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Research has shown that patient stories can heal. In this regard, Open Notes is a movement that can improve the doctor-patient relationship.
Research has shown that stories can actually heal.
This was conveyed by Jan Oldenburg, the founder of Participatory Health Consulting, and Kathy Nieder, MD, a physician liaison with the Baptist Medical Group who focuses on patient-centered care, speaking at the Healthcare Information and Management Systems Society (HIMSS) conference, held this year in Orlando, Fla.
Oldenburg and Nieder cited numerous studies which have shown that measurable clinical improvements are seen in patients who share their own stories of dealing with the clinicians caring for them. 'The speakers emphasized that patients are not the only ones to benefit when a healthcare organization's culture supports the practice of caregivers and patients really talking in a genuine way. Oldenburg and Nieder also cited studies showing decreased burnout in physicians who connect meaningfully with their patients.
"Illnesses unfold as stories and physicians need to learn how to listen to those stories," Oldenburg said. She said it also matters that healthcare providers and organizations make use of digital tools to capture patients' stories.
Everyone does better when patients feel heard
Nieder cited a 2012 study from researchers in Italy that looked at diabetic patients and asked those patients to rank their physicians for their degree of empathy. The results showed that patients who ranked their doctors as being more empathetic had better control of their disease. She also mentioned a 2009 study from researchers in Wisconsin looked at patients with colds. Patients in the care of physicians who they felt had really listened wound up having fewer symptoms and colds of shorter duration. While she acknowledged that many problems in healthcare settings today fuel burnout, she said, "Having that connection with your patient will act as an antiburnout pill."
The speakers both discussed current situations that stand in the way of physicians being able to listen closely to patient's stories. Nieder described her own frequently "distracted doctoring." This is caused by the fact that doctors try to listen but are also entering data at the same time, "typing and clicking and doing orders that take you away from the patient." It's also because doctors know they have "24 other patients waiting to be seen," and that knowledge itself is highly distracting.
Oldenburg observed that when patients must see a number of different specialists for care, "the gestalt of their story gets lost in individual data points." She described a woman with a difficult-to-diagnose autoimmune disease who was sent to one physician after another, in a variety of specialties. "Each specialty only looked at the markers for their specialty," said Oldenburg. In this case, many important clues about the woman's disease got lost in the protracted, fractured process.
Both speakers encouraged clinicians to use Open Notes, a movement that allows patients to have full access to their doctors' notes about them. Currently, Oldenburg said, 11 million patients have such access. The Robert Johnson Wood Foundation is one of the organizations supporting a shift toward Open Notes. Oldenburg said, "The outcomes are looking very good for patients [with such access] having a sense of being in control and feeling as if they have more information to take better care of themselves." She said the data also shows positive impacts on quality and safety, when Open Notes are used.
According to Nieder, the settings on her notes arranged so that her patients do have access to them, but that she has spoken with many doctors who didn't even realize that they had the option. She advised doctors to ask their IT department how to arrange matters so patients can read their clinical notes.
Nieder recalled a mentor who had told her long ago, "If you take care of your patients, they will take care of you." She said that this had in fact proven true, and that when doctors listen to their patients and include them as partners in their care, those same patients are the ones who send those doctors other patients for whom to care.