When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship

Abstract

Despite concerns about errors, offending language or defensive practice, transparent notes overall did not harm the patient-doctor relationship. Rather, doctors and patients perceived relational benefits. Traditionally more vulnerable populations-non-white, those with poorer self-reported health and those with fewer years of formal education-may be particularly likely to feel better about their doctor after reading their notes. Further informing debate about OpenNotes, the findings suggest transparent records may improve patient satisfaction, trust and safety.

A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships

“…In this study, they were the most common source of potential safety concerns reported by patients, perhaps preventing some harms. In general, reading notes may increase trust between patients and doctors,11 and transparent communication about mistakes nurtures better relationships, a key factor in lawsuits 43–45…”

“…Studies have found that 26% of primary care physicians believe patients would find non-trivial errors in their notes,11 that up to 60% of EHRs contain at least one error,12 that 43% of medications in the EHR may be inaccurate13 and that the mismatch rate between the medications patients take and those listed in the medical record may be as high as 95% 14…”

“…Some patients found medication errors in their notes; others read notes and were reminded of overlooked tests or appointments, such as a skin biopsy or follow-up for a pulmonary nodule. A total of 7% of patients reported contacting their doctor's office because of their notes; 22% of these did so because of a perceived error 11. Today, over 11 million US patients have online access to their notes 17.…”

Sharing notes with patients

“…Options include use of a nursing pool followed by distribution of messages to LIPs as needed or vice versa. Although evidence thus far has not shown a great increase in patient calls following the implementation of shared notes, 3 anecdotally, providers' experiences have varied. Practice effects may differ based on patient population and practice size and a practice should be prepared to receive an increased volume of communication.…”

Opening up to Open Notes and adding the patient to the team

“…This issue of BMJ Quality & Safety features a paper by Bell et al 1 that follows up on the original ‘Open Notes’ experiment with providing patients electronic access to their primary care providers' notes. In the first report,2 the intervention was well received by the patients and did not provoke the anticipated adverse impacts feared by physicians.…”