Patients are increasingly able to read the office notes written by their primary doctors about their medical condition, but should they also be allowed to read what their mental health providers say about their psychological condition?
I believe the answer the answer is yes, as my colleagues and I discussed in a recent issue of the Journal of the American Medical Association. We have recently begun a pilot study in the ambulatory psychiatry clinic at our hospital to explore the risks and benefits of this intervention.
Clinicians have understandable anxiety about sharing their assessments of patients’ thoughts, feelings, and behavior. What feels to the clinician like an objective evaluation might feel to the patient like a dismissive judgment. This is particularly true with regard to personality assessment.
Clinicians may reason as follows: although my patient with a stable pattern of maladaptive functioning feels only misery, if he sees that I think this is due to borderline personality disorder, he might feel blamed and humiliated.
However, we believe that allowing patients to see that we feel that their problematic behavior results from an understandable condition—that it is not their fault and they are not alone—in fact allows for better mutual understanding and better treatment.
This approach can help to destigmatize many conditions: the addict who feels like a failure; the patient with panic attacks who fears “going crazy;” the depressed patients who feels “weak and lazy.” Even delusional schizophrenic patients can be reassured that their health care provider can “agree to disagree” about the truth of their (faulty) convictions.
Transparent mental health notes further incentivize clinicians to highlight patients’ strengths as well as their vulnerabilities. Allowing patients to fact-check clinician notes could promote clinical accuracy.
All interventions have side effects and are sometimes contraindicated. In these likely rare circumstances a clinician might decide that the risks of a transparent mental health record exceed the benefit to the patient, and could choose to withhold a note from a patients’ view.
Overall however, we think that transparent mental health notes offer an exciting opportunity to improve patient care.
Michael W. Kahn, MD, is a psychiatrist at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and an assistant professor of psychiatry at Harvard Medical School.