Yesterday's post generated a heated discussion on Twitter (and in the comment section here) about what exactly the patient should have access to see. Some readers have had bad enough experiences with physicians that they want to be able to see things themselves to assure what they are being told is accurate. I can't say that I blame them. I took exception to the idea that anything I wrote should be available on the internet for the patient to see. I went over this ad nauseam yesterday, so I won't belabor the point. The bottom line for me is this: if I am required to publish everything I write online, the notes will not contain as much information. I will self-edit and limit the usefulness of the chart if I think the published information will compromise confidentiality or the care itself.
But there is another issue to consider. Here are two x-ray reports I have recently received:
So here is my question: do my patients really want to read this stuff? Do they really want to have the word "Pseudospoldylolisthesis" thrown at them? I'd have to look it up to know exactly what it means! X-Ray reports are often written in a way that is complex and hard to understand even for me. I would suspect that instead of answering questions this would raise a bunch of them. Patients would be scared that there is something terrible, when in fact it may just look that way on the x-ray reading.
I suspect that my patients would vote for a list of the procedures that were done and my interpretation. If they want to see the actual copy, then they can ask for it.
One of the folks on twitter said that patient fear was bad, but ignorance could kill. While I agree with the thought behind the statement (that's why I proposed opening up our records), I have to say that fear can be deadly as well. People can be paralyzed by too much information. We in the medical profession have seen patients do this by fixating on their problems and looking up everything they can on the Internet. The problem is not that they shouldn't know these things, it is that they don't know how to filter the information. I encourage patients to be involved in their care, but I do think there is such a thing as too much information. There is information that is important to have, but then there is information overload. Knowing where to draw the line is critical.
The top one is fine (granulomas like this are no big deal), the bottom one is arthritis in the spine that is impinging on nerves, but hasn't gotten worse. There is also atherosclerosis.