Shrinks Tell All

Have you ever wondered what your doctor thinks about you? Do you wonder what exactly he/she is furiously typing into the computer while you talk?

Many patients are now receiving answers to these very common and understandable questions. The medical record, after all, is your record, and it makes sense to be curious about it.

In the United States, patients have always been able to access their chart in accordance with the Health Insurance Portability and Accountability Act (HIPAA), established in 1996. But very few ever bothered to do so.

Gaining access was an arduous and expensive task. But recently, thanks to the OpenNotes project launched at Beth Israel Deaconess Medical Center (BIDMC), physicians and patients are coming to realize the benefits enjoyed when the patient's chart is made available in real-time.

The OpenNotes experiment found the vast majority of patients reporting a better understanding of their medical condition and feeling improvements in the quality of their health. Physicians also gleaned benefit in terms of making more accurate diagnoses and establishing a positive doctor-patient relationship.

OpenNotes has expanded throughout the country to hospitals, doctor’s offices, and health systems. Transparency in medical care is emerging as a new standard.

But what about when it comes to psychiatric care?

The relationship a person has with his/her psychiatrist is quite different from the typical doctor-patient relationship. There are transferences, countertransferences, and the one-way exchange of deeply intimate material. People reach out for mental health care for a variety of reasons, and for some, those reasons include distressing thoughts and uncharacteristic behaviors.

Do patients really want the most intimate and distressing parts of their symptomatology reinforced by having their doctor show them the notes where such details have been logged in perpetuity? Most likely, some patients do while some do not. The question is, where do the majority fit? The idea of transparency in psychiatric notes is quite provocative.

In these evolving times, OpenNotes are available to carefully selected psychiatric outpatients in a pilot program at BIDMC. All staff are trained to recognize the potential consequences and advantages of sharing their progress notes with patients, so we can do this in a positive and safe way.

Advocates of this approach say it enables more open and honest discussions about mental health treatment. While others worry about the chilling effects of potential harm to patients.

OpenNotes is just like any other therapy or medication offered to a patient – it is an intervention that carries risks and benefits that need to be weighed against each other.

Thus far there is enough evidence to suggest that the potential benefits of transparency in psychiatric care could be extraordinary and far outweigh any risks. One thing is for sure, we won’t know until we try.

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