The medical record mistakes jumped out at me through the patient portal. One painted me as an antibiotic seeker, despite my caution about taking drugs. That stung, because my mother suffered from infections that defied treatment, the result of overzealous antibiotic prescribing. As for me, one antibiotic left me bedridden for days; another sparked an allergic rash. Now, my doctor’s words threatened to bias my future treatment and risk my health.
On top of that, his visit notes said we had discussed several things that I believe never came up. It seemed that we had attended different virtual visits. I wondered if he had confused me with another patient.
Checking up on doctors
We all make mistakes, but medical mistakes do particular damage. A recent analysis found that health care saddles about 1 in 20 patients with preventable harm. Of those, it kills or permanently disables 12 percent.
To foster safety, the World Health Organization, the Leapfrog Group, and others have called for enlisting patients’ help. They want patients to serve as an extra pair of eyes, to ask questions, and to voice any concerns they have about their care.
Such thinking spurred efforts to expand patients’ access to their medical records. In that spirit, the OpenNotes project invited patients to log onto an online portal and read what clinicians wrote about their outpatient visits. A study led by Sigall Bell, M.D., of Beth Israel Deaconess Medical Center, asked patients who read at least one visit note why they did and what they found.
Most logged on to learn about their health or to clarify what the doctor said; 29 percent wanted to see if the notes were right. Often, they were not. In a later study, one fifth of those who read a visit note saw at least one mistake, which 42 percent deemed serious.
“Despite these known problems, systems for checking the accuracy of notes are almost nonexistent,” the researchers wrote.
Not just a difference of opinion
Even so, a picture of medical record accuracy comes from a study by Saul Weiner, M.D., of the Jesse Brown VA Medical Center, and colleagues. They sent actors, carrying hidden audio recorders, into clinics to portray patients. Afterwards, they checked recordings and transcripts of the visits against doctors’ records.
They uncovered mistakes in 9 out of 10 visit notes. Most were omissions of relevant facts. For instance, one doctor failed to document the wooziness and pounding chest mentioned by a patient with diabetes.
Another doctor wrote that a patient had no known drug allergies, despite not asking the patient about them. Such baseless statements comprised over a fourth of the errors. The researchers hinted that such errors increased with the use of templates and copy-and-paste shortcuts. They also blamed the use of medical records to decide provider pay. Indeed, the medical record mistakes they found favored overbilling.
“The medical record should not be assumed to reflect care delivered,” the researchers warned. That sounds scary, given the many uses of medical records. They include:
- Documenting and guiding patient care
- Giving patients information they need to take care of their health
- Providing data for medical research
- Monitoring and improving care quality
- Assessing liability for bad outcomes
- Determining payment.
In all those realms, medical record mistakes could trigger dreadful decisions.
Who designed this portal?
I had to set the record straight. Unfortunately, the portal offered no clear, timely way to fix medical record mistakes. The messaging options would only let me ask a nonurgent question, request a prescription refill, or request records. The Medications and Allergies buttons offered no help, either. Apparently, whoever designed the portal saw patients as supplicants, not as equal partners.
Leaving the portal, I checked the medical center’s website. Eventually, I found the Medical Records tab, and several clicks later, instructions for requesting an “amendment.” They told me to fill out a form and send it by mail or fax, as if no portal existed. They said to include documentation to support that a mistake happened, but I had no way to document who said what. They also said to wait up to 90 days to see if my doctor would fix the error. That could put me at risk if I needed care before then.
There had to be a better way. Back in the portal, I used the “Ask a Question” option to point out the errors and request corrections. The portal said to expect a response within two business days. Twelve days passed with no response.
I tried again. My second message noted my issues with some antibiotics. It further cited my legal right to request a correction. Within a day, the doctor apologized and made every change I sought.
Patients as safety monitors
Like me, most patients think they can help improve safety. After all, they know things about their health that no one else does. Fuurthermore, they may be less likely to confuse their data with another patient’s. That could make them valuable for spotting copy-and-paste errors.
Yet, what patients will do for safety rests on the details. They might feel comfortable asking the purpose of a medication, but fear that broaching safety concerns could upset their care providers and undermine their care. That same fear made me double-check my facts before contacting my doctor. Other patients hesitate to “waste” doctors’ time. Some downplay their concerns or delay mentioning them until their next visit.
Despite the difficulties, reporting errors can pay off. At one medical center, about half of patients’ requests to amend their record succeeded.
All too often, though, seeking corrections means fighting a health-care system that seems uneager to help. That frustrates and exhausts patients. Worse, it can discourage them from speaking up about future safety threats. Some even lose faith in their care provider. I changed doctors.
Safety partners need allies
Health-care providers say they want patients to partner with them on safety. If so, they must partner back better. They can start by giving patients straightforward ways to report medical record mistakes. Patients should be allowed to do so through portals, on paper, or however suits them. Additionally, portal users need easier-to-use sites with menus that let them flag every kind of mistake.
Most of all, patients who muster the courage to point out medical record mistakes deserve prompt, respectful replies. Otherwise, urging them to speak up could do more harm than good.
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Bell SK, Mejilla R, Anselmo M, et al. (2017 Apr). When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship. BMJ Quality & Safety, 26(4):262-270. https://doi.org/10.1136/bmjqs-2015-004697
Bell SK, Delbanco T, Elmore JG, et al. (2020 Jun). Frequency and types of patient-reported errors in electronic health record ambulatory care notes. JAMA Network Open, 3(6): e205867. https://doi.org/10.1001/jamanetworkopen.2020.5867
Bhavnani V, Fisher B, Winfield M, et al. (2011 Apr). How patients use access to their electronic GP record–a quantitative study. Family Practice, 28(2):188-194. https://doi.org/10.1093/fampra/cmq092
Blease CR, Bell SK (2019 Aug 27). Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety. Diagnosis (Berlin), 6(3):213-221. https://doi.org/10.1515/dx-2018-0106
Entwistle VA, McCaughan D, Watt IS, et al. (2010 Dec). Speaking up about safety concerns: multi-setting qualitative study of patients’ views and experiences. Quality & Safety in Health Care, 19(6):e33. https://doi.org/10.1136/qshc.2009.039743
Hanauer DA, Preib R, Zheng K, et al. (2014 Nov). Patient-initiated electronic health record amendment requests. Journal of the American Medical Informatics Association, 21(6):992-1000. https://doi.org/10.1136/amiajnl-2013-002574
Niazkhani Z, Toni E, Cheshmekaboodi M, et al. (2020 Jul 8). Barriers to patient, provider, and caregiver adoption and use of electronic personal health records in chronic care: a systematic review. BMC Medical Informatics and Decision Making, 20(1):153. https://doi.org/10.1186/s12911-020-01159-1
Panagioti M, Khan K, Keers RN, et al. (2019 Jul 17). Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. The BMJ, 366:l4185. https://doi.org/10.1136/bmj.l4185
Peat M, Entwistle V, Hall J, et al. (2010 Jan). Scoping review and approach to appraisal of interventions intended to involve patients in patient safety. Journal of Health Services Research & Policy, 15 Suppl 1:17-25. https://doi.org/10.1258/jhsrp.2009.009040
Schwappach DLB (2010 Apr). Review: engaging patients as vigilant partners in safety: a systematic review. Medical Care Research and Review, 67(2):119-148. https://doi.org/10.1177/1077558709342254
Waterman AD, Gallagher TH, Garbutt J, et al. (2006 Apr). Brief report: Hospitalized patients’ attitudes about and participation in error prevention. Journal of General Internal Medicine, 21(4):367-370. https://doi.org/10.1111/j.1525-1497.2005.00385.x
Weiner SJ, Wang S, Kelly B, et al. (2020 May 1). How accurate is the medical record? A comparison of the physician’s note with a concealed audio recording in unannounced standardized patient encounters. Journal of the American Medical Informatics Association, 27(5):770-775. https://doi.org/10.1093/jamia/ocaa027