Open notes will lead to greater provider accountability, patient responsibility

It used to be that discouraging health information was withheld from patients, but calls for access are growing as society moves toward a culture of open and free-flowing information. Providers should follow along, according to an editorial published Oct. 1 in the Annals of Internal Medicine. 

“As we enter the age of EHRs, with access to patient information almost a civil right, it is good to remember that communication patterns change in ways that reflect different community expectations and values,” wrote Michael Meltsner, JD, a professor at the Northeastern University School of Law in Boston and a patient who found value in his own providers’ openness. 

Having acquired a serious medical condition himself, Meltsner developed “a strong personal interest in finding out what my doctors thought was the source and nature of my illness, the available options, my precise response to treatment and what I could do to increase my chances of survival.” 

There are professional concerns with a healthcare culture where patients are granted access to their providers’ notes, Meltsner recognized, but there exists a rebuttal to each. 

Will writing honest notes appropriate for patients’ eyes take valuable time and disrupt workflow? “The key here is not more or less time, but best practices,” Meltsner wrote. “Is it not better in most cases to have an informed patient, one who can correct errors, clarify confusion, understand the effects of medications and be able to discuss specific treatments with family and friends?”

Will openness lead to an onslaught of lawsuits? “Secrecy, and a sense that the doctor is distant or indifferent, stimulates litigation as much as a free flow of information,” Meltsner countered. “Previously dormant errors will be uncovered -- that’s the way with more information. But to the extent that those errors are substantial, a profession that prides itself on correcting mistakes can hardly oppose broadening the opportunity to expose them.” 

Will greater patient involvement lead to decreased provider autonomy? “Most decisions have to be made by doctors, and wise patients are happy to let them,” Meltsner responded. “However, passivity robs patients of a wide range of steps that they, and only they, can take toward improved well-being. Not incidentally, patient involvement frees doctors from being thought miracle workers or failed miracle workers.” 

While a healthcare environment of free-flowing information is likely to develop more fully in the near future, it will require consideration of several issues, such as how to educate providers to make health information available and accessible to patients. Working out the kinks will be worth it, according to Meltsner. A greater flow of information will lead to increased accountability on behalf of healthcare professionals and increased responsibility on behalf of patients