LINDA WERTHEIMER, HOST:
Dr. Leana Wen was taking notes in the ER on a patient suffering from abdominal pain the first time it happened. The patient asked to see her notes. And Wen thought, well, why not? In a post on NPR's The Shots blog, Dr. Wen called that moment a turning point in her medical career. I spoke with her about the practice of doctors showing patients their notes, and why she has been doing it ever since.
DR. LEANA WEN: It helped me greatly in thinking about what this record is actually for. And I believe that it helped her, too, because it helped her think through her diagnosis with me and to come up with her treatment plan together - something that we hadn't done in the past.
WERTHEIMER: Now there was an attempt to sort of formalize this practice by a couple of medical people in 2010. They attempted to create a program called OpenNotes. Some doctors were a little bit weary of it. Why? I mean, what's the problem with doing that?
WEN: Medicine is very old-fashioned in a lot of ways. And even 20 years ago, patients had to literally sue the hospital to get access to their medical records. And so doctors aren't used to this concept. Some doctors said, well, maybe it will decrease patient trust in me if they see what I'm writing about them. Other doctors thought what if they sue me? Now they know exactly what I'm doing. So there's a lot of fear because they just don't know what to expect.
WERTHEIMER: Well, so what happened to the program? How did it go?
WEN: Amazingly well - 80 percent of patients who participated said that it increased their understanding of their medical condition. Two thirds of patients said that it increased their compliance with medications which I find to be astounding because increasing compliance is something that's incredibly hard to do. And none of the doctors who participated said that they wanted to withdraw from the program.
WERTHEIMER: Now OpenNotes has spread since 2010. The Mayo Clinic and the VA have adopted it. But there are still issues, are there not?
WEN: Dr. Delbanco, whom I interviewed for this piece, mentioned that OpenNotes, just like any new medication or any new treatment, will have unexpected side effects. And some of these things would include - what happens if the note is shared with a patient, and they want to post it on Facebook or Twitter? What will crowdsourcing do in terms of doctor-patient trust? And also what would happen if the patient wants to now record their medical encounter by smartphone and then post it everywhere? Does the doctor have a right to privacy as well? And what if the doctor says no? So there are all kinds of new issues that are coming up. But just because they're new issues doesn't mean that it's something we should turn back the clock and not try.
WERTHEIMER: Is there any kind of pushback coming?
WEN: So far OpenNotes has been tried primarily in the outpatient primary care setting where there is already an established relationship between the patient and their doctor. One could say that that is the easiest place, perhaps, to try something like this. This is not yet been tried in the ER setting - not yet been tried, as far as I know, in the inpatient setting where the patient is hospitalized. And I can imagine these settings being a little more problematic because these are acute settings where there's not that established relationship.
I do think that there could be an age component involved as well - that younger doctors like myself, perhaps, are more open to this idea because we're more comfortable with the electronic records, electronic sharing. But this is something that I would encourage every doctor to try. And patients, too, can ask their doctor. Your doctor may not say yes, but maybe they might.
WERTHEIMER: You can read Dr. Leana Wen's piece on The Shots blog on npr.org. Dr. Wen, thank you very much for joining us.
WEN: Thank you.
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