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Medical Care

How A Doctor's Note Can Improve Your Health

A simple note from a primary care doctor can be critical to keeping patients involved in their own health care, according to a new study.

The research, led by Dr. John Mafi, a professor at the David Geffen School of Medicine at UCLA, was published in the Journal of the American Medical Informatics Association. It examined a growing national program that provides patients with easy online access to their doctors’ notes about their appointments.

The program, OpenNotes, began in 2010, when 105 primary care physicians invited nearly 14,000 of their patients to view their electronic notes about their clinic visits. The initiative was intended to better engage patients in their own care and improve communication between patients and their doctors.

It turned out to be quite a success: Patients demonstrated better recall of their medical plans, felt more in control of their care and were more likely to take their medications. Doctors found that sharing their notes with patients had little negative impact on their workflow. Five years later, more than 5 million patients are participating in the OpenNotes movement. And recently, four nonprofits contributed a total of $10 million to expand the program to 50 million patients.

But even as the program began to grow, two major questions arose: Would patients continue to access the notes after the initial enthusiasm died down? And, how important were the doctors’ reminders in prompting patients to remain active participants in their own care?

The study suggests that the reminders are indeed very important. The researchers found that patients tended to view clinic notes substantially less once they stopped receiving the reminders, while patients who continued receiving them tended to continue accessing the notes.

Mafi said patients immediately forget between 40 percent and 80 percent of what their doctors tell them — and they get about half of what they do remember wrong.

“Poor patient–doctor communication represents one of the biggest problems in our health care system,” said Mafi, who conducted the research as a fellow in general internal medicine at Boston’s Beth Israel Deaconess Medical Center and Harvard Medical School. “OpenNotes offers patients a way to remember their doctors’ instructions, rationale for their care plan and any other critical information about their health. OpenNotes has the potential to empower patients to take charge of their health.”

Another recent study about OpenNotes found that patients who read their notes are more likely to take the medicine they need to lower their blood pressure.

The team led by Mafi studied 14,000 patients at Beth Israel Deaconess and at Geisinger Health System in Danville, Pennsylvania, for two years. Doctors at Beth Israel Deaconess sent reminders throughout the study; those at Geisinger stopped after one year.

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