Candid Doctors: Can We Handle It?

October 29, 2012

By Ami Patel

I recently started looking for a new primary care doctor, and when doing my research, both on the web and by referrals through friends, the doctors with the most enthusiastic support were the ones who were approachable and established a positive, communicative relationship with their patients. As I noticed this trend in categorizing a doctor as great or mediocre based on their communication level, I began to question why the rhetoric of provider groups has not transitioned into focusing more on patient engagement. After all, the doctor is a resource for healthcare information, and when we seek healthcare, there should be full disclosure of what is best for our body and lifestyle. It seems counterproductive when the provider withholds their true opinion in fear of offending or frightening the patient. How can the patient be empowered to take a multifaceted approach to maintaining a healthy lifestyle when the doctor fears the patient is not capable of handling such a diagnosis?

This concern was explored in a recent study by the Annals of Internal Medicine where a project, OpenNotes, was tested to review how patients felt when they knew everything their doctor was saying about them during and after the visit. The study showed doctors tend to be less supportive of such requests due to concerns that their workflow will be disrupted or fear of alarming the patient if such information is unveiled.

Such attitudes and misconceptions about patients and their hardiness to accept their health concerns were unjustified when the study revealed that more patients were enthusiastic about accessing the notes because they felt more in control of their care. The more blunt and candid expression in the notes even had the effect of giving some patients an extra push in making a needed lifestyle change and adhering to the doctors’ advice. Providers benefited by enhancing their communication skills and fortifying the doctor-patient relationship. After all, we typically seek advice from those we trust and respect because it is less likely to be “sugar-coated.” Often times we turn to family and close friends to give us tangible, unmasked, and direct advice; and by applying this approach to the doctor-patient relationship, more trust and respect can likewise be built for the doctor’s opinion.  It is a tangible indication that the doctor truly cares for the well-being and overall health of the patient by maintaining an open and honest dialogue.

In this study, some patients even detected errors in the doctors’ notes and helped clarify these mistakes to avoid unnecessary care. It supported the idea of these notes paving the way to a more approachable path to the doctor. The traditional notion of the doctor always being correct is based on the asymmetry of information that clinicians pose. This traditional relationship should allow flexibility for a more balanced approach to healthcare conformed to the needs of today’s empowered and savvy patient. Many doctors are hesitant to widen the gateway of communication in fear of losing their professional autonomy. Therefore, the open notes policy should benefit both the doctor and patient by alleviating fears of losing control for both parties. An optimal balance in discussing notes and finding solutions can be established by engaging both the patient and provider.

The feasibility of having access to doctor notes may have some implementation issues, but the concept of more patient engagement through open communication should be embraced. It engenders a discussion of evolving medical care to fortify the doctor-patient relationship and utilizing innovative methods to pave communication pathways to the patient. Such solutions emphasize the value that doctors place on leveraging communication techniques to empower patients in taking control of their health. Put best, the approach was “a brave effort at pushing the frontier of patient engagement.”

Ami Patel is a second year MPH student at the George Washington University with a concentration in Health Policy. She graduated from the University of Georgia with a degree in Health Promotion and Behavior and currently as works as a research assistant for the Center for Healthcare Quality at the George Washington University.