It's a perennial question with vocal advocates on both sides: Should your patients have access to the notes you make in their medical records? It's based, in part, on the idea that better-informed patients will take better care of themselves, that the doctor-patient relationship should be less paternalistic, more of a partnership. More than 20 institutions nationwide, including Harvard Medical School, Geisinger in Pennsylvania, and Harborview in Seattle have joined the Open Notes initiative in which physicians share their notes with an estimated 5 million patients (Shefali Lutha, Kaiser Health News, June 1, 2015). Those in favor of note-sharing say it puts patients "in a position to catch mistakes and have more informed conversations with their physicians. But others worry the practice could curb honesty in what doctors write about their patients, or cause confusion if patients misinterpret what's written."
Although note-sharing poses serious questions, "we certainly believe so far, the good outweighs the bad," says Jan Walker, a research associate at Harvard and Beth Israel Deaconess Medical Center. Kenneth Burman of MedStar Washington Hospital Center agrees, because when patients read their notes, they are more likely to look things up, and "occasionally correct references to things like family history, or add relevant details" that may have been missed. "Patients' abilities to fix errors in their records could encourage providers to adopt note-sharing, especially if it could reduce the odds of doctor mistakes," says Steven Weinberger, CEO of the American College of Physicians.
Critics of note-sharing argue that not all the data in the patient record is objective. Sometimes it's "notes we make to ourselves documenting things we observe, issues we want to follow up on, problems we are beginning to suspect," such as possible drug abuse or spousal relationship concerns. "If physicians knew that patients could routinely read such notes, would they continue to make them part of the medical record? If physicians only documented objective data, would patient care suffer?" (Medscape: Who Should Own a Medical Record -- the Doctor or the Patient?). Peter Elias, a physician in Auburn, Maine, adds that note-sharing "makes the difficult conversation essential. You can't skip them anymore."
For the locum tenens physician, the implications of this discussion are clear: Be aware of your client's note-sharing policy, because it may influence what you're willing to share.