tag:blogger.com,1999:blog-7476621888383604834.post8251786220024611983..comments2024-02-15T03:26:38.897-05:00Comments on Health Care Organizational Ethics: Patient Access to the Doctor's NotesJim Sabinhttp://www.blogger.com/profile/03087828142188534542noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-7476621888383604834.post-46467905282181606442009-06-30T07:07:00.191-04:002009-06-30T07:07:00.191-04:00Hi Lori -
Thank you for sharing your thoughts on ...Hi Lori -<br /><br />Thank you for sharing your thoughts on these issues.<br /><br />I think that many doctors would be ready to involve patients in the ways you describe if the logistics were easier for them. Technology could be a big help.<br /><br />In the blog world it's easy for readers to post comments and for the blogger to shape the process, as by rejecting spam. Over time, electronic medical records will be configured to allow physicians to make their notes accessible to their patients and for patients to add comments. And, exporting the notes to HealthVault would just take a click or two.<br /><br />Thanks for suggesting further posts on the topic. I'll keep my eye out for advances in the area!<br /><br />Best<br /><br />JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-55150367788529295562009-06-29T20:34:32.982-04:002009-06-29T20:34:32.982-04:00I really enjoyed reading your post. As someone who...I really enjoyed reading your post. As someone who sees a value in collaborating with my health care providers, I would welcome the opportunity to discuss notes, or participate in their creation. I also wish that doctors were more open with sharing them; I have helped shepherd my parents through illnesses, accompanying them so that they had an advocate taking notes and focusing on what the doctor is saying. When a patient has received a serious diagnosis, often (from what I have experienced) they try to focus on what the doctor is saying but they cannot remember the entire discussion because they became distracted when they wanted to ask a question, or became confused over some component of the treatment protocol. Or, if multiple options are presented, it's sometimes hard to remember all of the "if you do this, here is the result" options.<br /><br />It'd be even greater if these notes were available to put in the patient's personal health record, like the ones I created for my family in HealthVault, so that they could refer to them, much like my parents did the notes I took in the doctor's offices. <br /><br />Hopefully you can write more blogs on best practices on note writing for physicians who are truly concerned about this particular element of a patient's medical record.Anonymoushttps://www.blogger.com/profile/13028456274075968227noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-91081567605493128562009-06-28T08:45:44.228-04:002009-06-28T08:45:44.228-04:00Dear Judy -
Thank you for your comment!
It's...Dear Judy -<br /><br />Thank you for your comment!<br /><br />It's interesting that a doctor who you experienced as arrogant, condescending and obnoxious used his tape recorder in a way that you found to be respectful, in that he included your comments in what he dictated. Too bad that other aspects of the way he related to you didn't match his use of the recorder.<br /><br />There's no reason at all not to ask a doctor about your own recording of the appointment. I only had that experience a few times in my psychiatric practice, but the reasons the patients wanted to do the recording were much like yours. It appeared to be useful to the people involved. Sometimes they reported thinking more about a topic, and sometimes I was asked "what did you mean by XYZ?"<br /><br />Not every physician will be comfortable with the practice, but it's entirely reasonable to bring it up for discussion. If you do I'd love to hear how it turns out for you!<br /><br />Best<br /><br />JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-68468794141246548122009-06-26T19:18:08.872-04:002009-06-26T19:18:08.872-04:00Good idea! One I liked as well occurred w/probably...Good idea! One I liked as well occurred w/probably the most arrogrant, condescending, obnoxious doctor I ever encountered. (I'm delighted to see him advertising his practice on local TV - pickings must be getting slim).<br /><br />My family doctor of some 20+ years had died and I was "doctor shopping". It didn't take me long into that first and only appointment to KNOW he would NOT be my doctor. However, I WAS MOST IMPRESSED that he kept a small handheld tape recorder in his coat pocket which he took out and dictated his notes into at then end of our appointment. My comments got included on the tape. Whether they got included in the transcribed notes I don't know.<br /><br />BUT - I've often wished since then that I dared to ask my doctors if they minded my taping our office appointment. So often we try to cover so much in such limited time that I occasionally am not quite sure just exactly what we did agree upon. I usually manage to remember the important things or at least the most timely ones but ....Judy42noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-70720100964420203552009-06-22T07:11:28.040-04:002009-06-22T07:11:28.040-04:00Hi Eric -
Good to hear from you!
I agree that ne...Hi Eric -<br /><br />Good to hear from you!<br /><br />I agree that new technologies can often be adapted to enhance the doctor-patient relationship. I've imagined that if I were starting my career in psychiatry now I might make the incorporation of supportive IT into clinical practice an area of special interest.<br /><br />Your joke about collaborative note writing as a billable procedure makes a good point. The time we take with patients isn't properly compensated. Collaboration, whether on a note or in other forms of conversation, often improves outcomes and constrains costs. But in our current reimbursement system the physician is, in effect, penalized for doing the right thing.<br /><br />Best<br /><br />JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-55563479043686213672009-06-21T19:04:30.825-04:002009-06-21T19:04:30.825-04:00Hear, hear! Technology really can help the doctor...Hear, hear! Technology really can help the doctor-patient relationship. Sitting next to each other, working on a project (the patient's own medical record) together, learning from each other. We might not have the set-up in a hospital room, and we don't need it in every case. But it is good to have in our repertoire. Hmmm. I'm thinking that this collaborative note-writing constitutes a procedure, which could be billable in the old-fashioned health-care system that we are trying to leave behind.erichttps://www.blogger.com/profile/16137189911651175163noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-73196773921988499672009-06-19T21:21:11.374-04:002009-06-19T21:21:11.374-04:00Dear Anonymous -
Thanks for your comment.
You un...Dear Anonymous -<br /><br />Thanks for your comment.<br /><br />You understood what I meant to convey. Open notes go against mystification, secrecy and "doctor as God." I think it's a process that could have a positive impact on the outlook and attitudes of physicians. I believe it did that for me. I wouldn't want to emphasize the "legal record" aspect of having the patient sign the note, but I like the idea of going over the note together and either acknowledging agreement, or, as sometimes happens, agreeing to disagree, as can occur between the closest of friends.<br /><br />Take a look at my post from December 18, 2007 - "Physician Review by Patients." I think we see things the same way!<br /><br />Best<br /><br />JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-21402559808474919512009-06-19T19:41:26.674-04:002009-06-19T19:41:26.674-04:00Great idea. Your note writing process emphasizes t...Great idea. Your note writing process emphasizes the collaborative nature of decision making. Perhaps we could even get to the point where the patient co-signs the visit notes. That way, it is captured in a legal record that they understood and agreed with the decision, or if they had doubts, those would be captured. It also gets away from the "doctor as God" view that patients of the previous generations often held.Anonymousnoreply@blogger.com