OpenNotes and the Demise of Doctor-speak

By Ulfat Shaikh

Originally posted on Pulse Healthcare on Dec. 2, 2012

A recent study shows that allowing patients easy access to read their doctor’s notes can transform the doctor-patient relationship and result in high quality patient care.

Over one year, 105 physicians allowed more than 19,000 patients in Boston, rural Pennsylvania and Seattle electronic access to their medical office visit notes. Initial worries about this unconventional practice were unfounded. Patients reported that they more accurately remembered what was discussed during visits and felt more in control of their health care.

Not only this, OpenNotes also improve patient outcomes. More than half the patients reported a year later that they were more likely to take their medications as prescribed.

Not too surprisingly, almost all patients wanted continued access to their visit notes after the study ended. More unexpectedly – all doctor’s in the study chose to continue sharing notes with patients. So all in all, a pretty resounding endorsement for openness and transparency in medical records.

However, one question in my mind remained. Did opening up medical notes to patients affect the infamous doctor-speak? This refers to the sometimes amusing, sometimes offensive, but surprisingly universal form of communication invented, propagated and used by clinicians all over the world. And did it reduce doctor’s use of medical terminology, a whole new language by itself. To give you an idea of the magnitude of medical vocabulary the average doctor-in-training needs to pick up – Stedman’s Medical Dictionary has definitions for more than 107,000 terms, is 2100 pages long, and weights about the same as a small baby.

For instance, will a patient be offended if he reads in his medical records: 20-year-old male, SOB resolved, FU if recurs (in case you were wondering – shortness of breath and follow-up). Or is it in bad taste to note that someone has pea soup stool, coffee ground vomit, coca-cola colored urine, or ripe cheese odor?

Will a patient understand that a “negative” chest X-ray is actually a much more desirable thing to have than a “positive” one?

And then there is the whole other ethical issue surrounding medical slang. Turns out that some clinicians have made a hobby of this. Dr. Adam Fox, who has a day job as an allergy specialist in the UK, is a published medical slang expert. He spent 5 years rounding up a list of more than 200 medical terms, some of which seriously need be retired. The list includes FLK (Funny Looking Kid), GLM (Good Looking Mum), TEETH (Tried Everything Else, Try Homeopathy), and GOK (God Only Knows).

Less colorful doctor-speak can have issues too. A Canadian study showed that the more medical-sounding the term, the greater the scare-factor. Seborrheic dermatitis was perceived by the college students they surveyed as deadlier than dandruff, and androgenic alopecia was considered more serious than male pattern baldness.

So is doctor-speak a potentially extinct language?

A recent study that looked at the content of visit notes in a group practice in Minnesota found no change in the kinds of notes that doctors wrote after patients were given online access to their visit records. The researchers of OpenNotes had a slightly different experience. A few doctors in their study reported that they had changed how they composed their notes. Some said that they now wrote “better notes” and learnt “better documentation – a good thing.”

Dr. Fox’s compendium of medical slang may soon be of historical interest. I for one, will not be dejected to see this particular medical invention phase out.

-Ulfat Shaikh, MD, MPH, MS is director of health care quality at the University of California Davis School of Medicine. She blogs about health care quality improvement at Pulse.

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