Would You Want to Read Your Therapist’s Notes?

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If you’ve ever visited a therapist, you’ve likely experienced this very moment: You spill your heart out, anxiously await a response, and your doc looks down—scribbling into a notebook or tapping away at an iPad.

You’re stuck: “What is he writing?!”

About 700 patients at Boston’s Beth Israel Deaconess Hospital—part of a preliminary study at the hospital—needn’t worry about that moment. They have full access to their clinician’s notes, either during the appointment or later through an online database, as cited in a recent New York Times article.

And while this may seem like a novel concept, Stephen F. O'Neill, L.I.C.S.W., J.D., social work manager for psychiatry and primary care at Beth Israel urges it’s not: “I’ve always had an open note policy. Patients have a right to their records, and a lot of us here [at Beth Israel] have practiced this transparently.”

That’s right: Access to your therapist’s notes is your right (note: laws vary state by state and if it would be harmful to you for any reason, the therapist is allowed to provide a summary). But many people don’t ask for them. And many clinicians shy away from sharing. “Unfortunately, most therapists have been trained to practice defensively,” O’Neill says. “In graduate school a professor once said, ‘There are two kinds of therapists: ones who have been sued and ones who haven’t.’”

Running the risk of offending or confusing a patient through handing over your notebook, then? That’s arguably risky business. And O’Neill admits that knowing you’re on the receiving end of his note does change the way he writes (changes mainly come in the form making sure you’ll understand his lingo, he says). But practically speaking, the benefits outweigh the risks, he says: “If we deliver bad news, we expect patients won’t remember more than 30 percent of what we say. With good news, we expect them to remember 70 percent. Either way, you’re missing information. If patients can go back and remember, that helps.”

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In fact, access to notes cuts unnecessary phone calls from people seeking clarity on a session, lessening the strain on the overall system. And a recent study in the Annals of Internal Medicine found that people who saw their doc’s notes were more satisfied with their care and more likely to stick to their meds.

For many, note sharing is just one more tool to build a patient-therapist relationship. While initially worried that the practice could make paranoid patients flee (after all, what if they thought he was writing bad things about them?), O’Neill noticed the opposite: Knowing that (at any given time) a patient could see what he wrote bridged trust levels, producing a calming effect.

But the process isn’t one-size fits all—and currently, only a few other medical practices around the country are set to open notes from therapists to patients. “Part of our job is to figure out who is this going to work wonderfully for and who is this going to be a risk for.” And opposition is natural. If a therapist writes an interpretation of what they think is going on with someone, for example, and wants the patient to make that discovery in his or her own time, seeing a note prematurely could interrupt therapy’s flow, O’Neill explains.

And with the ability to see notes at home comes the reality that you never know who is reading over a patient’s shoulder. In cases of domestic violence or an affair, having an abuser or an unsuspecting spouse stumble upon notes could be problematic. (Note: There are safeguards to prevent this from happening, O’Neill says.)

The bottom line: You have to know yourself. Will you obsess over questions like, “What does that word mean?” or, “Is that what he really meant?” At Beth Israel, about one third of patients who have had the opportunity to opt in to the program have done so. But many others don’t want to. As O’Neill recalls, “One patient said, ‘It’s like brining your car to the mechanic—once he’s done, I don’t need to look under the hood.’”

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