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When Patients Read What Their Doctors Write

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Re: When Patients Read What Their Doctors Write

#21

Post by kijin »

motyar wrote: post #11

Doctors writes too bad (poor hand writting) that sometimes patients cant understand. In India we are talking about a rule ( law ) where doctors have to write in CAPITAL only.

That's going to be a non-issue once doctors start typing instead of writing. Maybe there should be a rule that requires doctors to type their notes whenever possible.

I'm not even talking about a real computer, which might be too expensive for doctors in rural India to purchase and maintain. Even a 60-year-old mechanical typewriter should be better than most people's handwriting.

Re: When Patients Read What Their Doctors Write

#22

Post by tokenadult »

idlewords wrote: post #5

One problem with this approach is patients who are making stuff up entirely. They're not a large part of the population, but since they relentlessly seek medical attention (often to the point of self-harm), every doctor is familiar with them. Giving such patients editorial power over doctors' notes gives them a further lever with which to manipulate the system. It's a weird situation in which the doctor/patient relat…

Our fellow participant idlewords remembers a real-life incident that he wrote about eloquently.[1] I learned about this essay of his from another Hacker News participant, and am grateful for the tip.

[1] http://idlewords.com/2012/09/no_evidence_of_disease.htm

Re: When Patients Read What Their Doctors Write

#23

Post by ensignavenger »

davycro wrote: post #12

I work in a family practice every other week as a requirement for medical school. I've noticed that EMRs are very disruptive to a doctors bedside manner. For every visit the doctor types notes into a laptop while the patient speaks to her. Communication is inhibited and the doctor struggles to maintain rapport with her patient. I would love to see the patients EMR displayed on a screen so the patient could see what t…

At least one of my wife's doctors does not type notes during the visit, but puts them into the computer immediately following. I think she keeps notes on paper while visiting.

Re: When Patients Read What Their Doctors Write

#24

Post by lambda »

idlewords wrote: post #5

One problem with this approach is patients who are making stuff up entirely. They're not a large part of the population, but since they relentlessly seek medical attention (often to the point of self-harm), every doctor is familiar with them. Giving such patients editorial power over doctors' notes gives them a further lever with which to manipulate the system. It's a weird situation in which the doctor/patient relat…

So, I think that the best way to address this would be to allow it to be mostly open. The default is for all notes from the doctors and patients visible to everyone; but doctors can write "hidden" notes that only other doctors are able to see.

In a lot of ways, I see this like a public bug tracker. For bug trackers, it's generally best for everyone to see all changes, to be kept up on what's going on and be able to most usefully provide extra information. But for security sensitive issues, or internal discussion that involves things that the end user needn't know about, many have a way of posting "protected" comments that only certain privileged users can see.

Re: When Patients Read What Their Doctors Write

#25

Post by XorNot »

carbocation wrote: post #20
SoftwareMaven wrote: post #4

I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to…

> In the process, I've stopped medications and have had to teach my doctor certain things (like why I'm not gong to either worry about my cholesterol or take any drugs for it). People have many values, one of which is health. Deciding not to worry about cholesterol may fit with your value system, but is unlikely to benefit your health. As a doctor, it would be reasonable to try to convince you of the benefit of carin…

Or to go another way: doctor's get paid on throughput, and at some point it's not worth the effort to keep arguing with the patient, provided you can show in your records you did advise them repeatedly that they were making an inadvisable decision.

Re: When Patients Read What Their Doctors Write

#26

Post by DanBC »

idlewords wrote: post #5

One problem with this approach is patients who are making stuff up entirely. They're not a large part of the population, but since they relentlessly seek medical attention (often to the point of self-harm), every doctor is familiar with them. Giving such patients editorial power over doctors' notes gives them a further lever with which to manipulate the system. It's a weird situation in which the doctor/patient relat…

You just create narrow exemptions to fit those situations.

In England I'm allowed to see my notes unless it's going to harm me. I'm allowed to add annotations, but I'm not allowed to change or remove any information.

Re: When Patients Read What Their Doctors Write

#27

Post by baldfat »

After going through Cancer with my sister in the 1990s and then the last 5 years with my son.

YOU ARE YOUR OWN EXPERT. Everyone else always drops something about you and you ALWAYS need to remind and talk about all the issues out loud with your doctor. If they don't find a new doctor if it is a big medical issue.

Re: When Patients Read What Their Doctors Write

#28

Post by novalis78 »

the only problem - in the US - with this is that the more you tell them the more they will bill you. It's like as if every little piece of information that otherwise should help a doctor identify what's wrong and result in a faster and more accurate diagnosis makes the billing department's job that much easier. Now they don't have to break down one single item and charge you 10 ways, they can break down each of your statements and charge you 10 ways for each.

Re: When Patients Read What Their Doctors Write

#29

Post by baldfat »

davycro wrote: post #12

I work in a family practice every other week as a requirement for medical school. I've noticed that EMRs are very disruptive to a doctors bedside manner. For every visit the doctor types notes into a laptop while the patient speaks to her. Communication is inhibited and the doctor struggles to maintain rapport with her patient. I would love to see the patients EMR displayed on a screen so the patient could see what t…

My doctor sits with me near him and always has the ability for me to read what he is typing.
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