A doctor who sees a child with an odd appearance might write “FLK” in his notes. Short for “funny-looking kid”, it is meant not as an insult, but as a reminder to watch for slow growth and mental retardation, which can accompany physical abnormalities. Later he may add “FLD”: funny-looking dads tend to have funnylooking offspring. But such candour may become a thing of the past as more hospitals and clinics make doctors’ notes available to patients and their guardians.
The trailblazers see open notes as a way to engage patients in their treatment, and to keep their other carers informed. A study in 2012 in the Annals of Internal Medicine of 105 American doctors who shared their notes with 20,000 patients backs this position. Over four-fifths of the patients who visited their doctors in the following year had looked at their notes. In a survey, about three-quarters said they felt more in control of their care. Few said the notes were confusing, offensive or worrisome; nearly all wanted access to continue.
The doctors who took part reported little change in their behaviour and little extra work, though some did alter the way they wrote about charged topics such as cancer, mental health, substance abuse and obesity. As for FLK and other medics’ slang, Tom Delbanco, one of the study’s authors, says: “Good doctors don’t label things; good doctors describe things.”
Some 3m American patients now have easy access to their doctors’ notes, including those at leading institutions such as the Cleveland and Mayo clinics, and 1m of those cared for by the Department of Veterans Affairs. This is good business as well as good medicine. Patients with Kaiser Permanente Northwest must register on its website in order to read their doctors’ notes, which makes their care easier to manage and lowers the chance that they will switch to a competitor.
Health administrators elsewhere are watching with interest. Some British doctors have already opened their notes and more are likely to follow suit if the National Health Service keeps its promise to give all patients online access to their records by next year. The next step, says Dr Delbanco, is getting patients to contribute to their records. Funny-looking doctors take note.
by Roger McShane