Educating Patients—and Ourselves

Oct 9, 2012, 2:18 PM, Posted by Beth Toner

Beth Toner Beth Toner

Last week, I had a flashback to a Saturday night in 2010, when I was in my last semester as a second-career nursing student.

It was a beautiful spring night and my family was gathered around a bonfire in the backyard. I, on the other hand, was sitting at the kitchen table, still in my scrubs. My laptop open, I was staring at the blinking cursor. As usual, I was struggling to finish my “patient database”—my school’s version of a nurse’s note about what happened, clinically, with my assigned patient that day:

1430: Patient received drowsy but AOx3. MAE, equal strength. Primary nurse reports patient requires one-person assist OOB to chair; patient not OOB this shift. PERRLA. Skin is warm & dry, no bruising noted. IV site (20 g left outer forearm) is clean, dry and intact; no pain or erythema noted. Capillary refill <3 sec. Heart sounds audible and regular. Radial and pedal pulses present & equal bilaterally. No edema noted. RR 16, unlabored. SAO2 94% on room air…

My note went on and on, as it often did. This “practice” documentation was our assigned task each Saturday night, designed to help us both summarize the care we’d provided that day in the clinical setting and think critically about how we would adjust our care plan for the same patient on Sunday. I had all the data I needed, gathered during my time in the hospital, but always struggled to put the clinical picture into just the right words—and abbreviations.

What a different task that might have been if I’d had OpenNotes!

Several years ago, study co-authors Jan Walker and Tom Delbanco set out to get an answer to a simple question: What happens when we give patients access to the notes their doctor writes about them? The results are now in. Patients clearly benefit from shared notes, and doctors see value in sharing those notes.

As I read the study results, I thought back to my days as a nursing student. What if I’d known my patients would be reading my notes about them? Well, certainly, I could have avoided those pesky abbreviations. I also would have been less concerned with getting my medical “jargon” right and more concerned about describing, in language the patient could understand, what was really going on with her condition and her care. My notes wouldn’t have been any less clinically complete—and, in fact, may have presented a clearer picture of the patient’s needs.

I think about how much more the patient and I might have learned together on Sundays, as we reviewed my note. The patient might have pointed out a valuable piece of clinical information I might have otherwise missed. By reviewing what I’d documented, the patient might have learned something about her hospitalization she hadn’t understood. And—best of all—after discussing the note, the patient and I could have planned, together, her care plan for that day.

OpenNotes has tremendous potential to exponentially increase transparency in all types of provider-patient relationships. And where better to begin building this culture of openness than in the enthusiastic medical and nursing students coming up through the ranks?  

This commentary originally appeared on the RWJF Pioneering Ideas blog.