Updated: Apr 27
Surprising; Some Doctors May Disagree with Patients Having Full Access to Their Medical Reports!
Information and data today are among the most valuable commodities. Those with a position to any form of information also bear the power of knowledge, thus controlling their environment.
Retaining as much information as possible is essential for leverage and clout, but it is also crucial for private information.
Patient medical reports and data in your medical report are the stories you created within the scope of your encounter with your doctor.
Your medical report contains critical data, which, in the wrong hands, can have devastating consequences for you. That stands beside its positive impacts when used within medical care rendered to you.
Besides telling the story about you, on the other end of the spectrum, a medical record also relates to a tale about your doctor and how they have reached the diagnosis and decisions.
A medical report reflects the doctor's professional and often even personal attitude about you as the patient. That is of particular significance in today's healthcare realm.
Based on what I just said, you must have access to every detail of their medical information. Not merely when requested, and certainly not after a day or two but access all the time, instantaneously in real-time.
But today, that is hardly the case!
Indeed, we all know every patient is entitled to a copy of their medical records. Accessing medical records is even becoming easier amidst the rollout of modern electronic health record systems. Yet, there are still exceptions to the rule.
There is always an option in the most prevailing Electronic Health Record (EHR) for physicians to decide whether to share certain information.
As of April 2021, all medical professionals, including physicians, provide patients access to all their medical reports. The latter is part of the 21st-century Cures Act, constituting your access to doctors' written comments and the entire clinical evaluation report.
Before this, in 2020, a survey suggested that only 74% of doctors approved open and liberal access to their notes. Their judgment is primarily from the notion that open-note patient access could increase their workload.
On the other hand, most patients (96%) reported their visit notes as accurate and understandable, based on a study published by J. Gen. Intern. Med.
Furthermore, the same patients believe if they find disparities, they are willing to reflect on the inaccuracies more so may have less confidence in that doctor.
Image By author Using Wonder Digital Art
Other studies also suggest that providing open notes, as mandated by the 21st-century Cures Act, impacts the quality of care, that is, through transparency and shared accountability.
Nevertheless, the sentiments among doctors have always been mixed.
Sharing visit notes has broad implications for quality of care, privacy, and shared accountability. That contrasts with high patient enthusiasm towards improved understanding of their condition and care delivery.
Another group of scholars believes that your liberal access to your personal information might negatively impact what is being written about you. Thus, further research is necessary to establish the truth.
Regardless of the challenges the open note system brings to the patient care stage, there are still many reasons for you, the patient, to own your medical records right from the start as it is being created. Some of those benefits include:
It is merely about you know what your doctor knows. That means reducing the considerable amnesia by returning to your notes and refreshing your memory, as discussed during your visit.
It is about clearly understanding your medical problem and health and engaging in your care.
Owning your information increases your trust in your healer.
It enhances your safety and reduces medical errors.
Owning your data means portability of your information and granting access to your data whenever, wherever, with whomever.
Most of all, maintaining the "first hand" ownership of your personal information cuts the middle agent's hands from what belongs to you. That prevents abuse of your medical information and its potential use against you. More so, you will retain the value of your data, from which more giant 3rd party corporations are earning trillions of dollars.
In summary, if there is one reason you should be for open notes and, more so, owning your data, it is yours.
DesRoches CM, Leveille S, Bell SK, et al. The Views and Experiences of Clinicians Sharing Medical Record Notes With Patients. JAMA Netw Open. 2020;3(3):e201753. doi:10.1001/jamanetworkopen.2020.1753
Leveille, Suzanne G et al. "Patients Evaluate Visit Notes Written by Their Clinicians: a Mixed Methods Investigation." Journal of general internal medicine vol. 35,12 (2020): 3510–3516. doi:10.1007/s11606–020–06014–7
Walker, Jan, et al. "Inviting patients to read their doctors' notes: patients and doctors look ahead: patient and physician surveys." Annals of internal medicine vol. 155,12 (2011): 811–9. doi:10.7326/0003–4819–155–12–201112200–00003
Crawford, Mark. "Declassifying Doctors' Notes" Journal of AHIMA 84, no.5 (May 2013): 22–25.
Blease, C., Torous, J., Hägglund, M., 2020. Does Patient Access to Clinical Notes Change Documentation? [WWW Document]. Frontiers. URL https://www.frontiersin.org/articles/10.3389/fpubh.2020.577896/full (accessed 2.3.23).
Leveille, S.G., Walker, J., Ralston, J.D., Ross, S.E., Elmore, J.G., Delbanco, T., 2012. Evaluating the impact of patients’ online access to doctors’ visit notes: designing and executing the OpenNotes project — BMC Medical Informatics and Decision Making [WWW Document]. BioMed Central. URL https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/1472-6947-12-32 (accessed 2.3.23).