Beth Israel opens doctors' notes to patients

Once again, the dollar speaks. I am not sure if the administrator, or the decision maker, at BIDMC is a doctor or has sufficient medical understanding of medicine to make this decision.

It is my opinion that this decision was made more for the grant money, rather than for the patient's (whom the hospital should be protecting above all else)benefit.

Every prudent and thorough physician must go through a list of differential diagnoses before arriving at a definitive diagnosis for a patient presenting with a medical problem. The differential list must include the first, worst, best, and the rest. Doctors do not share all of the differential diagnoses with their patients, but find tactical means of elimination of some of the diagnoses that can seem far fetch, insulting, and mistrusting (when a patient wonders how he or she is judged by the doctor0. When the patient judges the doctor, that list may make the patient see the doctor as unknowing, incompetent, and a quack. Either way, this is not good for doctor patient relationship, BUT the differential diagnosis is a necessity.

The doctor can only, in the likelihood of legal proceedings, demonstrate his/her thoroughness by documenting all of the differential diagnoses. This is done with the belief of, and in, privacy for the patient and doctor, BOTH.

What BIDMC is doing, will certainly harm doctor-patient relationships, and ultimately outcome performance. No patient needs his/her medical records in order to enhance compliance; that is a product of doctor-patient relationship. The doctor should, sufficiently, educate and support the patient. The patient should, in turn, have enough trust in the doctor. Short of that relationship, outcome will suffer.

Regardless of how BIDMC, and some like minded citizens try to justify this, it is making medical records public; and that is potentially dangerous. patients will "doctor hop", be less than candid (by not knowing who else has access), and the cost of healthcare will certainly continue its upwar spiral. Example of a patient making their own decision: a patient who suffered a fall, saw the doctor and exhibited no objective need for radiographic study. Assured and discharged, the patient was not satisfied with the diagnosis of a "bruise". The patient went to an ER, and returned to the original doctor with the threat of suing, because the ER doctor made a diagnosis of a "contusion" after x-rays. With access to medical records, patients will seek their own way of eliminating differential diagnoses, (if they are granted open access to complete medical records).

If doctors try to modify the documentation process, healthcare IT and information will suffer because the doctors will carry the differential diagnoses in their heads, or else where. This, too, is not conducive to quality outcome. We do not need Einstein to calculate what will happen to cost.
I am in favor of limited (definitive diagnosis and treatment modality) access and interactive data exchange. Unlimited access to medical records, by the patient, is harmful to the patient.