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Do you have access to your doctor's notes about you?

Patients feel more in control of their health when they have access to doctors' notes. If you see a nutritionist, physician, nurse, psychologist, social worker, counselor, or any other clinician, (in the field of healthcare) do you have access to the expert's notes? When you see a physician would you like to read that doctor's notes about you? There's a yearlong pilot program in three different cities where patients were given access to their doctor's notes about them from each visit. The experiment is called OpenNotes.

Do you have access to your doctor's notes about you?
Photo by David Silverman/Getty Images

When a patient is sick, tired or stressed during a doctor’s visit, they may forget what the doctor said or prescribed. Columbia St. Mary’s is addressing this issue by strengthening the patient-doctor partnership and giving their more than 300,000 patients secure online access to doctor’s notes after a visit. Called “OpenNotes,” the health care provider is the first in Wisconsin to launch convenient, round-the-clock access to their doctor’s notes, instructions, next steps, prescriptions and test orders through Columbia St. Mary’s secure access patient portal, CSMConnect.

Not all patients take small audio recording devices into the doctor's office because they don't have permission to record what the healthcare professional suggests and may not be able to take notes or remember directions or advice

It's about the patient feeling more in control in a doctor or dentist's office or in a setting where you're speaking to a nurse, counselor, social worker, or psychologist. “Patients are familiar with going online to access their medical record for general medical information such as confirming an upcoming appointment or viewing lab results,” says Dr. Bruce McCarthy, president of Columbia St. Mary’s Physician Division, according to a recent November 16, 2014 news release, Columbia St. Mary’s is First Wisconsin Health System to Launch Online Access To Doctor’s Notes. “But doctor’s notes are the thread that ties together many pieces of information in the medical record. OpenNotes could profoundly change the way people engage with their doctor and manage their care.”

Dr. McCarthy heard of the OpenNotes concept in theory years ago. “I became more intrigued as my own mom aged and started to develop signs of dementia,” he says in the news release. “She would go to her doctor and when I asked how the visit was, she would always say ‘the doctor says everything is fine’ while I knew that wasn’t the case.”

“It’s great to see Columbia St. Mary’s take this step and offer physician’s notes to their patients,” explains Steve Downs, in the news release. Downs is the chief technology and information officer at the Robert Wood Johnson Foundation. “It’s crucial at this state to have a set of early adopters whose experience will help pave the way for others.”

A national study in 2010 funded by the Robert Wood Johnson Foundation, the nation’s largest philanthropy organization devoted exclusively to health and health care, tested the OpenNotes concept with 105 primary care physicians and more than 13,000 patients during a year-long voluntary program. The findings were published in the Annals of Internal Medicine.

Patients reported:

• Having better recall after visits

• Feeling more in control of their care

• Better communication and collaboration with their doctor

• Feeling better educated

• Taking medications more effectively

• Preventing important mistakes

• Sharing their notes with family, friends and health professionals

Patients support, use, and benefit from reading their doctor's notes

“When this study began it was a fascinating idea in theory,” says Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation. “Now it has been tested and proven. The evidence is in: Patients support, use and benefit from open medical notes, according to the October 1, 2012 news release, "Patients Feel More Control of Their Health When Doctors Share Notes."

These results are exciting – and hold tremendous promise for transforming patient care. Patients with access to notes written by their doctors feel more in control of their care and report a better understanding of their medical issues, improved recall of their care plan and being more likely to take their medications as prescribed, a Beth Israel Deaconess Medical Center-led study has found.

Doctors participating in the OpenNotes trial at BIDMC, Geisinger Health System in Danville, PA and Harborview Medical Center in Seattle reported that most of their fears about an additional time burden and offending or worrying patients did not materialize, and many reported enhanced trust, transparency, and communication with their patients.

“Patients are enthusiastic about open access to their primary care doctors’ notes. More than 85 percent read them, and 99 percent of those completing surveys recommended that this transparency continue,” says Tom Delbanco, MD, co-first author, a primary care doctor at BIDMC and the Koplow-Tullis Professor of General Medicine and Primary Care atHarvardMedicalSchool. “Open notes may both engage patients far more actively in their care and enhance safety when the patient reviews their records with a second set of eyes.”

“Perhaps most important clinically, a remarkable number of patients reported becoming more likely to take medications as prescribed,” adds Jan Walker, RN, MBA, co-first author and a Principal Associate in Medicine in the Division of General Medicine and Primary Care at BIDMC and Harvard Medical School. “And in contrast to the fears of many doctors, few patients reported being confused, worried or offended by what they read.”

The findings reflect the views of 105 primary care physicians and 13,564 of their patients who had at least one note available during a year-long voluntary program that provided patients at an urban academic medical center, a predominantly rural network of physicians, and an urban safety net hospital with electronic links to their doctors’ notes

Of 5,391 patients who opened at least one note and returned surveys, between 77 and 87 percent reported open notes made them feel more in control of their care, with 60 to 78 percent reporting increased adherence to medications. Only 1 to 8 percent of patients reported worry, confusion or offense, three out of five felt they should be able to add comments to their doctors’ notes, and 86 percent agreed that availability of notes would influence their choice of providers in the future.

Among doctors, a maximum of 5 percent reported longer visits, and no more than 8 percent said they spent extra time addressing patients’ questions outside of visits. A maximum of 21 percent reported taking more time to write notes, while between 3 and 36 percent reported changing documentation content.

No doctor elected to stop providing access to notes after the experimental period ended

“The benefits were achieved with far less impact on the work life of doctors and their staffs than anticipated,” says Delbanco, in the October 1, 2012 news release, Patients Feel More Control of Their Health When Doctors Share Notes. “While a sizeable minority reported changing the way their notes addressed substance abuse, mental health issues, malignancies and obesity, a smaller minority spent more time preparing their notes, and some commented that they were improved.”

“As one doctor noted, according to the news release: ‘My fears? Longer notes, more questions and messages from patients … In reality, it was not a big deal.’” Walkersuggests that so few patients were worried, confused or offended by the note because “fear or uncertainty of what’s in a doctor’s ‘black box’ may engender far more anxiety than what is actually written, and patients who are especially likely to react negatively to notes may self-select to not read them.”

“We anticipate that some patients may be disturbed in the short term by reading their notes and doctors will need to work with patients to prevent such harms, ideally by talking frankly with them or agreeing proactively that some things are at times best left unread.”

“When this study began, it was a fascinating idea in theory,” says Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation, the primary funder of the study, according to the news release. “Now it’s tested and proven. The evidence is in: Patients support, use, and benefit from open medical notes. These results are exciting – and hold tremendous promise for transforming patient care.”

In addition to Delbanco and Walker, co-authors include: Sigall K. Bell, MD, Henry J. Feldman, MD, Nadine Farag, MS, Roanne Mejilla, MPH, Long Ngo, PhD and Neha Trivedi, BIDMC; Suzanne G. Leveille, PhD, RN, University of Massachusetts-Boston; Jonathan D. Darer, MD, MPH, Geisinger Health System; Joann G. Elmore, MD, MPH, University of Washington Medical School and Harborview Medical Center; James D. Ralston MD, MPH, Group Health Cooperative, Seattle; Elisabeth Vodicka, BA, Harborview Medical Center and Stephen E. Ross, MD, University of Colorado Health Sciences Center.

The study is funded primarily by the Robert Wood Johnson Foundation, with additional support from the Drane Family Fund, the Richard and Florence Koplow Charitable Foundation and the National Cancer Institute. No conflicts were reported.

Do you see a nutritionist or a physician if you want information about what foods are healthiest for your individual system?

Is the person a registered dietitian, someone with a graduate degree in genetic and metabolic nutrition, or a person with a graduate degree in nutrition education, nutrition counseling, consumer science, home economics, or nutrition communication? For example, the Master's Degree Program in Nutrition Communication at the Nutrition Communication | Friedman School of Nutrition Science and Policy is designed to prepare its graduates for the growing job opportunities available to professionals in the media who write, produce videos/films, or speak about nutrition and healthy foods.

Americans' top sources of nutrition information are magazines, television, newspapers, and the Internet. The print, broadcast, and electronic media are constantly seeking professionally-trained nutritionists who can communicate effectively. The same is true of public relations agencies, the food industry, and health and fitness centers. Community-based health promotion programs are also relying more and more on techniques of effective mass communication to influence behavior. The Master's Degree Program in Nutrition Communication is designed to prepare its graduates for the growing job opportunities available to professionals trained to explain research findings in ways that the public can understand and apply.

The Master's Degree Program in Nutrition Communication is a two-year academic program offered in partnership with the Tufts Master's Program in Health Communication, in collaboration with the Emerson College School of Communication, Management and Public Policy. It is designed to prepare graduates for the growing job opportunities available to professionals trained to communicate sound nutrition information effectively.

The program combines the expertise of Tufts' own internationally recognized faculty, the unique skills of health communication experts at Emerson College, and the enormous breadth of knowledge available across all the Tufts campuses with a wealth of opportunities for related work experience. Together, the combination of academic courses and practical experience prepares graduates for exciting and rewarding careers in which effective communication makes a difference.

What type of careers are there in nutrition communication and coaching?

The answer are many besides the registered dietitian working with patients in medical or other health care settings. The nutrition writer is a communications expert who writes about food, nutrition, and health. The wellness coach and fitness educator helps to promote nutrition and fitness or health and nutrition (since health and fitness are different goals) in corporate, commercial, hospital, academic, and community settings.

The family/child nutrition specialist provides technical assistance or training to school food service programs, childcare food programs, and programs for low-income or other special need populations. The marketing and media specialist specializing in nutrition leads marketing strategies for specialty brands, including foods marketed to hospitals. That person would also oversee new brands as they're developed for the healthcare market.

The WIC Nutrition educator provides assessment, education and counseling in areas pertaining to nutrition. One example might be to participate in voucher insurance. Another aspect of such a job might be to make referrals to educational, medical, social, or various community services. A wellness coordinator provides health and fitness counseling, training, or instruction and/or designs wellness programs or teaches classes.

A nutrition assistant/diet aide makes sure each patient in a facility, care center, or senior community gets and follows an individualized, prescribed diet. A wellness coordinator like a wellness coach provides health and fitness instruction or counseling emphasizes giving informational resources to the client, such as educational materials or directions on where to find information about nutrition and health from reliable, validated resources. The wellness coordinator may also teach classes or implement wellness programs.

The entrepreneur in nutrition is in business as an independent contractor, such as a lifestyle coach working with families or older adults or an independent journalist and/or book author or speaker

The recreation-based nutrition and activity director on cruise ships, in travel programs, or working at country clubs and other community centers does counseling or coaching and teaching or provides informational materials on nutrition and health. A senior nutrition specialist might oversee nutrition programs offered for seniors such as home delivered meals and senior nutrition programs at various community centers. The senior nutrition specialist also provides assessment, education, and counseling to the senior community or senior population.

All these careers can be achieved by different educational/training routes and degrees. It depends upon whether you want to communicate nutrition information to the general public, to special groups, or work in medical settings or as an entrepreneur. A nutrition communicator or coach is not a registered dietitian, but a registered dietitian can be a nutrition communicator by working in settings where the job calls for communication in writing or speaking, or in teaching or counseling. An entrepreneur also can be a distributor of supplements or a speaker and writer on the various supplements for various companies that produce them or open/manage a health food store.

A coach is different than a counselor

You can be a wellness coach with one type of training as a coach, but being licensed a counselor is regulated by a different set of rules, whereas being a registered dietitian means passing a national licensing exam. For example, in California, you don't need a dietitian's license to practice as a wellness coach or a nutrition communicator, since you're referring people to other licensed healthcare professionals or giving them educational information and resources to read under the rule of offering information about where to find studies published in the various scientific, medical, or technical journals.

A communicator in nutrition or in other fields such as history of medicine can write articles and books or refer people to educational materials and information in professional journals or news articles about scientific studies. But you can't play doctor, treat anyone, or practice medicine, nursing, and you can't do the work of a licensed registered dietitian.

What you can practice is communication, teach cooking skills, and write or talk about nutrition in a way where you refer people to the research of other professionals and experts in the field. Nutrition communication and healthcare journalism are very broad fields for the professional communicator who offers breaking news, refers people to a variety of published research, and validated, preferably peer-reviewed educational, informational materials and credible news for others to read and fact-check the research.

A communicator has the choice of discussing censored news, self-published studies, and/or peer-reviewed news, studies, and other research materials

A nutrition communicator has a wide variety of fields to choose from, hopefully from the best, reliable news sources on health information that is published each year. Examples of what nutrition and healthcare communicators cover are topics such as affordable care, access to your doctor's notes about you as a patient, covering the rate of hospital infections and causes.

One example is writing about topics published by the Centers for Disease Control and Prevention, such as what doctors take a stand against. You could write about unnecessary treatments, maintaining healthy weight and exercise topics. Or you might research and write articles or speak about how to cut medicine/drug costs by calling various pharmacies to ask for the price of what you or others need or use frequently. Another topic for investigative reporters in health or nutrition is covering topics such as whether nursing home residents are being "quieted down" with antipsychotropic drugs instead of better nutrition and activities such as music therapy or hobbies.

For example, a lot of those psychotropic drugs given to nursing home patients with some memory loss don't help dementia and have been linked to a higher risk of fatalities in the elderly. Are communicators in healthcare and nutrition covering that type of investigative reporting? Check out the reports and statistics from the Centers for Medicare and Medicaid Services.

Some states have reduced the use of prescription antipsychotic drugs for those in nursing homes. But there's room for more improvement in how to help older adults with activities that are enjoyable instead of "drugging them down" to stay sweet and keep quiet.

How about communicating to professionals and the public about more creativity-enhancing times such as water color painting/collage-making, and music therapy, sculpture, paper crafts, chorus singing, reminiscing activities, chair Yoga/Tai Chi/Qi Gong, or other joyful experiences that relax the mind at any age and in any condition in a nursing home or a senior daycare setting?

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