For me, the crux of the problem is this: Do Open Notes conflict with the ideal of compassionate care?
When I was in practice I spent a great deal of time and effort tailoring what I said to each patient when reviewing my findings and presenting my recommendations. Which facts I shared and how I phrased them depended on:
- The patient's preferences for information
- The patient's communication style
- The patient's level of medical knowledge
- The patient's medical situation
- Our relationship over time
I strived to communicate information in ways that promoted each patient's Healthy Survivorship -- even though back then I didn't call it that.
The acts of breaking news -- good or bad -- and making recommendations were dynamic processes that occurred in real time. I constantly adjusted what I was saying, depending on the patient's response to what was being said, as well as the patient's questions or comments.
In contrast, physicians notes are stripped of the filter of compassion -- words and actions that help patients hear and process medical information in healing ways.
I see now that my initial reservations reflect my knee-jerk assumption that Open Notes couldn't possibly support compassionate care. Over the past week, as I've written this series of posts I've come to see that maybe I was wrong. I'll explain in my next post.