A New Chapter in Patient-Centered Care: Sharing the Medical Note?

Monika M. Safford

doi:10.7326/M17-2802

Editorials |20 February 2018

A New Chapter in Patient-Centered Care: Sharing the Medical Note?

Monika M. Safford, MD

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The 21st century has ushered in a distinct emphasis on patient-centered care in allopathic medicine, as manifested by the increasing implementation of patient-centered medical homes and the frequent use of patient-centeredness in guidelines, health systems, and insurance language (1–5). The overall goal of this movement is to improve communication between physicians and patients, ultimately increasing patients' engagement in care and improving the shared decision-making process, and thereby increasing their proclivity to follow their physicians' advice. The costs attributed to nonadherence are staggering, estimated at $290 billion for medication nonadherence alone (6). Efforts to improve this situation are clearly warranted.

Mafi and colleagues (7) report on their findings from a qualitative study that moves this agenda in a new direction: having patients contribute to writing the note that documents what occurred in the office encounter. The investigators interviewed 29 health care experts on the concept of co-producing notes—including primary care physicians, specialists, nurse practitioners, health information technology professionals, patient advocates, and a policy expert—resulting in various perspectives, albeit all from a convenience sample as the authors acknowledge. The themes that emerged support the idea of co-produced notes, with some caveats. Anything that increases physician workload should be avoided, and some patients may not want to participate. Legal issues will undoubtedly need to be worked through. The investigators have used the results of their qualitative study and the general enthusiasm of its participants to pursue iterative pilot studies to explore how best to implement this novel concept.

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2017 American College of Physicians

Editorials |20 February 2018

A New Chapter in Patient-Centered Care: Sharing the Medical Note?

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Editorials |20 February 2018

A New Chapter in Patient-Centered Care: Sharing the Medical Note?

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