To the Editor:
Patient and family engagement is gaining attention as a priority in patient care1 and medical education.2 OpenNotes, an innovation that invites patients to read their visit notes through a secure online portal, has demonstrated several health benefits.3 Over five million U.S. patients have online access to their notes today; shared visit notes may not only engage patients in care but also open the door to new educational innovations.
Intrigued by the idea of patient/family feedback on visit notes, our research team asked residents and their supervisors whether such feedback would be helpful.4 In surveys and focus groups, many agreed it would be.
Then, in a pilot study,5 we invited about 5,000 patients to provide feedback on their notes. Patients shared both positive and constructive feedback. One patient wrote, “[Reviewing] my doctors’ notes allows me to see how well I am communicating my issues, [and] how well my doctors are hearing and documenting my issues. It also allows me to catch errors.” Another added, “Doctors do not always hear what the patient is saying or [do] not realize that a particular concern … may [be] more important than [the] doctor is willing to address.” A third reported, “I am amazed that he has the time to write such extensive notes (although I recognize that some cutting and pasting from prior notes may have occurred!).”
From learning how to communicate about errors and partner with patients for safety, to developing a shared clinic visit agenda and to bringing patients into conversations about medical professionalism, educational opportunities abound. Patients and families may help frame lessons in ways that are particularly meaningful to some students, trainees, and faculty, including a focus on relational and communication skills, and the potentially stark differences between what doctors “prescribe” and what patients experience. As patients increasingly demand access to their data and an active role in their care, doctors will need to learn how to effectively engage patients and families.
In short, patients show interest in reading notes (in the OpenNotes study, 99% wanted continued access3), trainees/faculty think patients’ feedback would be valuable,4 and now early data suggest that an online OpenNotes patient feedback tool can add fresh perspectives to education. Mechanisms to elicit and effectively use patient/family feedback can augment learners’ skills and also help fill a gap in meaningful patient- and family-centered educational experiences.
Sigall K. Bell, MD
Associate professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Sbell1@bidmc.harvard.edu.
Patricia H. Folcarelli, RN, PhD
Senior director of patient safety, Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Jan Walker, RN, MBA
Assistant professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
2. Weinberger SE, Johnson BH, Ness DL.. Patient- and family-centered medical education: The next revolution in medical education? Ann Intern Med. 2014;161:73–75
3. Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors’ notes: A quasi-experimental study and a look ahead. Ann Intern Med. 2012;157:461–470
4. Crotty BH, Anselmo M, Clarke DN, et al. Opening residents’ notes to patients: A qualitative study of resident and faculty physician attitudes on open notes implementation in graduate medical education Acad Med. 2016;91:418–426
5. Bell SK, Mejilla R, Barry M, French B, Gerard M, Goldman B, et al. Partnering with patients for safety: The OpenNotes patient reporting tool. Poster presentation at the Annual Meeting of the Society for General Internal Medicine, Toronto, Ontario, Canada, April 2015.