Should you read your doctor's notes?

The Los Angeles Times had an interesting blog post today about the notes that physicians write in patient's charts. The patient's chart ultimately belongs to the patient, and so one hospital system is starting a new project where patients can access the notes in their chart by a secure Internet portal. But will being able to read these notes cause more harm than good? Will physicians be as candid in their notes if they know the patients will read them later? But, the notes can give patients insight into their illness and how the physician is approaching it.

It is an interesting discussion and it is one that will only continue as more clinics and hospitals convert to electronic medical records.

Taking the patient into consideration when planning the medical home

Dr. Pauline Chen's article this week in the New York Times shows what happens when doctors and health systems make plans, but fail to consider the patients needs or even the patients reactions. The article examine the concept of the "patient-centered medical home," a team-based, comprehensive approach to preventative care, facilitated by electronic medical records. It sounds like an efficient system. But some practices implementing the system have found that patients do not understand and even dislike the system that was put in place to center around the patient. Now practices are playing catch-up by setting up patient advisory panels and other mechanisms for patient feedback.

The findings of the early medical home models demonstrates the importance of patient buy-in to any type of medical practice reform. Without patient buy-in, medical care comes to a sudden halt.

Two important aspects of communication

Our research team, even while plugging away on two population-scale communication research projects, is thinking about the future and how we can build on the projects we have already done. Our conversations led us to consider two important, but different, aspects of communication: content and conduct.

• Content is the "what" that is communicated.
• Conduct is "how" it is communicated.

It is especially important to consider both content and conduct when considering physician communication with patients. Is the physician giving correct information? Is the information appropriate for the stage of the conversation? But even if the content is correct, it is not enough if it is not communicated effectively. Does the physician use words the patient is likely to understand? Does the physician check in with the patient to see if the patient understands what is being said? Does the physician consider the patient's emotional reaction?

And so physician-patient communicators continue to seek way to measure and improve both the content and conduct of physician communication.

How hard should you try to convince a patient to do something?

The Wall Street Journal Health blog reported last week on an editorial in the Journal of the National Cancer Institute. The editorial considered whether it might be more worthwhile to invest money into improving cancer screening technologies such as mammograms, rather than spending that money on getting more patients to get existing, imperfect tests. Some patients may have a rational, logical and well thought-out reason for turning down an imperfect screening test. No amount of education campaigns is likely to change that decision.

The article points to a larger discussion of what the goal of physician counseling should be. Is the physician's goal to convince the patient to do what he or she wants the patient to do (i.e. get the screening test)? Or should the physician's goal be to simply counsel and educate the patient, and then let the patient make a decision? It is easy to say that the goal should be the latter, but in practice, this is difficult for both the physician and the patient. Physicians face the reality of practice standards and pay-for-performance schemes that say what tests a patient should get and when. And patients may not be willing to make difficult decisions or may make poor decisions no matter how much evidence is given to them. The task of counseling does not have any easy answers. But it seems that if 71% of women are getting a screening test, the reason the other 29% are not is not as simple as a lack of discussion.