in the same office, even though it's much, much easier for me to get into the younger neuro than my guy.
drdeadringer 12y ago
Not having access to my own medical records is something that continues to annoy me to this day. I've heard a few arguments as to why the security is better than Fort Knox, many of these touched upon in the article ["Doctors want to be Free" and "Oh my, Liability"], but I have yet to buy any of them. I hope this "open note" deal continues to trend, and becomes more so; horray for privacy, but bleh to "so secure, I can't see it".
- ghkbrew 12y ago
  As the article mentions, HIPAA gives you the legal right to access your own medical records. If you request it your hospital or health care provider they have to give you a copy. Admittedly it may not be as timely as the OpenNote system, but you do have access. (Assuming you live in the US. Does anyone know about similar laws in Europe?)
  - raarts 12y ago
    In The Netherlands a law called WBGO gives you the right to access - and correct - your own medical records. The law was instated Apr 1995.
- deleted 12y ago
  [deleted]
baldfat 12y ago
After going through Cancer with my sister in the 1990s and then the last 5 years with my son. YOU ARE YOUR OWN EXPERT. Everyone else always drops something about you and you ALWAYS need to remind and talk about all the issues out loud with your doctor. If they don't find a new doctor if it is a big medical issue.
novalis78 12y ago
the only problem - in the US - with this is that the more you tell them the more they will bill you. It's like as if every little piece of information that otherwise should help a doctor identify what's wrong and result in a faster and more accurate diagnosis makes the billing department's job that much easier. Now they don't have to break down one single item and charge you 10 ways, they can break down each of your statements and charge you 10 ways for each.
- judk 12y ago
  Extraordinary claims require extraordinary evidence. Please share.
  - novalis78 12y ago
    From personal experience, I saw how a level 1 sprained wrist ER visit turned into a level 4 case, using some of my detailed description to establish criteria that made the case seem bigger than it actually was. It's called "upcoding", "phantom billing" etc and are common medical billing fraud practices. http://www.business2community.com/health-wellness/the-5-most-common-types-of-medical-billing-fraud-0234197#!bFAgN2 http://www.business2community.com/health-wellness/the-5-most...
chintan 12y ago
Back in the day, when Google Health tried to show patients their EHR data, here is what ensued: http://www.zdnet.com/blog/healthcare/google-health-faces-its-first-test/2122 http://www.zdnet.com/blog/healthcare/google-health-faces-its...
Silhouette 12y ago
This doesn't surprise me at all, but I'm happy to see it. Just look at how many blatant errors are in an average person's credit history, one of the most sensitive and important files any other party will ever hold about them, and mostly driven by computer-generated automatic updates. They are still borderline works of fiction for significant numbers of people. Those credit histories are a lot more limited and objective than a person's current medical condition and past medical history, so I find it difficult to imagine even the most diligent medical professionals could collectively hold numerous conversations with a patient and perform numerous tests over the course of that patient's entire lifetime and never misunderstand something, fail to record a potentially significant fact mentioned in passing during a conversation, or simply make a mistake and record the wrong thing. I learned something about lawyers and accountants very quickly after I started my first business. They charge a lot of money for their expert knowledge, and often they do understand subtleties in their fields that I don't, but they also still make dumb mistakes. I have found my working relationships with those professionals are dramatically improved, and the end results likewise, if we work more collaboratively. For simpler things, I get familiar with the issues (often with the expert's help) and make a first attempt myself that the expert can then review. For more complicated things that I simply can't do, we schedule time for the expert to talk me through the big picture and double-check any key details. I cannot imagine why doctors do not routinely work the same way. It seems to offer all the same benefits and moderate all the same risks for all the same reasons. The only major difference is that in the case of a doctor it could literally be my life or quality of life at stake rather than just some numbers on a page or words in a court, which surely makes it all the more sensible to work collaboratively as much as possible.
MisterBastahrd 12y ago
The biggest indicator of health is nutrition, yet it's one of the most poorly understood topics in medicine. Ask five different doctors and you'll get five different responses as to what are the accepted parameters in a healthy diet. What we need is a concerted research effort by governments to make headway in figuring this thing out instead of relying on research by teams funded by large agribusiness conglomerates. We also need (at least in the US) to start regulating what goes into our food. It's unacceptable to call something "lite" when you've just stripped out healthy fats and added chemical fillers made from corn sugar. It's just as unacceptable that someone can graduate from high school without knowing how to balance a checkbook, open a checking account, or know that you should probably be reading the nutritional labels on the back of the food products you purchase... it's a societal failure.
- deleted 12y ago
  [deleted]
- DanBC 12y ago
  > Ask five different doctors and you'll get five different responses as to what are the accepted parameters in a healthy diet. You really wont. It'll be pretty much advice about eating a varied diet, not too much fat, salt, or sugar, with a lot of vegetables and a wide range of fruit and veg.
  - Domenic_S 12y ago
    You really will. Eggs, for example, have been controversial forever [0]. And who could forget the USDA Food Pyramid, encouraging people to eat 6-11 servings of carbs [1]? The 90s heralded the low-fat craze with the mantra "Sugar doesn't make you fat. Fat makes you fat." [2] We've swung the other way in recent years with the anti-carb options that started in earnest with Atkins and branched out to keto/paleo. Nutrition is tricky and is heavily marketed by extremely powerful industries. [0] https://www.google.com/search?q=eggs+health+controversy https://www.google.com/search?q=eggs+health+controversy [1] http://upload.wikimedia.org/wikipedia/commons/6/6d/USDA_Food_Pyramid.gif http://upload.wikimedia.org/wikipedia/commons/6/6d/USDA_Food... [2] http://articles.baltimoresun.com/1998-10-25/features/1998298194_1_sugar-makes-you-fat-premature-aging http://articles.baltimoresun.com/1998-10-25/features/1998298...
svec 12y ago
Similar topic: "How Doctors Think" (http://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/0547053649/ http://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/0...) is a great book. Amazon blurb: "How Doctors Think is a window into the mind of the physician and an insightful examination of the all-important relationship between doctors and their patients. In this myth-shattering work, Jerome Groopman explores the forces and thought processes behind the decisions doctors make. He pinpints why doctors succeed and why they err. Most important, Groopman shows when and how doctors can -- with our help -- avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health."
gingerlime 12y ago
I've met the guys behind a German startup called "Was hab ich?"[0] - which translates roughly to "what have I got?". It's a platform that lets people post their doctor's notes and have med students interpret it for them in an easy to digest form. It helps both patients better understand their conditions and med students learn how to read and interpret diagnosis. It's a non-profit as far as I'm aware, since part of their philosophy is giving access to patients irrespective of their financial ability. I think it's a really neat concept. Sadly only available in German / Germany. [0] https://washabich.de/ https://washabich.de/
- eli 12y ago
  Very interesting. What happens if the med students give advice contrary to the physician?
  - gingerlime 12y ago
    I'm not entirely sure, but I don't think they give any advice. The students only interpret / translate what the physician wrote in their usually-cryptic notes, and turn it into a simple, understandable form that almost any person can understand. If I remember correctly (I don't speak German nor understand medicine), the note can say something like "test XYZ - negative results". This can sound scary to someone who doesn't understand what this test is about. The interpretation could be that negative results on this test means the patient does not suffer from some kind of disease, and this indicates normal function...
ersii 12y ago
In some of the counties ("Landsting") in Sweden, the patient may log on electronically with a electronic ID (certificate based, issued by banks) and view their journal at any time. All patients have a right to their journals, as far as I know - although, there might be restrictions on parts - such as psychiatric treatment I guess - and everyone can request to get a copy of their journal. A bit of a pain in the ass to obtain - but surely possible. I just thought it might be interesting to add to the conversation/article how things are working in another country/part of the world.
jtheory 12y ago
Brief article, but well-done -- this is one of the core ideas of our start-up (though we have no direct association with OpenNotes project). I liked this in particular: Delbanco tells me that he considers OpenNotes to be "like a new medication." Just like any new treatment, it will come with unexpected side effects. We've been negotiating these side-effects for a few years, now, with more & more success. Many of the obvious objections ("I need to discuss test results with patients before they see them!") have simple technical solutions, so we implement them (blacklist a set of tests that have a built-in delay before the actual result is shown to patients --though they can see that a new result is ready -- and give the clinician a daily list of what patients have gotten delayed-view results). It is difficult for many doctors to get used to the idea; I have personal experience trying to get access to letters being written between specialists about me & my treatment, and just getting evasive answers even to persistent attempts. But it's so valuable to good care.
GhotiFish 12y ago
You know. I checked the source (still checking) but it really seams what they did was give patients access to their notes, and then ASK them if that improved things. How could this honestly be considered evidence that this is a good idea? This is the standard of evidence that a Homeopath would present. Who could take this seriously? Patients reported taking their medication more regularly, here's an obvious question: Did they actually take their medication more regularly? Maybe somewhere in the body this is answered. Let me keep looking. edit: NO although self-reports fall short of objective data, open notes may prove to be a simple intervention that has an important effect on medication adherence. Good, glad they lamp-shaded it. edit2: http://www.myopennotes.org/ http://www.myopennotes.org/ oooooohhh. This makes more sense. This is a paid for study. Why does this have 200 upvotes?
CWuestefeld 12y ago
I've had Crohn's disease for about 35 years, and my experience makes me agree strongly with the article. I have to go see my GI doctor a couple of times a year[1]. He's the department head at a teaching hospital, and so my appointments with start with a first-year resident examining me. After that, the "real" doc comes in, and the resident presents to the doc his findings and conclusions. While I guess that some folks might object to an examination by "only" a resident, I find that this helps me because of the interchange between the resident and the teaching doc. At the same time the doctor is teaching his resident, he's also leaking that teaching to me. As a result, I come to understand my condition better than I would if were just going to a regular GI practice. And because management of a chronic disease like Crohn's is all about understanding its effects specific to your own case, getting this kind of feedback is invaluable. [1] I moved recently, and need to find a new doctor with whom I can relate to like this. But it's easier to talk about in the present tense.
cherryblasters 12y ago
I would love this!

281 points by mkempe 12y ago

I think this is great; I know for a fact that when I try to describe a series of symptoms to my doctor he will be typing away, and I think there's a lot of what I'm saying that gets lost going from the ears to the fingers. I also think, having both patient and doctor "on the same side" makes it seem more like a team effort and empowers people to take more of an active role in their health.

krisgee 12y ago

As a complete outsides I don't see why anyone would be surprised, going to the doctor is quite often an expression of powerlessness, you have no idea and no control over what is going on in your own body and you need this powerful semi-stranger to do some divination on you and tell you what's wrong. Of course giving someone even a semblance of control over the proceedings helps them feel more engaged and more knowledgeable about themselves.

hrktb 12y ago
I think it can be pretty complex. A lot of people (especially older people) will have a preconceived idea of what they have, and come to the doctor only to get confirmation, or have a prescription. Then some will only take the drugs matching what they think they have, and just ignore everything else the doctor told them (my parents do that). Or for people with chronic issues, there isn't much mystery about what's going on, only some variations between a month and another, most of the time. What's special is that the patient will be motivated enough to do a lot of research (in the time there was no internet, go through medical documentation, even research papers), taking time to understand well enough what's happening to them. Then, a doctor might diagnose something different than their previous doctor. Or prescribe different drugs with different side effects. Or sometimes the doctor might not be as well informed on the subject as their patient is, because it's not their specialty for instance. These might be the cases where having transparency and trust between the doctor and patient are the most important and crucial to have the patient cooperate.

SoftwareMaven 12y ago

I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to a (hopefully) trusted, knowledgable advisor. That change frightens many in the medical community[1], but it will yield better outcomes. My own story is one of overcoming obesity and, at times, nearly crippling depression using that ability to gain knowledge to learn how to feed my body. In the process, I've stopped medications and have had to teach my doctor certain things (like why I'm not gong to either worry about my cholesterol or take any drugs for it). The medical community currently has an abysmal record with treating chronic health problems. There are a lot of reasons for that, but, IMO, the most glaring is people abdicating their health reonsibility to somebody else (whether doctors, pharmaceutical companies, or government guidelines). As people take control back...when they realize they have some control...they will become more healthy. 1. Source: my wife is part of that community and sees it regularly.

chimeracoder 12y ago
> My own story is one of overcoming obesity and, at times, nearly crippling depression using that ability to gain knowledge to learn how to feed my body. In the process, I've stopped medications and have had to teach my doctor certain things (like why I'm not gong to either worry about my cholesterol or take any drugs for it). > As people take control back...when they realize they have some control...they will become more healthy. Your story is great, and a good example of the upside of patient control and involvement in care. However, the downside also exists, and is very real. For some patients, having control over their care means demanding unnecessary tests and treatments, which leads to phenomenal increases in costs to the insurer and/or provider, as well as a reduction in compliance with medication and treatment regimens[0] - this has implications both for public health and the patient's own health. Or, worse, demanding medications that they think are helpful but are actually harmful (this happens all the time). The problem is that control isn't very meaningful without an appropriate level of knowledge to supplement it, and even when the resources are available, very few patients are willing to take the time to educate themselves to the extent necessary to make informed decisions about their own care. > Once patients become knowledgable, the doctor moves from a pillar of all knowledge to a (hopefully) trusted, knowledgable advisor. That change frightens many in the medical community[1], but it will yield better outcomes. To be blunt, it's more likely that the doctor will move towards being the person who enacts the wishes of the insurer (or whichever entity is acting as the insurer). This isn't a particularly bold prediction - it's already happened, in that doctors are increasingly beholden to the pressures of insurers. Once you take into account the massive costs that arise from mismanagement of long-term conditions (whether from the patient or the doctor), it's not hard to understand why insurers are taking increasingly active roles in patient care. [0] This isn't always bad, but think of diseases which require adherence to antibiotics (or, worse, diseases like HIV, which are chronic and for which compliance is a matter of public health) and you'll see why this can get problematic very quickly.

deleted 12y ago

[deleted]

idlewords 12y ago

One problem with this approach is patients who are making stuff up entirely. They're not a large part of the population, but since they relentlessly seek medical attention (often to the point of self-harm), every doctor is familiar with them. Giving such patients editorial power over doctors' notes gives them a further lever with which to manipulate the system. It's a weird situation in which the doctor/patient relationship is actually adversarial, and it poisons a lot of otherwise good ideas predicated on the assumption that doctors and patients want the same thing.

skybrian 12y ago
This could be fixed by having a section of the notes that only doctors can read. Hopefully it wouldn't be needed most of the time.
drdeadringer 12y ago
> patients who are making stuff up entirely I'm not sure how making notes visible, or invisible, to patients would change the adage that "patients lie". Exacerbation or reduction arguments, perhaps, but the fundamental principle I'm not sure would change. Toward the "further lever to manipulate the system", that may be something to consider in terms of who has editorial access to the records vs. simple readability access to the records... little more.
- pyre 12y ago
  It's not about the patient editing the record directly. It's more about the patient talking to a different doctor than the one that wrote the notes, and then saying, "oh, that's wrong. This is the right information." If the doctor takes that at face-value (like in the article's example), I assume that it ends up on the notes.
  - judk 12y ago
    Ultimately anyone can lie to anyone, and misplaced trust is a separate problem from letting people know. Plenty of records are incorrect, and kill people.

dfan 12y ago

My doctor types at a computer whose screen is explicitly set up to point at both of us. I was surprised and appreciative when he first did so.

hbosch 12y ago
I too have seen this at a chain of clinics where I live: the doctor's laptop is hooked up to a wall-mounted screen, where I can actively watch what is being typed into my reports. It surprised me too, and makes me feel much better about the whole experience.
- hollerith 12y ago
  Do you have any implementation details I could take to my doctor? (My doc currently uses a laptop that only she can see.)

motyar 12y ago

Doctors writes too bad (poor hand writting) that sometimes patients cant understand. In India we are talking about a rule ( law ) where doctors have to write in CAPITAL only.

kijin 12y ago
That's going to be a non-issue once doctors start typing instead of writing. Maybe there should be a rule that requires doctors to type their notes whenever possible. I'm not even talking about a real computer, which might be too expensive for doctors in rural India to purchase and maintain. Even a 60-year-old mechanical typewriter should be better than most people's handwriting.
- DanBC 12y ago
  > That's going to be a non-issue once doctors start typing instead of writing. It will be a lot better, but: 35 instead of 3.5? 7.5 uG or 7.5 mG?
kamaal 12y ago
In 90% of the cases this is a non issue, if you visit any doctor in any India metro, the guy will never write you a prescription which isn't available with the medical shop they tie up with. These days I can more or less guess what medication the doctor where I regular go to generally writes.

davycro 12y ago

I work in a family practice every other week as a requirement for medical school. I've noticed that EMRs are very disruptive to a doctors bedside manner. For every visit the doctor types notes into a laptop while the patient speaks to her. Communication is inhibited and the doctor struggles to maintain rapport with her patient. I would love to see the patients EMR displayed on a screen so the patient could see what the doctor typed as he spoke. This would make the process collaborative instead of one sided. It would also be a great feedback mechanism where the patient could double check that his doctor understood what he just said.

alsetmusic 12y ago
A doctor also might theorize about possible causes of the issue while trying not to implanting ideas of symptoms in the patients head. When I did computer repair, I was very careful not to put my own words in the clients vocabulary when I was still trying to gather information, as I wanted to keep from coloring their memory / experience. Same thing would apply here. Maybe a good compromise would be for the doc to summarize their notes at the end and ask for feedback.
mhb 12y ago
For other readers, like me, who are not doctors, I will share that I have discovered that EMR means Electronic Medical Record.
ensignavenger 12y ago
At least one of my wife's doctors does not type notes during the visit, but puts them into the computer immediately following. I think she keeps notes on paper while visiting.
baldfat 12y ago
My doctor sits with me near him and always has the ability for me to read what he is typing.
imroot 12y ago
My neurologist is relatively old-school -- he uses an EMR in the room to order scripts and lab works, however, he uses his time with me talking to me, and then enters records into his EMR in between appointments. As such, I prefer visiting this guy (an older gentleman) versus a young, fresh out of school neuro in the same office, even though it's much, much easier for me to get into the younger neuro than my guy.

drdeadringer 12y ago

Not having access to my own medical records is something that continues to annoy me to this day. I've heard a few arguments as to why the security is better than Fort Knox, many of these touched upon in the article ["Doctors want to be Free" and "Oh my, Liability"], but I have yet to buy any of them. I hope this "open note" deal continues to trend, and becomes more so; horray for privacy, but bleh to "so secure, I can't see it".

ghkbrew 12y ago
As the article mentions, HIPAA gives you the legal right to access your own medical records. If you request it your hospital or health care provider they have to give you a copy. Admittedly it may not be as timely as the OpenNote system, but you do have access. (Assuming you live in the US. Does anyone know about similar laws in Europe?)
- raarts 12y ago
  In The Netherlands a law called WBGO gives you the right to access - and correct - your own medical records. The law was instated Apr 1995.
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baldfat 12y ago

After going through Cancer with my sister in the 1990s and then the last 5 years with my son. YOU ARE YOUR OWN EXPERT. Everyone else always drops something about you and you ALWAYS need to remind and talk about all the issues out loud with your doctor. If they don't find a new doctor if it is a big medical issue.

novalis78 12y ago

the only problem - in the US - with this is that the more you tell them the more they will bill you. It's like as if every little piece of information that otherwise should help a doctor identify what's wrong and result in a faster and more accurate diagnosis makes the billing department's job that much easier. Now they don't have to break down one single item and charge you 10 ways, they can break down each of your statements and charge you 10 ways for each.

judk 12y ago
Extraordinary claims require extraordinary evidence. Please share.
- novalis78 12y ago
  From personal experience, I saw how a level 1 sprained wrist ER visit turned into a level 4 case, using some of my detailed description to establish criteria that made the case seem bigger than it actually was. It's called "upcoding", "phantom billing" etc and are common medical billing fraud practices. http://www.business2community.com/health-wellness/the-5-most-common-types-of-medical-billing-fraud-0234197#!bFAgN2 http://www.business2community.com/health-wellness/the-5-most...

chintan 12y ago

Back in the day, when Google Health tried to show patients their EHR data, here is what ensued: http://www.zdnet.com/blog/healthcare/google-health-faces-its-first-test/2122 http://www.zdnet.com/blog/healthcare/google-health-faces-its...

Silhouette 12y ago

This doesn't surprise me at all, but I'm happy to see it. Just look at how many blatant errors are in an average person's credit history, one of the most sensitive and important files any other party will ever hold about them, and mostly driven by computer-generated automatic updates. They are still borderline works of fiction for significant numbers of people. Those credit histories are a lot more limited and objective than a person's current medical condition and past medical history, so I find it difficult to imagine even the most diligent medical professionals could collectively hold numerous conversations with a patient and perform numerous tests over the course of that patient's entire lifetime and never misunderstand something, fail to record a potentially significant fact mentioned in passing during a conversation, or simply make a mistake and record the wrong thing. I learned something about lawyers and accountants very quickly after I started my first business. They charge a lot of money for their expert knowledge, and often they do understand subtleties in their fields that I don't, but they also still make dumb mistakes. I have found my working relationships with those professionals are dramatically improved, and the end results likewise, if we work more collaboratively. For simpler things, I get familiar with the issues (often with the expert's help) and make a first attempt myself that the expert can then review. For more complicated things that I simply can't do, we schedule time for the expert to talk me through the big picture and double-check any key details. I cannot imagine why doctors do not routinely work the same way. It seems to offer all the same benefits and moderate all the same risks for all the same reasons. The only major difference is that in the case of a doctor it could literally be my life or quality of life at stake rather than just some numbers on a page or words in a court, which surely makes it all the more sensible to work collaboratively as much as possible.

MisterBastahrd 12y ago

The biggest indicator of health is nutrition, yet it's one of the most poorly understood topics in medicine. Ask five different doctors and you'll get five different responses as to what are the accepted parameters in a healthy diet. What we need is a concerted research effort by governments to make headway in figuring this thing out instead of relying on research by teams funded by large agribusiness conglomerates. We also need (at least in the US) to start regulating what goes into our food. It's unacceptable to call something "lite" when you've just stripped out healthy fats and added chemical fillers made from corn sugar. It's just as unacceptable that someone can graduate from high school without knowing how to balance a checkbook, open a checking account, or know that you should probably be reading the nutritional labels on the back of the food products you purchase... it's a societal failure.

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DanBC 12y ago
> Ask five different doctors and you'll get five different responses as to what are the accepted parameters in a healthy diet. You really wont. It'll be pretty much advice about eating a varied diet, not too much fat, salt, or sugar, with a lot of vegetables and a wide range of fruit and veg.
- Domenic_S 12y ago
  You really will. Eggs, for example, have been controversial forever [0]. And who could forget the USDA Food Pyramid, encouraging people to eat 6-11 servings of carbs [1]? The 90s heralded the low-fat craze with the mantra "Sugar doesn't make you fat. Fat makes you fat." [2] We've swung the other way in recent years with the anti-carb options that started in earnest with Atkins and branched out to keto/paleo. Nutrition is tricky and is heavily marketed by extremely powerful industries. [0] https://www.google.com/search?q=eggs+health+controversy https://www.google.com/search?q=eggs+health+controversy [1] http://upload.wikimedia.org/wikipedia/commons/6/6d/USDA_Food_Pyramid.gif http://upload.wikimedia.org/wikipedia/commons/6/6d/USDA_Food... [2] http://articles.baltimoresun.com/1998-10-25/features/1998298194_1_sugar-makes-you-fat-premature-aging http://articles.baltimoresun.com/1998-10-25/features/1998298...

svec 12y ago

Similar topic: "How Doctors Think" (http://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/0547053649/ http://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/0...) is a great book. Amazon blurb: "How Doctors Think is a window into the mind of the physician and an insightful examination of the all-important relationship between doctors and their patients. In this myth-shattering work, Jerome Groopman explores the forces and thought processes behind the decisions doctors make. He pinpints why doctors succeed and why they err. Most important, Groopman shows when and how doctors can -- with our help -- avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health."

gingerlime 12y ago

I've met the guys behind a German startup called "Was hab ich?"[0] - which translates roughly to "what have I got?". It's a platform that lets people post their doctor's notes and have med students interpret it for them in an easy to digest form. It helps both patients better understand their conditions and med students learn how to read and interpret diagnosis. It's a non-profit as far as I'm aware, since part of their philosophy is giving access to patients irrespective of their financial ability. I think it's a really neat concept. Sadly only available in German / Germany. [0] https://washabich.de/ https://washabich.de/

eli 12y ago
Very interesting. What happens if the med students give advice contrary to the physician?
- gingerlime 12y ago
  I'm not entirely sure, but I don't think they give any advice. The students only interpret / translate what the physician wrote in their usually-cryptic notes, and turn it into a simple, understandable form that almost any person can understand. If I remember correctly (I don't speak German nor understand medicine), the note can say something like "test XYZ - negative results". This can sound scary to someone who doesn't understand what this test is about. The interpretation could be that negative results on this test means the patient does not suffer from some kind of disease, and this indicates normal function...

ersii 12y ago

In some of the counties ("Landsting") in Sweden, the patient may log on electronically with a electronic ID (certificate based, issued by banks) and view their journal at any time. All patients have a right to their journals, as far as I know - although, there might be restrictions on parts - such as psychiatric treatment I guess - and everyone can request to get a copy of their journal. A bit of a pain in the ass to obtain - but surely possible. I just thought it might be interesting to add to the conversation/article how things are working in another country/part of the world.

jtheory 12y ago

Brief article, but well-done -- this is one of the core ideas of our start-up (though we have no direct association with OpenNotes project). I liked this in particular: Delbanco tells me that he considers OpenNotes to be "like a new medication." Just like any new treatment, it will come with unexpected side effects. We've been negotiating these side-effects for a few years, now, with more & more success. Many of the obvious objections ("I need to discuss test results with patients before they see them!") have simple technical solutions, so we implement them (blacklist a set of tests that have a built-in delay before the actual result is shown to patients --though they can see that a new result is ready -- and give the clinician a daily list of what patients have gotten delayed-view results). It is difficult for many doctors to get used to the idea; I have personal experience trying to get access to letters being written between specialists about me & my treatment, and just getting evasive answers even to persistent attempts. But it's so valuable to good care.

GhotiFish 12y ago

You know. I checked the source (still checking) but it really seams what they did was give patients access to their notes, and then ASK them if that improved things. How could this honestly be considered evidence that this is a good idea? This is the standard of evidence that a Homeopath would present. Who could take this seriously? Patients reported taking their medication more regularly, here's an obvious question: Did they actually take their medication more regularly? Maybe somewhere in the body this is answered. Let me keep looking. edit: NO although self-reports fall short of objective data, open notes may prove to be a simple intervention that has an important effect on medication adherence. Good, glad they lamp-shaded it. edit2: http://www.myopennotes.org/ http://www.myopennotes.org/ oooooohhh. This makes more sense. This is a paid for study. Why does this have 200 upvotes?

CWuestefeld 12y ago

I've had Crohn's disease for about 35 years, and my experience makes me agree strongly with the article. I have to go see my GI doctor a couple of times a year[1]. He's the department head at a teaching hospital, and so my appointments with start with a first-year resident examining me. After that, the "real" doc comes in, and the resident presents to the doc his findings and conclusions. While I guess that some folks might object to an examination by "only" a resident, I find that this helps me because of the interchange between the resident and the teaching doc. At the same time the doctor is teaching his resident, he's also leaking that teaching to me. As a result, I come to understand my condition better than I would if were just going to a regular GI practice. And because management of a chronic disease like Crohn's is all about understanding its effects specific to your own case, getting this kind of feedback is invaluable. [1] I moved recently, and need to find a new doctor with whom I can relate to like this. But it's easier to talk about in the present tense.

cherryblasters 12y ago

I would love this!