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Eng K, Johnston K, Cerda I, Kadakia K, Mosier-Mills A, Vanka A. A Patient-Centered Documentation Skills Curriculum for Preclerkship Medical Students in an Open Notes Era. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11392. [PMID: 38533390 PMCID: PMC10963659 DOI: 10.15766/mep_2374-8265.11392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/04/2024] [Indexed: 03/28/2024]
Abstract
Introduction New legislation allows patients (with permitted exceptions) to read their clinical notes, leading to both benefits and ethical dilemmas. Medical students need a robust curriculum to learn documentation skills within this challenging context. We aimed to teach note-writing skills through a patient-centered lens with special consideration for the impact on patients and providers. We developed this session for first-year medical students within their foundational clinical skills course to place bias-free language at the forefront of how they learn to construct a medical note. Methods One hundred seventy-three first-year medical and dental students participated in this curriculum. They completed an asynchronous presession module first, followed by a 2-hour synchronous workshop including a didactic, student-led discussion and sample patient note exercise. Students were subsequently responsible throughout the year for constructing patient-centered notes, graded by faculty with a newly developed rubric and checklist of best practices. Results On postworkshop surveys, learners reported increased preparedness in their ability to document in a patient-centered manner (presession M = 2.2, midyear M = 3.9, p < .001), as rated on a 5-point Likert scale (1 = not prepared at all, 5 = very prepared), and also found this topic valuable to learn early in their training. Discussion This curriculum utilizes a multipart approach to prepare learners to employ clinical notes to communicate with patients and providers, with special attention to how patients and their care partners receive a note. Future directions include expanding the curriculum to higher levels of learning and validating the developed materials.
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Affiliation(s)
- Kathleen Eng
- Fourth-Year Medical Student, Harvard Medical School
| | | | - Ivo Cerda
- Third-Year Medical Student, Harvard Medical School
| | | | | | - Anita Vanka
- Assistant Professor, Department of Medicine, Harvard Medical School
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2
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Kharko A, Buergler S, Bärkås A, Hägglund M, Gaab J, Fagerlund AJ, Locher C, Blease C. Open notes in psychotherapy: An exploratory mixed methods survey of psychotherapy students in Switzerland. Digit Health 2024; 10:20552076241242772. [PMID: 38559581 PMCID: PMC10981219 DOI: 10.1177/20552076241242772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Background In a growing number of countries, patients are offered access to their full online clinical records, including the narrative reports written by clinicians (the latter, referred to as "open notes"). Even in countries with mature patient online record access, access to psychotherapy notes is not mandatory. To date, no research has explored the views of psychotherapy trainees about open notes. Objective This study aimed to explore the opinions of psychotherapy trainees in Switzerland about patients' access to psychotherapists' free-text summaries. Methods We administered a web-based mixed methods survey to 201 psychotherapy trainees to explore their familiarity with and opinions about the impact on patients and psychotherapy practice of offering patients online access to their psychotherapy notes. Descriptive statistics were used to analyze the 42-item survey, and qualitative descriptive analysis was employed to examine written responses to four open-ended questions. Results Seventy-two (35.8%) trainees completed the survey. Quantitative results revealed mixed views about open notes. 75% agreed that, in general open notes were a good idea, and 94.1% agreed that education about open notes should be part of psychotherapy training. When considering impact on patients and psychotherapy, four themes emerged: (a) negative impact on therapy; (b) positive impact on therapy; (c) impact on patients; and (d) documentation. Students identified concerns related to increase in workload, harm to the psychotherapeutic relationship, and compromised quality of records. They also identified many potential benefits including better patient communication and informed consent processes. In describing impact on different therapy types, students believed that open notes might have differential impact depending on the psychotherapy approaches. Conclusions Sharing psychotherapy notes is not routine but is likely to expand. This mixed methods study provides timely insights into the views of psychotherapy trainees regarding the impact of open notes on patient care and psychotherapy practice.
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Affiliation(s)
- Anna Kharko
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Annika Bärkås
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | | | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Basel, Switzerland
| | - Charlotte Blease
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Uppsala, Sweden
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3
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Meier-Diedrich E, Davidge G, Hägglund M, Kharko A, Lyckblad C, McMillan B, Blease C, Schwarz J. Changes in Documentation Due to Patient Access to Electronic Health Records: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e46722. [PMID: 37639298 PMCID: PMC10495856 DOI: 10.2196/46722] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Internationally, patient-accessible electronic health records (PAEHRs) are increasingly being implemented. Despite reported benefits to patients, the innovation has prompted concerns among health care professionals (HCPs), including the possibility that access incurs a "dumbing down" of clinical records. Currently, no review has investigated empirical evidence of whether and how documentation changes after introducing PAEHRs. OBJECTIVE This paper presents the protocol for a scoping review examining potential subjective and objective changes in HCPs documentation after using PAEHRs. METHODS This scoping review will be carried out based on the framework of Arksey and O'Malley. Several databases will be used to conduct a literature search (APA PsycInfo, CINAHL, PubMed, and Web of Science Core Collection). Authors will participate in screening identified papers to explore the research questions: How do PAEHRs affect HCPs' documentation practices? and What subjective and objective changes to the clinical notes arise after patient access? Only studies that relate to actual use experiences, and not merely prior expectations about PAEHRs, will be selected in the review. Data abstraction will include but will not be limited to publication type, publication year, country, sample characteristics, setting, study aim, research question, and conclusions. The Mixed Methods Appraisal Tool will be used to assess the quality of the studies included. RESULTS The results from this scoping review will be presented as a narrative synthesis structured along the key themes of the corpus of evidence. Additional data will be prepared in charts or tabular format. We anticipate the results to be presented in a scoping review at a later date. They will be disseminated at scientific conferences and through publication in a peer-reviewed journal. CONCLUSIONS This is the first scoping review that considers potential change in documentation after implementation of PAEHRs. The results can potentially help affirm or refute prior opinions and expectations among various stakeholders about the use of PAEHRs and thereby help to address uncertainties. Results may help to provide guidance to clinicians in writing notes and thus have immediate practical relevance to care. In addition, the review will help to identify any substantive research gaps in this field of research. In the longer term, our findings may contribute to the development of shared documentation guidelines, which in turn are central to improving patient communication and safety. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46722.
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Affiliation(s)
- Eva Meier-Diedrich
- Brandenburg Medical School, Immanuel Hospital Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, Rüdersdorf, Germany
- Faculty for Health Sciences, Brandenburg Medical School, Neuruppin, Germany
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Kharko
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Camilla Lyckblad
- Department of Archives, Libraries, and Museums, Uppsala University, Uppsala, Sweden
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Julian Schwarz
- Brandenburg Medical School, Immanuel Hospital Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, Rüdersdorf, Germany
- Faculty for Health Sciences, Brandenburg Medical School, Neuruppin, Germany
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Schiller PT, Wong CJ, Golob AL, Kimel-Scott K, Sobel HG, Pasanen ME, Pincavage AT. Internal Medicine Intern Preparedness to Document Clinical Encounters in the Era of Open Notes: a Needs Assessment Survey. J Gen Intern Med 2023; 38:1556-1558. [PMID: 36814052 PMCID: PMC10160254 DOI: 10.1007/s11606-023-08099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Patrick T Schiller
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | | | - Anna L Golob
- Department of Medicine, University of Washington, Seattle, USA
| | - Karen Kimel-Scott
- Division of General Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Halle G Sobel
- Department of Medicine, University of Vermont, Burlington, USA
| | - Mark E Pasanen
- Department of Medicine, University of Vermont, Burlington, USA
| | - Amber T Pincavage
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
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Brooks JV, Zegers C, Sinclair CT, Wulff-Burchfield E, Thimmesch AR, English D, Nelson-Brantley HV. Understanding the Cures Act Information Blocking Rule in cancer care: a mixed methods exploration of patient and clinician perspectives and recommendations for policy makers. BMC Health Serv Res 2023; 23:216. [PMID: 36879318 PMCID: PMC9990332 DOI: 10.1186/s12913-023-09230-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The 21st Century Cures Act Interoperability and Information Blocking Rule was created to increase patient access to health information. This federally mandated policy has been met with praise and concern. However, little is known about patient and clinician opinions of this policy within cancer care. METHODS We conducted a convergent parallel mixed methods study to understand patient and clinician reactions to the Information Blocking Rule in cancer care and what they would like policy makers to consider. Twenty-nine patients and 29 clinicians completed interviews and surveys. Inductive thematic analysis was used to analyze the interviews. Interview and survey data were analyzed separately, then linked to generate a full interpretation of the results. RESULTS Overall, patients felt more positive about the policy than clinicians. Patients wanted policy makers to understand that patients are unique, and they want to individualize their preferences for receiving health information with their clinicians. Clinicians highlighted the uniqueness of cancer care, due to the highly sensitive information that is shared. Both patients and clinicians were concerned about the impact on clinician workload and stress. Both expressed an urgent need for tailoring implementation of the policy to avoid unintended harm and distress for patients. CONCLUSIONS Our findings provide suggestions for optimizing the implementation of this policy in cancer care. Dissemination strategies to better inform the public about the policy and improve clinician understanding and support are recommended. Patients who have serious illness or diagnoses such as cancer and their clinicians should be included when developing and enacting policies that could have a significant impact on their well-being. Patients with cancer and their cancer care teams want the ability to tailor information release based on individual preferences and goals. Understanding how to tailor implementation of the Information Blocking Rule is essential for retaining its benefits and minimizing unintended harm for patients with cancer.
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Affiliation(s)
- Joanna Veazey Brooks
- University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Carli Zegers
- University of Kansas School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Christian T Sinclair
- University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | | | - Amanda R Thimmesch
- University of Kansas School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Daniel English
- University of Kansas School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
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Posada J, Potvin H, Cookson C. Opening Up with Open Notes: Writing Notes in the Era of Full Patient Access. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:259-263. [PMID: 34309805 DOI: 10.1007/s40596-021-01510-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Hannah Potvin
- University of California San Francisco, San Francisco, CA, USA
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7
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Golden BP, Kelly MM, Olson APJ. Defining the gold standard: What is success in electronic health record documentation? J Hosp Med 2022; 17:71-72. [PMID: 35504587 DOI: 10.1002/jhm.2737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Blair P Golden
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Andrew P J Olson
- Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Weber DE, Held JD, Jandarov RA, Kelleher M, Kinnear B, Sall DR, O'Toole JK. Improving trainee clinical documentation through a novel curriculum in internal medicine. J Hosp Med 2022; 17:28-35. [PMID: 35504574 DOI: 10.1002/jhm.27410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/21/2021] [Accepted: 12/11/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Clinical documentation is a key component of practice. Trainees rarely receive formal training in documentation or assessment of their documentation. Effective methods of improving documentation remain unknown. OBJECTIVE The objective of this study was to determine if the implementation of a documentation curriculum led to improvement in admission note quality. DESIGNS Admission notes written prior to implementation of the curriculum and after the curriculum intervention were assessed. Notes were assessed from two-time frames for both years to account for improvement with time not associated with the intervention. SETTINGS AND PARTICIPANTS Admission notes written by University of Cincinnati interns were assessed. INTERVENTIONS The documentation curriculum consisted of educational sessions and routine admission note assessments with feedback. MAIN OUTCOMES AND MEASURES Admission notes were assessed via the 16 checklist items and two global assessment items of the Admission Note Assessment Tool (ANAT). RESULTS Six ANAT items showed statistically significant differences. The review of systems item improved with the intervention only (odds ratio: 3.61, p < .001) while the assessment and plan item 1 and global assessment item 2 improved with time only (β = .08, p = .03 and β = .25, p = .02, respectively) in univariate models. In univariate models the physical exam item, diagnostic data item 2, and global assessment item 1 showed improvement with both intervention and time, respectively, with additive effects seen in models with both intervention and time. CONCLUSION Several aspects of documentation can improve with a formal documentation curriculum which includes a routine assessment with feedback, and some aspects of documentation improve with time.
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Affiliation(s)
- Danielle E Weber
- Department of Internal Medicine, University of Cincinnati Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Justin D Held
- Department of Internal Medicine, University of Cincinnati Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Roman A Jandarov
- Department of Internal Medicine, University of Cincinnati Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew Kelleher
- Department of Internal Medicine, University of Cincinnati Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Benjamin Kinnear
- Department of Internal Medicine, University of Cincinnati Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Dana R Sall
- Department of Internal Medicine, HonorHealth Thompson Peak Medical Center, University of Arizona College of Medicine-Phoenix, Scottsdale, Arizona, USA
| | - Jennifer K O'Toole
- Department of Internal Medicine, University of Cincinnati Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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9
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Ralston JD, Yu O, Penfold RB, Gundersen G, Ramaprasan A, Schartz EM. Changes in Clinician Attitudes Toward Sharing Visit Notes: Surveys Pre-and Post-Implementation. J Gen Intern Med 2021; 36:3330-3336. [PMID: 33886028 PMCID: PMC8061150 DOI: 10.1007/s11606-021-06729-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinician perceptions before and after inviting patients to read office notes (open notes) are unknown. OBJECTIVE To describe changes in clinicians' attitudes about sharing notes with patients. DESIGN, PARTICIPANTS, AND MAIN MEASURE Survey of outpatient primary and specialty care clinicians who were from a large group practice and had one or more patients who accessed notes. The main outcome was percent change (before vs. after implementation) in clinician perception that online visit notes are beneficial overall. KEY RESULTS Of the 563 invited clinicians, 400 (71%) took the baseline survey; 295 were eligible for a follow-up survey with 192 (65%) responding (119 primary care, 47 medical specialties, 26 surgical specialties). Before implementation, 29% agreed or somewhat agreed that visit notes online are beneficial overall, increasing to 71% following implementation (p<0.001); 44% switched beliefs from bad to good idea; and 2% reported the opposite change (p<0.001). This post-implementation change was observed in all clinician categories. Compared to pre-implementation, fewer clinicians had concerns about office visits taking longer (47% pre vs. 15% post) or requiring more time for questions (71% vs. 16%), or producing notes (57% vs. 28%). Before and after implementation, most clinicians reported being less candid in documentation (65% vs. 52%) and that patients would have more control of their care (72% vs. 78%) and worry more (72% vs. 65%). CONCLUSIONS Following implementation, more primary and specialty care clinicians agreed that sharing notes with patients online was beneficial overall. Fewer had concerns about more time needed for office visits or documentation. Most thought patients would worry more and reported being less candid in documentation.
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Affiliation(s)
- James D Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Arvind Ramaprasan
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Ellen M Schartz
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Fernández L, Fossa A, Dong Z, Delbanco T, Elmore J, Fitzgerald P, Harcourt K, Perez J, Walker J, DesRoches C. Words Matter: What Do Patients Find Judgmental or Offensive in Outpatient Notes? J Gen Intern Med 2021; 36:2571-2578. [PMID: 33528782 PMCID: PMC8390578 DOI: 10.1007/s11606-020-06432-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/09/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sharing outpatient notes with patients may bring clinically important benefits, but notes may sometimes cause patients to feel judged or offended, and thereby reduce trust. OBJECTIVE As part of a larger survey examining the effects of open notes, we sought to understand how many patients feel judged or offended due to something they read in outpatient notes, and why. DESIGN We analyzed responses from a large Internet survey of adult patients who used secure patient portals and had at least 1 visit note available in a 12-month period at 2 large academic medical systems in Boston and Seattle, and in a rural integrated health system in Pennsylvania. PARTICIPANTS Adult ambulatory patients with portal accounts in health systems that offered open notes for up to 7 years. APPROACH (1) Quantitative analysis of 2 dichotomous questions, and (2) qualitative thematic analysis of free-text responses on what patients found judgmental or offensive. KEY RESULTS Among 22,959 patient respondents who had read at least one note and answered the 2 questions, 2,411 (10.5%) reported feeling judged and/or offended by something they read in their note(s). Patients who reported poor health, unemployment, or inability to work were more likely to feel judged or offended. Among the 2,411 patients who felt judged and/or offended, 2,137 (84.5%) wrote about what prompted their feelings. Three thematic domains emerged: (1) errors and surprises, (2) labeling, and (3) disrespect. CONCLUSIONS One in 10 respondents reported feeling judged/offended by something they read in an outpatient note due to the perception that it contained errors, surprises, labeling, or evidence of disrespect. The content and tone may be particularly important to patients in poor health. Enhanced clinician awareness of the patient perspective may promote an improved medical lexicon, reduce the transmission of bias to other clinicians, and reinforce healing relationships.
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Affiliation(s)
- Leonor Fernández
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Alan Fossa
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Zhiyong Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA
| | - Tom Delbanco
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joann Elmore
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Patricia Fitzgerald
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA
| | - Kendall Harcourt
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA
| | - Jocelyn Perez
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA
| | - Jan Walker
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Catherine DesRoches
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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11
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Pohontsch NJ, Zimmermann T, Lehmann M, Rustige L, Kurz K, Löwe B, Scherer M. ICD-10-Coding of Medically Unexplained Physical Symptoms and Somatoform Disorders-A Survey With German GPs. Front Med (Lausanne) 2021; 8:598810. [PMID: 33859988 PMCID: PMC8042316 DOI: 10.3389/fmed.2021.598810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background: General practitioners (GPs) are reluctant to use codes that correspond to somatization syndromes. Aim: To quantify GPs' views on coding of medically unexplained physical symptoms (MUPS), somatoform disorders, and associated factors. Design and Setting: Survey with German GPs. Methods: We developed six survey items [response options “does not apply at all (1)”—“does fully apply (6)”], invited a random sample of 12.004 GPs to participate in the self-administered cross-sectional survey and analysed data using descriptive statistics and logistic regression analyses. Results: Response rate was 15.2% with N = 1,731 valid responses (54.3% female). Participants considered themselves familiar with ICD-10 criteria for somatoform disorders (M = 4.52; SD =.036) and considered adequate coding as essential prerequisite for treatment (M = 5.02; SD = 1.21). All other item means were close to the scale mean: preference for symptom or functional codes (M = 3.40; SD = 1.21), consideration of the possibility of stigmatisation (M = 3.30; SD = 1.35) and other disadvantages (M = 3.28; SD = 1.30) and coding only if psychotherapy is intended (M = 3.39; SD = 1.46). Exposure, guideline knowledge, and experience were most strongly associated with GPs' self-reported coding behaviour. Conclusions: Subjective exposure, guideline knowledge, and experience as a GP, but no sociodemographic variable being associated with GPs' subjective coding behaviour could indicate that GPs offer a relatively homogeneous approach to coding and handling of MUPS and somatoform disorders. Strengthening guideline knowledge and implementation, and practise with simulated patients could increase the subjective competence to cope with the challenge that patients with MUPS and somatoform disorders present.
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Affiliation(s)
- Nadine J Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Zimmermann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Rustige
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katinka Kurz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Halaska C, Sachs P, Sanfilippo K, Lin CT. Patient Attitudes About Viewing Their Radiology Images Online: Preintervention Survey. J Med Internet Res 2019; 21:e12595. [PMID: 31322124 PMCID: PMC6670277 DOI: 10.2196/12595] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 05/12/2019] [Accepted: 06/18/2019] [Indexed: 01/17/2023] Open
Abstract
Background Although patient data is available through electronic portals, little information exists about the benefits and/or challenges of providing patients with online access to their radiology images. Objective The aims of this quality improvement project were to understand patient attitudes toward being able to view their radiology images online and determine how information should be presented to ensure the images are helpful to the patients, rather than causing confusion and anxiety. Methods An online survey of consumers was conducted to evaluate attitudes toward online access to personal radiological images. Results A total of 105 responses were received from 686 community members (15.3%). Of 105 consumers, 94 (89.5%) reported a desire to have access to the radiology images within their online patient portal; 86.7% (91/105) believed it would help them better understand their medical conditions and 81.0% (85/105) said this would help them feel more in control of their care. Most respondents (74/105, 70.5%) said it would help them feel reassured that their doctor was doing the right thing, and 63.8% (67/105) said it would increase their level of trust in their doctor. Among surveyed patients, 78.1% (82/105) valued viewing their radiology images online, while 92.4% (97/105) valued their online radiology reports. Most patients (69/105, 65.7%) wished to discuss their results with their ordering clinician, 29.5% (31/105) wished to discuss with their interpreting radiologist, and 3.8% (4/105) wished to share their images on social media. The biggest potential concern among 23.8% (25/105) was that the images would be confusing. Conclusions A large majority of surveyed patients desired the ability to view their radiology images online and anticipated many benefits and few risks. Health care organizations with electronic health records and online patient portals should consider augmenting their existing portals with this highly desired feature. To avoid the biggest patient concern, radiology reports should accompany images. Patients wanted to discuss their results with their ordering physician and their interpreting radiologist. Some even would like to share results on social media. Further research on the actual experience with such a tool will be needed.
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Affiliation(s)
| | - Peter Sachs
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States
| | | | - Chen-Tan Lin
- University of Colorado School of Medicine, Aurora, CO, United States
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