Reading Doctor's Notes

What the Doctors Is Really Thinking

I read this article with a lot of interest. The OpenNotes project is a great idea, and I hope to see it implemented globally.The piece is well written, with attention paid to both the benefits and downsides.

I know that when I read my records, I usually feel both edified and intimidated. I spend a lot of time looking up acronyms and how tests results are interpreted. The time and effort that it takes to understand those notes, however, also increases what I get out of subsequent visits: I am better able to articulate my questions and better able to understand the answers.

I see a lot of benefits here. Often, it seems that a lot of information can be tossed about during an office visit, and even though I take notes and ask questions, it is still fairly easy to miss something important. Also, if you were given a prescription months ago, and are just now trying to remember if it is okay to enjoy a glass of wine you can easily check. If your doctor told you to come see her again in six months, you can confirm when you should next schedule. This also eliminates a lot of hassle for everyone when you need a copy of your records -- you can decide exactly what you need and print it out.

Regarding the trouble of the way doctors take notes, I think the best solution would be to have a database of terminology and whatnot, and if a doctor writes "SOB" in his notes, the system itself could automatically hotlink it to another page, or a pop-up window that indicates that this acronym usually mean "shortness of breath."