Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Gen Intern Med. 2021 Sep;36(9):2571-2578. doi: 10.1007/s11606-020-06432-7. Epub 2021 Feb 2.
Sharing outpatient notes with patients may bring clinically important benefits, but notes may sometimes cause patients to feel judged or offended, and thereby reduce trust.
As part of a larger survey examining the effects of open notes, we sought to understand how many patients feel judged or offended due to something they read in outpatient notes, and why.
We analyzed responses from a large Internet survey of adult patients who used secure patient portals and had at least 1 visit note available in a 12-month period at 2 large academic medical systems in Boston and Seattle, and in a rural integrated health system in Pennsylvania.
Adult ambulatory patients with portal accounts in health systems that offered open notes for up to 7 years.
(1) Quantitative analysis of 2 dichotomous questions, and (2) qualitative thematic analysis of free-text responses on what patients found judgmental or offensive.
Among 22,959 patient respondents who had read at least one note and answered the 2 questions, 2,411 (10.5%) reported feeling judged and/or offended by something they read in their note(s). Patients who reported poor health, unemployment, or inability to work were more likely to feel judged or offended. Among the 2,411 patients who felt judged and/or offended, 2,137 (84.5%) wrote about what prompted their feelings. Three thematic domains emerged: (1) errors and surprises, (2) labeling, and (3) disrespect.
One in 10 respondents reported feeling judged/offended by something they read in an outpatient note due to the perception that it contained errors, surprises, labeling, or evidence of disrespect. The content and tone may be particularly important to patients in poor health. Enhanced clinician awareness of the patient perspective may promote an improved medical lexicon, reduce the transmission of bias to other clinicians, and reinforce healing relationships.
将门诊病历与患者共享可能会带来重要的临床获益，但有时病历也会导致患者感到被评判或冒犯，从而降低信任度。
作为一项更大规模调查的一部分，该调查研究了开放病历的影响，我们旨在了解有多少患者因在门诊病历中读到的某些内容而感到被评判或冒犯，以及原因是什么。
我们分析了来自波士顿和西雅图的 2 家大型学术医疗系统以及宾夕法尼亚州一家农村综合卫生系统中，使用安全患者门户且在 12 个月内至少有 1 次就诊记录的大量成年患者的互联网大样本调查的回复。
在提供开放病历长达 7 年的医疗系统中拥有门户账户的成年门诊患者。
（1）对 2 个二项问题的定量分析，以及（2）对患者认为具有评判性或冒犯性的内容的自由文本回复的定性主题分析。
在回答了 2 个问题且至少阅读过 1 份记录的 22959 名患者受访者中，有 2411 名（10.5%）报告因在其记录中读到的某些内容而感到被评判或冒犯。健康状况差、失业或无法工作的患者更有可能感到被评判或冒犯。在感到被评判或冒犯的 2411 名患者中，有 2137 名（84.5%）描述了是什么引发了他们的感受。出现了 3 个主题领域：（1）错误和意外，（2）贴标签，以及（3）不尊重。
十分之一的受访者报告因在门诊病历中读到的某些内容而感到被评判或冒犯，原因是他们认为这些内容包含错误、意外、贴标签或不尊重的证据。对于健康状况较差的患者，内容和语气可能尤其重要。增强临床医生对患者视角的认识可能会促进改进医学词汇，减少偏见传递给其他临床医生，并加强治愈关系。
