MEDICAL ECONOMICS SPECIAL SECTION: Give patients their visit notes

Key Points

With an electronic health record (EHR), printing progress notes and handing them to patients is as easy as ABC. But does that mean it's a good idea? Internist/pediatrician Salvatore S. Volpe, who began giving his visit notes to patients in April 2006, soon after he purchased an EHR, responds with an enthusiastic Yes. Among the advantages Volpe cites:

"When patients require multiple tests, referral slips on which I've written 'chest x-ray' and 'abdominal CT scan' aren't as useful as a progress note spelling out the diagnoses that support the tests," says Volpe, who has a solo practice in Staten Island, NY.

"Studies show that patients forget half of what we tell them during office visits," Volpe continues. "Or they might have more questions than we can deal with in a short visit. The printout of the chart notes that I give them not only has my diagnosis, follow-up recommendations, and referral information, it facilitates Internet research about particular illnesses because it contains terms related to patients' medical problems."

The modern way to keep patients informed

Physicians began giving chart notes to patients long before anyone had an EHR or even photocopiers. Indeed, cardiologist Edward Gosfield, Jr., who opened a solo practice in Philadelphia in 1950, dictated his progress notes, as well as letters to referring physicians, in front of patients. He then sent the notes to a transcription service that made multiple carbon copies, one of which Gosfield sent to the patient.

Gosfield, who retired in 2002, says the patients who received visit notes became more active participants in their own care. But he acknowledges that his system of distributing these notes was expensive and inefficient. Physicians who have EHRs, however, can generate multiple copies of progress notes cheaply and easily. Sal Volpe tells patients during their first visit with him that he's going to do his best to document their discussion, and at the end of that and subsequent visits they'll get a copy of what transpired, as well as a summary of the plan of care. He then prints the note himself and hands it to the patient. Or if he needs to work on the note a bit longer, a staffer gives the patient the note after the patient takes care of business at the checkout desk.

OTHER PHYSICIANS give patients select portions of progress notes, or reports that they think patients will find helpful. Tacoma, WA, family physician Richard Waltman, for one, gives patients printouts of their labs and meds, as well as graphs of how they're doing with weight, blood pressure, HbA1c, and other measurements. And ob/gyn Timothy E. Phelan of Folsom, Calif., sees that patients have copies of their lab, ultrasound, pathology, and operative reports and photographs. "Most patients don't know what to do with the information, but some greatly appreciate getting copies for their personal health files," he says.

Those who choose not to distribute visit notes to patients cite time pressures and concern that the notes will confuse laypersons. "Patients often panic at anything in the medical record that they don't understand, even if it's normal," says Stephen W. Leslie, a urologist in Lorain, Ohio. "This means wasted time explaining why a prostate estimated at 20 g is nothing to worry about, and neither is having one testicle slightly smaller than the other." Similarly, Manoj Singh, a family physician in West Chester, Ohio, points out that his notes contain medical shorthand and Latin, both of which baffle most patients. "Also, primary care is a very low-margin business, and copying charts is an added expense that isn't reimbursable," he says.