It is pleasing to see that a medical school curriculum now includes material and methods for use in training medical students to write Open Notes. Teaching Doctors to Write for Patients | Harvard Medicine Magazine
https://magazine.hms.harvard.edu/articles/teaching-doctors-write-patients
Here are extracts of the article in Harvard Medicine written by Amos Esty.
"It is encouraging to note that "Over just five years, from 2017 to 2022, the percentage of Americans who accessed their medical records online through an app or patient portal more than doubled, reaching 57 percent by 2022."
"With support from the Josiah Macy Jr. Foundation at Harvard Medical School, Anita Vanka, MD, and her team, developed a first-of-its-kind open notes curriculum for medical students."
Educator Anita Vanka, MD, and colleagues, developed 10 best practices for teaching clinicians to write clear, respectful, and patient-centered open notes.
"Over just five years, from 2017 to 2022, the percentage of Americans who accessed their medical records online through an app or patient portal more than doubled, reaching 57 percent by 2022.
One problem, Vanka realized, was that there were no clear guidelines available on how to do that. What did it mean to write a patient-centered note?
"We did four focus groups. They included patient advocates who were familiar with open notes, physicians who are very familiar with open notes, medical education leaders who teach students these same clinical skills, and resident physicians who had not received any formal curriculum around this but worked with students on a regular basis and are usually the frontline teachers for a lot of our students.
And that is what we anchor our curriculum on. After we developed the checklist of ten best practices, we developed the workshop that we implemented for the first-year students, and this is what we teach our students, as well as their faculty preceptors.
“I think what we did learn, though, is that guidelines are just guidelines. Every patient is different. So when we think about using person-first language, we want to understand what our patients want and represent it accurately. It’s not going to be the same for everyone.
“Let’s say you’re seeing a patient for management of their blood pressure, rather than saying something in your note like “the patient has failed three different medications” or “continues to not achieve optimal blood pressure,” which sounds very negative, you might say, “We have not achieved our target yet. We will continue to work on this.”
I started using the word “I” to be transparent about my own thought process. It gives room for the fact that this might change if the patient comes back three days later and symptoms are different, rather than sounding absolute.
"Have you noticed a change in the way physicians are writing notes since the law went into effect?
"I see it with my medical students. Unfortunately, I don’t see it yet in the clinical space.
"We implemented student training 2021 with medical students who had been in medical school for about a month and had just started our clinical skills course. It was fascinating to see that this was not surprising to them because they’re coming into this curriculum from a vantage point of being a patient previously. Maybe they’ve read their own notes or notes for their loved ones. They haven’t yet been indoctrinated into the medical vernacular. It was almost like this curriculum was not needed. They were like, “Well, of course, saying ‘patient complaint’ sounds terrible.” I don’t think we were expecting that at all.
"One guideline recommends avoiding the use of jargon or shorthand as much as possible. I think that’s the toughest one to combat. Our medical students who are writing notes for practice during their first year have the ability to spell things out, and I think it’s good for them as they’re learning. But I’ll tell you that in our clinical spaces, it’s really hard to do it. But yeah, because you’re crunched for time or you’re writing many notes, we see this happen.
"Physicians aren’t the only ones documenting in the medical record, right? We have nurses and social workers and physical therapists and others. How do we extend this curriculum’s teaching to all health care professionals? And how do we also think about educating patients too?
"With support from the Josiah Macy Jr. Foundation at Harvard Medical School, Anita Vanka, MD, and her team, developed a first-of-its-kind open notes curriculum for medical students.
HIFA profile: Richard Fitton is a retired family doctor - GP. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data Email address: richardpeterfitton7 AT gmail.com