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The other night, a patient gave me a piece of his mind. Mr. Q was a middle-aged man debilitated by days of nausea, vomiting and intractable belly pain. That morning, his wife finally convinced him to get medical attention and drove him to our emergency department. On arrival, he sat in a cubicle in the waiting room and explained his story to a triage doctor: how he was doing well until he ate a particularly rich meal a few days ago. How he'd vomited five, maybe six times. How he hadn't noticed any fevers. How he'd tried Tums for his symptoms with little effect. After he was escorted to a bay in the emergency room, he repeated the unpleasant details for the resident who came in to evaluate him. This time, he added that he takes a statin for his high cholesterol, that penicillin gives him a rash, and that he doesn't smoke. Within the hour, he gave a repeat performance for the emergency room attending.
Just as he was settling into his slightly-more-permanent bed on the medicine floor, here I was, poised before a laptop on wheels and demanding yet another re-hashing of a narrative that had grown both trite and physically exhausting: “So, Mr. Q. What brought you to the hospital?”
"Doesn’t anyone write this stuff down?" He followed with a few other choice phrases.
When I joined the Ambulatory Practice of the Future (APF) as a first-year resident, I learned that the primary care clinic had an open notes policy: whatever we wrote about our patients could be seen by our patients through a secure online portal. It was a startling departure from medicine's tradition of records shrouded in the secrecy of long, Latin-rooted words written in chicken scratch and kept out of patients' reach by mounds of paperwork.
I liked the concept of open notes but wondered how it would play out. What would patients make of all the medical jargon? How could I be forthcoming in documenting, say, obesity or a personality disorder if I risked offending my unintended audience? The past year-and-a-half has convinced me that record transparency is worthwhile - even when balanced against the potential for discomfort. A recent article in the Annals of Internal Medicine shows how about one hundred primary care physicians (PCPs) and thousands of patients in Boston, Seattle, and Danville, PA came to the same conclusion.