Your Health


This is MORNING EDITION from NPR News. I'm Linda Wertheimer.


And I'm Steve Inskeep. Good morning. Today in Your Health, a small town doctor makes house calls and takes his office with him on his laptop. First, NPR's Richard Knox on a revolutionary experiment: letting patients in on what their doctors really think about them.

Dr. HOWARD LIBMAN (Beth Israel Deaconess Medical Center): So how have you been doing since your last visit?

Mr. AMIT DIXIT: Doing well. Doing well.

RICHARD KNOX: Dr. Howard Libman is having a routine visit with his patient. He's a Boston software engineer named Amit Dixit.

Dr. LIBMAN: Have you had any other doctor's visits since you saw me last?

Mr. DIXIT: No, I haven't.

Dr. LIBMAN: Okay. Let me just go over your labs with you from last time.

(Soundbite of typing)

KNOX: Later, Libman writes his notes on Dixit's visit for his files.

Dr. LIBMAN: Amit Dixit. Date of visit was 09-15-09. This is a follow-up visit. The patient complains of recent insomnia that he attributes to stress from his work.

KNOX: Soon, some patients like Dixit will be able to go online and see their doctor's notes. At Harvard, Dr. Tom Delbanco is starting an experiment to let patients in on this secret stuff. He calls it open notes.

Dr. TOM DELBANCO (Harvard Medical School): Look, the medical record has traditionally been viewed by the medical establishment as something that they own. It's my private notes. This is my stuff.

KNOX: Delbanco is at Harvard Medical School. He says doctor's notes aren't really secret anyway. Other doctors see them. So do insurance companies and lawyers. And under a 1996 federal law, patients have every right to see their complete medical records.

Dr. DELBANCO: You can get it. We do everything in the world to make sure that you don't get it.

KNOX: Patients often have to pay hefty page charges. Some places say doctors have to be present when patients read their notes to clear up any confusion. But not in Delbanco's experiment.

Dr. DELBANCO: My hope is that it will be a method of communicating with patients so that patients see what we're thinking, where our head is, what our plans are, why we're suggesting what we do suggest and will grasp more carefully what's going on and more fully.

KNOX: Many patients like the idea, such as Amit Dixit, Howard Libman's patient.

Mr. DIXIT: I would actually find it very useful. It's a great reminder of what I need to do, number one, and also, so to understand where Dr. Libman is coming from.

KNOX: But doctors are a harder sell.

Dr. DELBANCO: The physician response is all over the lot. It ranges from, well, transparency is here, this will be good for patients, they'll be more actively involved in their care, they'll learn from what I'm writing, isn't it a terrific idea, to, this is the worst thing I've ever heard of.

KNOX: Dr. Michael Thane is one of the skeptics. He works in the same hospital as Delbanco.

Dr. MICHAEL THANE (Harvard Medical School): My guess is that many of my colleagues would be decidedly cool to the idea.

KNOX: Thane brings up a common concern that doctors may pull their punches if they know the patient's looking over their shoulders.

Dr. THANE: We may be less candid. We may not as accurately describe the mood of the patient, the tenor of the encounter, for fear that we may get someone perhaps already a little angry during the encounter, more so after they log on and read the note that I just finished.

KNOX: And doctors have more worries: that patients will call up wanting to know what something means or demand a correction, that it might lead to more lawsuits, that it'll scare patients. Dr. Thomas Lee is president of the physician group at Partners, New England's largest health care network. He says it scares physicians, too.

Dr. THOMAS LEE (President, Partners): But I think the big, broad directions are clear, which is: patients have to be put in the center of their care more and more. That doesn't mean patients call all the shots. But it means patients really to really be a team member.

KNOX: To be a team member, Lee says, they've got to see the playbook. But he's not ready to open the medical records to patients in his network.

Dr. LEE: To be perfectly honest, I'm glad someone else is doing it as opposed to the place where I am practicing myself.

KNOX: He says he wants to see how it works across town of his competitor, the Beth Israel Deaconess. But they're ambivalent about it over there, too.

Dr. JULIA LINDENBERG (Beth Israel Deaconess): This is Julia Lindenberg dictating…

KNOX: I catch up with Dr. Lindenberg at Beth Israel Deaconess while she's dictating a patient's note.

Dr. LINDENBERG: I absolutely believe that it's something that patients should have the right to see. And I actually think that it may affect care positively.

KNOX: But Lindenberg isn't going to volunteer for Tom Delbanco's experiment. It'll involve about 100 doctors and 30,000 patients at Beth Israel Deaconess, Geisinger Clinic in rural Pennsylvania, and Harborview Medical Center in Seattle. Lindenberg wants to see how that comes out before she invites her patients to read her notes.

Richard Knox, NPR News, Boston.

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