Can a peek at doctors' notes help patients?

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It is, perhaps, the most infamous doctor’s visit in television history: The “Seinfeld” episode where Elaine Benes sneaks a peek at her doctor’s notes and, after finding herself described as “difficult,” cooks up an elaborate plan to steal the document.

The scheme — which involved Kramer dressing up as a fake Dr. Martin van Nostrum — might have been harebrained. But new research lends credence to the underlying idea: Patients who spent a year with access to their doctor’s notes say their quality of care improved.

The doctors were using software called OpenNotes, which gave patients access to all those notes scribbled during appointments. Doctors at three medical systems tested out the new system with just more than 13,000 patients. After a year, researchers had patients and doctors fill out surveys about how the new system affected their health. Their results are now available in an Annals of Internal Medicine study.

Overall, the ratings were positive when it came to the quality of care, with patients appearing to be significantly more enthusiastic about the program than their doctors.

Patients across the board reported that they felt more prepared for their doctor’s appointments and had better adhered to their prescriptions. As one patient put it, “Having it written down, it’s almost like there’s another person telling you to take your meds.”

Doctors, however, didn’t totally agree with this assessment. About one-third agreed that the new system was changing how well patients managed their care.

Those were the positives — but there were also some drawbacks. Just as Elaine became more anxious after she saw a doctor’s note describing her as “difficult,” some doctors reported patients becoming more worried after seeing their charts.

Forty-two percent of doctors at Geisinger Health System in Pennsylvania said they thought the OpenNotes system meant their patient “worries more” than had he or she not had access to the records. Doctors sometimes changed how they described patients when they knew that description could be read, using “body mass index” in place of “obesity.”

The study does have limitations. It was only conducted at three sites and, in studies like these, there tends to be a bias toward more positive opinions (people like to say, for example, that they’re taking better care of themselves). Still, a year into the project, no doctor elected to leave the program, suggesting that some of the gains might offset any of the negatives of having patients peek at their own medical records.

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