When Patients Read What Their Doctors Write • Hacker News Board

Re: When Patients Read What Their Doctors Write

#31

Post by idlewords » Mon, Aug 18, 2014, 1:37 AM UTC

kijin wrote: post #18

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…

Giving patients a copy of doctors' notes != giving them editorial power over doctors' notes. They're doctors' notes, after all. Both the doctor and the patient can look at the screen, but only the doctor has the keyboard. Of course, the psychological pressure to bend to the patient's wishes might be stronger if the patient can see what is being written down. But that's a kind of problem that rigorously trained profes…

I would be interested to hear what physicians on HN have to say about this.

Re: When Patients Read What Their Doctors Write

#32

Post by Silhouette » Mon, Aug 18, 2014, 1:41 AM UTC

This doesn't surprise me at all, but I'm happy to see it.

Just look at how many blatant errors are in an average person's credit history, one of the most sensitive and important files any other party will ever hold about them, and mostly driven by computer-generated automatic updates. They are still borderline works of fiction for significant numbers of people.

Those credit histories are a lot more limited and objective than a person's current medical condition and past medical history, so I find it difficult to imagine even the most diligent medical professionals could collectively hold numerous conversations with a patient and perform numerous tests over the course of that patient's entire lifetime and never misunderstand something, fail to record a potentially significant fact mentioned in passing during a conversation, or simply make a mistake and record the wrong thing.

I learned something about lawyers and accountants very quickly after I started my first business. They charge a lot of money for their expert knowledge, and often they do understand subtleties in their fields that I don't, but they also still make dumb mistakes. I have found my working relationships with those professionals are dramatically improved, and the end results likewise, if we work more collaboratively. For simpler things, I get familiar with the issues (often with the expert's help) and make a first attempt myself that the expert can then review. For more complicated things that I simply can't do, we schedule time for the expert to talk me through the big picture and double-check any key details.

I cannot imagine why doctors do not routinely work the same way. It seems to offer all the same benefits and moderate all the same risks for all the same reasons. The only major difference is that in the case of a doctor it could literally be my life or quality of life at stake rather than just some numbers on a page or words in a court, which surely makes it all the more sensible to work collaboratively as much as possible.

Re: When Patients Read What Their Doctors Write

#33

Post by MisterBastahrd » Mon, Aug 18, 2014, 1:42 AM UTC

The biggest indicator of health is nutrition, yet it's one of the most poorly understood topics in medicine. Ask five different doctors and you'll get five different responses as to what are the accepted parameters in a healthy diet. What we need is a concerted research effort by governments to make headway in figuring this thing out instead of relying on research by teams funded by large agribusiness conglomerates. We also need (at least in the US) to start regulating what goes into our food. It's unacceptable to call something "lite" when you've just stripped out healthy fats and added chemical fillers made from corn sugar.

It's just as unacceptable that someone can graduate from high school without knowing how to balance a checkbook, open a checking account, or know that you should probably be reading the nutritional labels on the back of the food products you purchase... it's a societal failure.

Re: When Patients Read What Their Doctors Write

#34

Post by [deleted] » Mon, Aug 18, 2014, 1:54 AM UTC

MisterBastahrd wrote: post #33

The biggest indicator of health is nutrition, yet it's one of the most poorly understood topics in medicine. Ask five different doctors and you'll get five different responses as to what are the accepted parameters in a healthy diet. What we need is a concerted research effort by governments to make headway in figuring this thing out instead of relying on research by teams funded by large agribusiness conglomerates.…

[deleted]

Re: When Patients Read What Their Doctors Write

#35

Post by carbocation » Mon, Aug 18, 2014, 1:55 AM UTC

kijin wrote: post #18

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…

Giving patients a copy of doctors' notes != giving them editorial power over doctors' notes. They're doctors' notes, after all. Both the doctor and the patient can look at the screen, but only the doctor has the keyboard. Of course, the psychological pressure to bend to the patient's wishes might be stronger if the patient can see what is being written down. But that's a kind of problem that rigorously trained profes…

I write all of my notes under the assumption that the patient will read them. I consider my notes to be the patient's property - they (or their insurers) are paying me for them, anyway.

It removes needless judgment (positive or negative) which is totally useless in the doctor/patient relationship, and permits me to stay focused on the subjective and objective facts, and my assessment.

Re: When Patients Read What Their Doctors Write

#36

Post by ghkbrew » Mon, Aug 18, 2014, 1:58 AM UTC

drdeadringer wrote: post #13

Not having access to my own medical records is something that continues to annoy me to this day. I've heard a few arguments as to why the security is better than Fort Knox, many of these touched upon in the article ["Doctors want to be Free" and "Oh my, Liability"], but I have yet to buy any of them. I hope this "open note" deal continues to trend, and becomes more so; horray for privacy, but bleh to "so secure, I ca…

As the article mentions, HIPAA gives you the legal right to access your own medical records. If you request it your hospital or health care provider they have to give you a copy. Admittedly it may not be as timely as the OpenNote system, but you do have access. (Assuming you live in the US. Does anyone know about similar laws in Europe?)

Re: When Patients Read What Their Doctors Write

#37

Post by ghiculescu » Mon, Aug 18, 2014, 2:04 AM UTC

lambda wrote: post #24

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 m…

Where do you draw the line about what's "protected"? It seems pretty arbitrary, so easy to abuse.

Re: When Patients Read What Their Doctors Write

#38

Post by imroot » Mon, Aug 18, 2014, 2:06 AM UTC

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 neurologist is relatively old-school -- he uses an EMR in the room to order scripts and lab works, however, he uses his time with me talking to me, and then enters records into his EMR in between appointments.

As such, I prefer visiting this guy (an older gentleman) versus a young, fresh out of school neuro in the same office, even though it's much, much easier for me to get into the younger neuro than my guy.

Re: When Patients Read What Their Doctors Write

#39

Post by SoftwareMaven » Mon, Aug 18, 2014, 2:07 AM UTC

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 I've done enough research to see what is correlation, what is not, what actually correlates and what does not. Total cholesterol has zero predictive power (2/3 of heart attack sufferers have below-normal total cholesterol), yet that number is used as a marker for prescribing "treatment".

That doesn't mean there aren't numbers with value in your blood. Triglycerides, HDL/LDL ratio, and LDL type have some predictive values, so I pay more attention to those.

I would encourage nobody to trust me at my word, though. Do the research. Take control of your own health. It's ok to disagree with your doctor.

Re: When Patients Read What Their Doctors Write

#40

Post by SoftwareMaven » Mon, Aug 18, 2014, 2:13 AM UTC

chimeracoder wrote: post #9

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…

> My own story is one of overcoming obesity and, at times, nearly crippling depression using that ability to gain knowledge to learn how to feed my body. 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). > As people take control back...when they realize they have some control...they will become…

The problem you describe is an economics problem. Doctors and patients are shielded from the costs associated with their health care. Having insurance act as a group savings plan is catastrophic for all aspects of healthcare.

If, on the other hand, people were paying out of pocket for those tests, who cares? What is the downside of a person being more knowledgable and involved?

Unfortunately, the ACA took a step in the wrong direction by hiding more costs from the consumers. If we want a healthy health care system, we need price tags (and insurance for catastrophic events!).