by Gwen Darling

At the time I didn't know it. But in hindsight I'd have to say my most valuable class in high school was Mrs. Alva Johnson's typing class. Not only did she teach me a skill I've counted on virtually every day since then (and there have been quite a few days since then!), but it led me to my first part-time job in the healthcare industry as a medical transcriptionist for a solo practice physician who specialized in geriatrics.

I loved this job, largely due to the doctor's personal approach.

[More:]

At 16, I hadn't heard of most of the "old people" ailments and conditions that flew out of Dr. Columbus' mouth as he spoke into the Dictaphone. And typing the technical jargon over and over could get tedious. But he kept it interesting by documenting his personal notes for the record, as well.

I soon learned the story behind 87-year-old Mr. Goodruff's weekly B-12 shots (young girlfriend), the fact that the very proper Mrs. Peterson had suffered many sleepless nights over her daughter's new career choice (stripper), and that grouchy old Mr. Neumann kept $40,000 in cash stuffed in his box spring. All of these juicy tidbits were fascinating to me. Up until then I'd been just a Catholic girl who led a pretty sheltered life.

But Dr. Columbus didn't share these personal notes with me to be entertaining. Instead, he documented these conversations so that he could be a better doctor, treating the "whole" person.

And the patients?

Although they didn't know that Dr. Columbus took careful notes of what they considered to be non-medical details, upon their next visit they were always thrilled when he "remembered" the girlfriend, the stripper, or the box spring.

So, I had mixed emotions when I read this week about an "Open Notes" project that is beginning to test if patients fare better when given fast electronic access to more of their medical chart-specifically focusing on the detailed notes that doctors record about you during and after every visit--including the juicy tidbits.

Although I'm all for transparency, and a patient's right to know, I'm not so sure how I feel about this. And according to the article, I'm not the only one who isn't sure if full disclosure is a terrific idea or a disastrous one.

To find out, three large health centers--Beth Israel, the Geisinger Health System in Pennsylvania and Seattle's Harborview Medical Center--are enrolling 115 doctors and up to 25,000 patients in the Open Notes study.

For a year, participants will get an email after each office visit saying their doctor's note is available through a secure online portal. Researchers will track if patients read it and find errors, and how they use it. Doctors' habits are being tracked, too, to see if they censor themselves or write more patient-friendly notes.

Hmmmm. Dr. Columbus is no longer with us, but I can pretty safely bet that he would feel the need to sterilize his notes if he knew his patients would be poring through them later. On the flip side, however, advocates for this open approach argue that patients who are given an uncensored account of their doctor's opinions tend to be more compliant. Learning that your doctor has categorized you as obese in his notes might have a greater impact than simply being told to lose some weight.

The project's complete abstract gives a fuller overview and spells out the perceived pros and cons of open notes. I, for one, will be following this project with great interest. What's your take on this?

Gwen Darling is the CEO of Healthcare IT Central, a career center for healthcare IT job seekers and employers. She's also the founder and editor of Healthcare IT Today, a blog about healthcare IT career development, and writes and blogs for Healthcare Informatics magazine. She can be reached at GwenDarling@HealthcareITCentral.com.