The Optimized Doctor

A note about OpenNotes


 

“He is a frequent flyer.” This is a term we reserve for patients who consume a lot of services. In the outpatient clinic, it’s the type of patient who comes for frequent visits, perhaps more often than medically necessary. Oftentimes, more than we’d like. They can be demanding. They can also be an invaluable resource: None of your patients will likely be more forthright with you than those who are so motivated.

I saw one of my frequent flyer patients recently. He, like all patients, has medical problems, but, unlike most, he never misses an opportunity to schedule an appointment to solve them. A once red-, now gray-haired engineer, he has quite a record of skin issues and has meticulously documented all of them himself.

Dr. Jeffrey Benabio

Dr. Jeffrey Benabio

“I read what you said about me,” he said, “in your last note ... It was not exactly what happened.” Oh. I suddenly realized that this wasn’t going to be an easy 10 minutes. “You wrote that we discussed the risks and benefits of freezing my keratoses. But you didn’t. You just froze them,” he pointed out.

I felt myself stiffening. I added him on to my schedule today because I’m a good guy, yet he wants a piece of me? Bring it.

“So, you can read my notes online?” I asked. “Yes,” he replied, “for some reason I can read all of my charts for dermatology visits.”

“Well, that’s because I volunteered for our OpenNotes program,” I said. As a participant, all of my patients are able to read all of my notes, if they choose to do so. They can access them but cannot make any changes.

Yeah, great idea, Jeff.

“I just want to know, why would you put that if you didn’t do it?” he asked.

“Well, it’s not a lie. We did discuss the risks and benefits of my freezing your AKs previously, right?” “Yes, we did,” he replied. “Did you not want me to freeze them?” I asked. “No, I did,” he answered. “I just wanted you to know that I can see what you write about me, and I don’t want you to say anything you don’t want me to read because I really trust you.”

“I won’t,” I said.

That’s because I understand that you are my patient, and all patients deserve my unmitigated care. It’s what makes me a doctor.

I’ve since added to my EMR template: “Previously discussed risks and benefits.” Not because it really matters. But because it matters to him. And that matters to me.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.

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