Patients actively involved in their care demonstrate better health outcomes. Using secure internet portals, clinicians are increasingly offering patients access to their narrative visit notes (open notes), but we know little about their understanding of notes written by clinicians.
We examined patients’ views on the clarity, accuracy, and thoroughness of notes, their suggestions for improvement, and associations between their perceptions and willingness to recommend clinicians to others.
We conducted an online survey of patients in 3 large health systems, June–October 2017. We performed a mixed methods analysis of survey responses regarding a self-selected note.
Respondents were 21,664 patients aged 18 years or older who had read at least 1 open note in the previous 12 months.
We asked to what degree the patient recalled understanding the note, whether it described the visit accurately, whether anything important was missing, for suggestions to improve the note, and whether they would recommend the authoring clinician to others.
Nearly all patients (96%) reported they understood all or nearly all of the self-selected note, with few differences by clinician type or specialty. Overall, 93% agreed or somewhat agreed the note accurately described the visit, and 6% reported something important missing from the note. The most common suggestions for improvement related to structure and content, jargon, and accuracy. Patients who reported understanding only some or very little of the note, or found inaccuracies or omissions, were much less likely to recommend the clinician to family and friends.
Patients overwhelmingly report understanding their visit notes and usually find them accurate, with few disparities according to sociodemographic or health characteristics. They have many suggestions for improving their quality, and if they understand a note poorly or find inaccuracies, they often have less confidence in their clinicians.
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The datasets generated and/or analyzed during the current study are not available.
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The authors thank John Santa, MD, for his valuable suggestions and critique.
Conflict of Interest
The authors report funding from the Robert Wood Johnson Foundation, Gordon and Betty Moore Foundation, Peterson Center on Healthcare, and Cambia Health Foundation. The funders had no role in designing or conducting the study, analyzing the data, preparing the manuscript, or deciding to submit the manuscript for publication. Dr. Bell reports unrelated grant funding from the Agency for Healthcare Research and Quality within the past 36 months.
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Leveille, S.G., Fitzgerald, P., Harcourt, K. et al. Patients Evaluate Visit Notes Written by Their Clinicians: a Mixed Methods Investigation. J GEN INTERN MED 35, 3510–3516 (2020). https://doi.org/10.1007/s11606-020-06014-7