It’s increasingly common for patients to have access to their medical records.  By and large, this digitization of patient data is a good thing and empowers patients to take a greater role in their own healthcare, but a recent study set out to explore whether such transparency was a help or hindrance to those suffering from mental health issues.

“We found that reading mental health notes may strengthen as well as strain patient-clinician relationships by enhancing or undermining trust,” the authors say.

The study, which was led by the Center to Improve Veteran Involvement in Care (CIVIC), aimed to build on previous work examining the risks and benefits of OpenNotes, which provide patients with access to their medical records.

The benefits for mental health

The analysis uncovered a number of positives when patient records are open and transparent.  For instance, patients begin to appreciate the consistency in approach between what happens in each appointment and what appears in the notes.  This helps to foster trust in the relationship.

This level of trust also increased when the notes highlighted how their clinicians had both listened to what was said in the session, and understood the personal stories shared.  It helped develop a sense that sessions weren’t identical from one patient to the next.

The flip side

There were some negative aspects reported however.  For instance, when there was incongruity between what happened in the session and what appeared in the notes, this eroded trust and caused patients to worry about whether such misrepresentation might influence the care they received from other providers.

There was also discontent when diagnoses appeared in the notes despite not having been discussed with the patient themselves.  Both of these resulted in trust slipping away and the quality of relationship declining.

The sharing of electronic patient records is only likely to grow, so these kind of studies are important to understand how patients respond to them, and the way the transparency of notes needs to influence how clinicians behave.

“Proactive clinician communication with patients about the content of notes and the note-writing process, as well as documenting strengths and highlighting the individuality of patients, may improve the likelihood of maintaining or developing stronger therapeutic alliances between patients and clinicians in the context of OpenNotes,” the authors advise.