Category Archives: Pioneer
Have you read “The Swerve,” the Pulitzer Prize-winning book by renowned historian Stephen Greenblatt? In it a canny Renaissance era book hunter discovers and releases knowledge in the form of a medieval, controversial poem lost to posterity. The poem had dwindled down to a single handmade, leather-bound version held behind the vine-covered, ancient walls of an Italian monastery. According to Greenblatt, the unleashing of that book changed everything that came after. That small book with the long poem on the nature of things set in motion forces that challenged the status quo and triggered dramatic, world-wide change—a swerve. The only way that knowledge survived the millennia was because monks trained in hand crafting books had carefully copied the one survivor—and saved it for centuries.
Last week, the Khan Academy, AAMC (Association of American Medical Colleges) and the Robert Wood Johnson Foundation may not have triggered quite such a momentous unleashing—but this powerful collaboration did start something very interesting with potentially significant implications for health care education.
Tom Delbanco, MD, MACP, is Koplow-Tullis Professor of Medicine at Harvard Medical School, Beth Israel Deaconess Medical Center. He is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program.
In a recent blog post, Anjali Gopalan, MD, a Robert Wood Johnson Foundation Clinical Scholar, weighed the pros and cons of OpenNotes—an effort to share clinicians’ notes with patients that is a stimulating collaboration among a large group of investigators, practitioners and patients in Boston; Danville, Pennsylvania; and Seattle.
Dr. Gopalan made a number of insightful observations that I’d like to comment on, but I need first to correct a fundamental misperception: OpenNotes is decidedly not a software program!!!
OpenNotes is an effort to convince patients, families, and clinicians to share openly any and, most often, all material that pertains to a patient’s care. The goal of such action is to improve communication between clinicians and patients, and to help patients engage more actively in managing their health and health care.
OpenNotes doesn’t depend on electronic health records or other software. Purely and simply, we are suggesting to patients that they routinely ask for a copy of their providers’ notes (to which they are legally entitled through HIPAA). And we are suggesting to clinicians that they routinely invite their patients to read them. Pull down the invisible firewall that we clinicians have long established, and the patient (and others whom he or she wishes to involve) can view the thinking that leads us to conclusions and recommendations.
To be sure, patient portals can facilitate sharing information with patients, and their future potential is enormous. But unblinding the story, the warp and woof of an individual’s experience that’s documented in clinicians’ notes, can also be done by low-tech means such as providing print copies of the notes at the end of a visit or later by mail.