Would You Like to Read Your Doctor’s Notes?
With electronic medical records you may be able to. But there’s a dark side:
Patients may panic if their doctor speculates in writing about cancer or heart disease, leading to a flood of follow-up calls and e-mails. And doctors say they worry that some medical terms can be taken the wrong way by patients. For instance, the phrase “the patient appears SOB” refers to shortness of breath, not a derogatory designation. And OD is short for oculus dexter, or right eye, not for overdose.
Also, “NERD” means “no evidence of recurrent disease” and “imp” is short for “impression” — the doctor’s conclusion of a patient’s condition.
Full article on what your doctor is really thinking.
Interesting. I had never thought about it this way.
I think the bottom line is: If patients are going to look at their medical records, the records are going to look very different than they do today.
This is sort of like a Heisenberg uncertainty principle. Patients cannot access their doctors notes without changing the notes. So the notes can either be accurate and unseen, or seen and inccurate, or at least incomplete.
Some of the notes contain information that patients find offensive. For instance, a doctor who suspects a patient of doctor-shopping for hydrocodone might put this information in the patient’s record. A doctor might also have reason to document suspected cases of medical non-adherence, when someone complains the blood pressure pills aren’t working. A physician might note that weight gain isn’t a “glandular” problem when a patient claims they “eat like a bird.” A doctor might even record that a patients admission of drinking only a couple drinks a day is probably off by a factor to four.
I’m not sure I would want to read my doctor’s notes.
What if the doctor really thinks his patient is a nerd and an SOB that is headed for an OD? Ah the daners of shorthand.
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OK nice to see- interesting comments are always helpful!
While I rsailee you can only recount your own experience, as a British person (who lives in the US) the tone of this article does come off as being rather naive. A couple of things that jumped out at me:1 You *should* have been charged for treatment, as you are non-EU the only reason you were not is because it was so minor it probably wasn’t worth their time to do the paperwork. If you had had a serious accident requiring surgery or had required a hospital admission for something like dialysis I am certain you would have been billed for it.2 The NHS is *not free*! It is free at the point of need. It is funded by National Insurance, which you pay if you are working.3 I’m astonished that you were offered a housecall in the middle of the night for something like conjunctivitis. You certainly wouldn’t have got a night time visit from the surgery I used to be registered at at home unless you had something potentially life-threatening like suspected meningitis or unless you were elderly and very frail. But then I looked at where you were in London oh surprise surprise only Marylebone, one of the most affluent parts of London, nay the world, and home of Harley Street. And then you were treated in Kensington, which is the same. I’m not surprised they have bloody excellent services can you imagine what kind of tax revenue the boroughs of Westminster and K&C get? It’s like being surprised that there is quite good health care available in the Upper East Side.4 Imagine a traveler from London coming down with a mysterious infection while on holiday in the States, waking up in a hotel room with burning eyes at 2am. Who does he or she call ? 911? The answer is that nobody from Britain with half a brain cell would travel to the US without taking out travel health insurance. It is pretty cheap and the standard thing to do when travelling outside the EU. This is what EVERY visitor to the US has to do if they don’t want to risk being in an accident and getting a huge hospital bill. I’m a bit surprised that this would never have occurred to someone.