Health systems increasingly are offering patients ready electronic access to clinician notes and patients strongly support such practice, citing many potentially important clinical benefits. Allowing patients a window into how clinicians view them and their conditions, however, such notes also may cause patients to feel judged or offended, and thereby reduce trust. A study described in the September 2021 issue of the Journal of General Internal Medicine involved data collected from 22,959 patient respondents in three health systems: Beth Israel Deaconess Medical Center in the Boston area, University of Washington Medicine in Seattle, and Geisinger, a rural integrated health system in Pennsylvania to determine what patients may find judgmental or offensive in their notes.
A thematic analysis had a focus on the following domains: Errors and Surprises, involving descriptions of finding inaccuracies in the record and instances when the note negatively surprised the patient. For example, patients reported feeling judged/offended due to documentation of physical examinations or discussions that the patient believed had not occurred. Labeling, which entailed patients reported feeling judgment/offense when they felt they were labeled by clinicians. Descriptions of obesity were a frequent cause of feeling negatively labeled, as were other personal descriptors such as “elderly,” ”anxious,” “well-groomed,” or descriptions of patients’ emotional demeanor. Disrespect, with some patients feeling disrespected when they perceived their perspective was not recorded, misunderstood, represented incorrectly, or not valued. Among the patient respondents who had read at least one note and answered two questions, 2,411 (10.5%) reported feeling judged and/or offended by something they had read. Individuals who reported poor health, unemployment, or inability to work were more likely to feel judged or offended. Among those patients, 2,137 (84.5%) wrote about what prompted their feelings. Conclusions reached in the study are that content and tone may be particularly important to patients in poor health. Enhanced clinician awareness of the patient perspective may promote an improved health care lexicon, reduce the transmission of bias to other clinicians, and reinforce healing.