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Should Psychotherapists Open Their Notes to Patients?

What can sharing clinical notes with patients add to care?

This blog post was authored by Charlotte Blease, Ph.D., Keane Scholar at OpenNotes, Beth Israel Deaconess Medical Center/Harvard Medical School.

As the coronavirus pandemic continues to disrupt work and personal life, for many social distancing is also exacting a serious toll on mental health. Helping to work around this new reality, increasingly clinicians and patients are availing of telemedicine—the use of electronic communications to replace face to face appointments. Evidence shows that another electronic tool can also help patients feel more empowered, better supported, and more engaged with their care.

A growing body of research suggests that transparent access to the notes that clinicians write, via secure online portals, can help patients feel more control over their healthcare. Now replicated in several large-scale surveys, primary care patients rate online access to their doctor’s notes as “very important” for taking care of their health, better remembering their treatment plans, and better understanding why medications have been prescribed. Contrary to doctors’ predictions, surveys also show that very few patients feel more confused or anxious as a result of viewing their online visit notes.

While new federal legislation unveiled in the US in March this year mandates that doctors must “open” their notes to patients, the new ruling makes an exception if doing so might harm patients. In addition, psychotherapists are exempt: unlike doctors, they are not obliged to share the notes that they write. Should psychotherapy patients also be permitted to access their therapists’ session notes?

A recent study of patients who had access to their therapists’ documentation found that the overwhelming majority believed that access was a good idea and desired that it continue. Furthermore, just like primary care patients, participants rated the practice as important for feeling in control of their care, trusting their therapist, and taking care of themselves. Not all patients, however, report benefits. Some perceived notes to be inaccurate or disrespectful.

So, how should psychotherapists balance risks with respect when it comes to transparency? We suggest that sharing clinical notes in this context will be more challenging, requiring both psychotherapist and patient training. Therapists will need guidance on how to write notes that are clear, empathic, and encouraging. Patients will require advice on how to read their notes and how to constructively raise concerns in therapy sessions. Entrusting psychotherapy patients with greater transparency, however, may help to shed the mystique behind the process and enable persons with mental health problems to feel like grown-up care partners.

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