Sunday, June 22, 2014

A friend is seen by a doctor at a primary care practice that is a participant in the Open Notes experiment, which permits patients to view their doctors' notes, which are posted on the patient portal.

He was recently reviewing his PCP's notes, which were written after he was diagnosed with a common ailment, important but not life-threatening.  The doctor said, that he "has multiple questions, some of which were challenging to answer."

He was concerned and didn't know how to react to this.  Is "challenging" a code word for "this is an annoying person?"  Does it mean that the doctor thought he was challenging the recommendations of the care team?  Or, does it simply mean that the questions were difficult even for the doctor to answer because of uncertainties in the situation.

Theoretically, Open Notes would be a stimulus to an expanded conversation to clarify this ambiguity, but my friend--in case the interpretation might be the first or second one listed--is reluctant to raise the issue.  He's worried that if he's already considered a bother, the doctor will not answer honestly or will be further annoyed.

The Open Notes people assert: "Our evidence suggests that opening up visit notes to patients may make care more efficient, improve communication, and most importantly may help patients become more actively involved with their health and health care."

But there are always unintended consequences from experiments.  What do you think my friend should do?

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