3Qs: Patients' access to doctors' notes examined

In a pilot study called Open­Notes, more than 100 primary-​​care physi­cians vol­un­teered to invite more than 20,000 patients to review their doc­tors' notes fol­lowing an office visit to deter­mine the effects of facil­i­tating that access. The results of the study, pub­lished in the Annals of Internal Med­i­cine in October, found that a majority of patients felt more in con­trol of their care, adhered to med­ica­tion pre­scrip­tions and wanted the program to continue.

We asked Michael Melt­sner, the George J. and Kath­leen Waters Matthews Dis­tin­guished Uni­ver­sity Pro­fessor in Northeastern's School of Law, who par­tic­i­pated in the study and wrote an accom­pa­nying edi­to­rial, to dis­cuss the study and issues of trans­parency around patients' med­ical records.

What information are patients legally entitled to? How easily accessible is this information?

Patients are legally enti­tled to their records but access to them is dif­fi­cult. Obsta­cles are put in their way by health­care per­sonnel, many of whom aren't used to sharing the records or knowing just where they can be located. All too often, patients give up the quest in frus­tra­tion. But there is now a growing national movement for doc­tors to open their notes to patients. Recent research con­cludes that fears patients will be con­fused by what they are told or that doc­tors will have to waste valu­able time writing and dis­cussing their notes are overblown.

Why are some doctors and medical professionals viewed as being resistant to full transparency? Does transparency put them at any legal risk?

I think it's less fear of lia­bility than a sense that patients won't know what to do with the infor­ma­tion that doc­tors often feel they are writing for other doc­tors, rather than the patient. There may also be anx­iety that the physi­cian will lose some con­trol and be sub­ject to nag­ging ques­tions about the treat­ment and the patient's med­ical his­tory. But patients over­whelm­ingly want to see these records when they are given the chance and once health­care providers realize this, arrange­ments that facil­i­tate sharing infor­ma­tion are inevitable.

How does full transparency and access to medical information benefit patients? Does the healthcare system as a whole benefit?

I tried to sum­ma­rize the com­pli­cated answers to these ques­tions in my October edi­to­rial in the Annals of Internal Med­i­cine, but my sum­mary response is that infor­ma­tion is usu­ally valu­able, espe­cially if you believe that indi­vid­uals have to play a role in their own devel­op­ment, care and treat­ment. Patients, for example, often suffer selec­tive amnesia after dis­cussing serious issues at an office visit. Having a copy of the doctor's notes allows a ready check of what was said and rec­om­mended as well an oppor­tu­nity to con­sult over the details with family and friends.