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Six Awkward Concerns in My Not-Yet-Opened Notes

Note: This baby is not a veteran, nor is this the VA Medical Record system. 
The VA has just taken a big bold leap forward: access to progress notes has been added to MyHealtheVet.

I'm impressed and think this is great. I also however can't help thinking of several awkward issues, related mainly to geriatrics, that crop up regularly in my own progress notes.

So I've written a blog post on this issue, and it's live today on The Health Care Blog.

In the post, I describe the following six awkward topics that might make patients (or caregivers) upset, if they were to read about my concerns in the progress notes. Here's my quick list:
  • Possible cognitive impairment
  • Possible elder mistreatment (a subject just recently raised on this very blog)
  • Possible abuse or diversion of prescription drugs
  • Possible substance abuse, especially alcohol
  • Concerns about ability to manage safely at home or while driving
  • Concerns voiced by family or caregivers

As we know, these are issues of importance to the health of older adults. Unfortunately, to date they've generally gone under-recognized and under-addressed by clinicians overall.

Any thoughts on how we should navigate these issues in an age of OpenNotes?

And are there other awkward topics that you find yourself wondering how you'll document?

by: Leslie Kernisan, MD MPH

Comments

Maggie said…
I suppose it's obvious why a caregiver might be upset if your Open Note mentions possible elder mistreatment.

But the rest? If you're my doctor, I want you to discuss your concerns with me. If you're wondering about cognitive impairment, it's very likely that I already worry about that. Writing it in your notes without telling me seems ... Well, you'd have to explain your rationale.

Concerns about my ability to drive? In my younger days, driving was almost as important as eating. But if you're concerned about my driving, who would you tell, if not me?
Jill said…
It’s all about transparency in communication. Someone (forgive me for not remembering who) recently said, “No on cares more about my medical record than I do.”

How much have we learned about the power of saying “I’m sorry,” when mistakes are made? It reduces misunderstanding, builds trust, and decreases the number of lawsuits resulting from medical error.

Now is the time to teach the next generation of medical caregivers of all disciplines that the medical record truly does belong to the patient and teach them how to give the person who is most concerned the true information: the good, the bad and the ugly. Sensitivity is not secrecy – it is learning to say the whole truth with tact and with a compassionate understanding of how the knowledge will be applied.
leslie kernisan said…
Thanks for these comments!

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