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When Patients Read What Their Doctors Write

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Re: When Patients Read What Their Doctors Write

#41

Post by shortstuffsushi »

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…

> The medical community currently has an abysmal record with treating chronic health problems.

Could you elaborate on this a bit more? What sort of 'chronic health problems' are you referring to, and what is it that the medical community is failing to provide (short of cures, presumably)?

Re: When Patients Read What Their Doctors Write

#42

Post by svec »

Similar topic: "How Doctors Think" (http://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/0...) is a great book. Amazon blurb:

"How Doctors Think is a window into the mind of the physician and an insightful examination of the all-important relationship between doctors and their patients. In this myth-shattering work, Jerome Groopman explores the forces and thought processes behind the decisions doctors make. He pinpints why doctors succeed and why they err. Most important, Groopman shows when and how doctors can -- with our help -- avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health."

Re: When Patients Read What Their Doctors Write

#43

Post by raarts »

ghkbrew wrote: post #36
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?)

In The Netherlands a law called WBGO gives you the right to access - and correct - your own medical records. The law was instated Apr 1995.

Re: When Patients Read What Their Doctors Write

#44

Post by bayesianhorse »

idlewords wrote: post #17
bayesianhorse wrote: post #16

Earlier quoted context omitted.

Editorial power? I must have missed that in my reading of the article. As far as I understood it, patients weren't able to redact/change their notes. Reported symptoms and complaints are listed comprehensively, but the doctor is not compelled to do any unnecessary testing, or even falsify test results. Because of the outrageous amount of data that is dumped into a doctor's head, he is able to recognize "hypochondriac…

This is not about hypochondria, but people who knowingly fake illness. They can be extremely manipulative.

Then the open records don't make the job of the doctor any more difficult or easier. Arguably, it's not really the responsibility of the doctor to figure out, beyond some reasonable point, if he is being "manipulated" by the patient.

Re: When Patients Read What Their Doctors Write

#45

Post by nmjohn »

SoftwareMaven wrote: post #39
carbocation wrote: post #20

Earlier quoted context omitted.

> 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…

I'm going to give you the benefit of the doubt, being that you are sufficiently educated to comprehend the studies you're reading - both biology and statistics - and have actually invested a non-trivial amount of time ensuring you're actively trying to seek information to disprove your hypothesis rather than the alternative. (ie. You're looking for research suggesting that cholesterol has significant predictive power as opposed to looking for research just confirming what you already believe.) [0]

And under those conditions, I agree with you! Get involved with you health and engage in discussion based dialog with your doctor, and push harder if you don't agree. The healthcare system in this country may be incredibly screwed up, but at the end of the day most doctors are incredibly intelligent and if you have information suggesting they are wrong they very much would like to hear it. (Though like the rest of humans, some of them let pride and ego get in the way of rationality.)

However, the fact of the matter is the kind of person I described makes up a fractional percent of our society. Most people are not even close to being able to do that. Even if they could comprehend the biology, statistics are hard. Most people are incredibly naive and arrogant with their regard to their comprehension of statistics (probably myself included), which is why they are so powerful in misleading people. Ex: "A and B have a strong correlation so you should do C" - when in fact the correlation's r value is 0.3 and the correlation described was more likely random noise... but there is a correlation! [1]

Thus it is important to keep in mind general population when considering the effects of changes impacting more than yourself. If our healthcare system demanded we take more control of our own health, there is a small group of people who would be greatly benefited, but there is a much larger group who would suffer.

[0]: If that came across in an attacking manner I do apologize as that isn't my intent. My thoughts are much less about your specific case rather society as a whole.

[1]: Just to clarify my thoughts, I'm not suggesting most people are not intellectually capable of acquiring the knowledge to do any of this - It's not like it takes a special kind of super genius - most people simply just have not acquired the knowledge and thus are incapable for that reason.

Re: When Patients Read What Their Doctors Write

#46

Post by DanBC »

SoftwareMaven wrote: post #40
chimeracoder wrote: post #9

Earlier quoted context omitted.

> 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 t…

> What is the downside of a person being more knowledgable and involved?

More tests does not mean more knowledgeable. It just means the patient has more noise to either listen to or ignore.

That has consequences: stress from some test result; taking action based on a test result when there's nothing wrong; and so on.

Re: When Patients Read What Their Doctors Write

#47

Post by pyre »

SoftwareMaven wrote: post #40
chimeracoder wrote: post #9

Earlier quoted context omitted.

> 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 t…

Well, I can think of one downside to just giving the demanding people what they want: over-use of antibiotics creating 'super' strains of bacteria.

(I realize that you're specifically talking about tests, but I see tests as just an example of the, "I know better than the doctor," people.)

Re: When Patients Read What Their Doctors Write

#48

Post by DanBC »

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.…

> Ask five different doctors and you'll get five different responses as to what are the accepted parameters in a healthy diet.

You really wont. It'll be pretty much advice about eating a varied diet, not too much fat, salt, or sugar, with a lot of vegetables and a wide range of fruit and veg.

Re: When Patients Read What Their Doctors Write

#49

Post by DanBC »

kijin wrote: post #21
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.

> That's going to be a non-issue once doctors start typing instead of writing.

It will be a lot better, but:

35 instead of 3.5?

7.5 uG or 7.5 mG?

Re: When Patients Read What Their Doctors Write

#50

Post by pyre »

drdeadringer wrote: post #14
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…

> patients who are making stuff up entirely I'm not sure how making notes visible, or invisible, to patients would change the adage that "patients lie". Exacerbation or reduction arguments, perhaps, but the fundamental principle I'm not sure would change. Toward the "further lever to manipulate the system", that may be something to consider in terms of who has editorial access to the records vs. simple readability ac…

It's not about the patient editing the record directly. It's more about the patient talking to a different doctor than the one that wrote the notes, and then saying, "oh, that's wrong. This is the right information."

If the doctor takes that at face-value (like in the article's example), I assume that it ends up on the notes.

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