When physicians share notes with their patients

first_imgPatients across the country are voicing a growing desire for greater engagement in, and control over, their own medical care. A new study led by Beth Israel Deaconess Medical Center (BIDMC) will examine the impact of adding a new layer of openness to a traditionally one-sided element of the doctor-patient relationship – the notes from patients’ doctors’ visits. Funded through a $1.4 million grant from the Robert Wood Johnson Foundation (RWJF) Pioneer Portfolio, the 12-month OpenNotes Project will bring together approximately 100 primary care physicians and 25,000 patients to evaluate the impact on both patients and physicians of sharing the comments and observations made by physicians after each patient encounter. Physicians and patients at Geisinger Health Systems in Pennsylvania and Harborview Medical Center in Seattle will also participate in the 12-month trial.“Patients remember precious little about what happens in the doctor’s office,” says Tom Delbanco, a primary care physician at BIDMC and the Richard and Florence Koplow-James Tullis Professor of General Medicine and Primary Care at Harvard Medical School. “We expect OpenNotes will improve patient recall, help patients take more charge of their care, and offer an opportunity for avoiding potential medical errors as patients and families monitor and think about their care in a much more active and knowledgeable way.”That premise is based in part on a recent study by Delbanco and Jan Walker, an instructor in medicine in the Division of General Medicine and Primary Care at BIDMC and Harvard Medical School. Reporting in the Journal of General Internal Medicine, Delbanco and Walker found that consumers want full access to all of their medical records and are willing to make some privacy concessions in the interest of making their medical records completely transparent.The study also found that, going forward, consumers fully expect that computers will play a major role in their medical care, even substituting for face-to-face doctor visits.“We learned that, for the most part, patients are very comfortable with the idea of computers playing a central role in their care,” Walker says. In fact, patients said they not only want computers to bring them customized medical information, they fully expect that in the future they will be able to rely on electronic technology for many routine medical issues, she says.“Doctors have strong differences of opinion about this, but there is almost a religious character to the debate – it’s uninformed by evidence,” says Stephen Downs, an assistant vice president at RWJF and member of the foundation’s Pioneer Portfolio, which supports innovative ideas and projects that may lead to important breakthroughs in health and health care. “It’s a subtle change – but it could reposition notes to be for the patient instead of about the patient, which might have a powerful impact on the doctor-patient relationship and, in the long run, lead to better care.”To collect evidence, physicians and patients will fully share, through a simple one-step intervention, all encounter notes. By contrasting the experience of trial participants with unenrolled physicians and patients, the researchers hope to measure the impact of access to the notes through online surveys of both doctors and patients.“While this intervention potentially could disrupt the current flow of primary health care, it holds considerable potential to transform the doctor-patient relationship,” says Delbanco. “By enabling patients to read their clinicians’ notes, OpenNotes may break down an important wall that currently separates patients from those who care for them. It may promote insight and shared decision making by bringing closer together the unique expertise of the clinician and the unique understanding of himself or herself that each patient possesses.”last_img read more

I’m not a nice guy, will sledge Virat Kohli if needed: AB de Villiers

first_imgDismissing popular perception, AB de Villiers said he is not a nice guy on the field and, if required, can go to any extent in sledging and get someone like “Virat Kohli off his game by talking about the little flaws” in his batting.Set to play in his landmark 100th match in the second Test against India here on Saturday, the South African batting lynchpin, perceived to be a friendly player among cricketers, said he is not a nice guy once he enters the cricket field.Also read: Don’t give a damn about 100 Tests, says AB de Villiers”I’m not a nice guy on the field. I want to win games. I’ll do whatever it takes for us to win games of cricket. If I have to sledge, I’ll get involved like that. I’ll try and intimidate a player if I have to. I’ll try and get Virat off his game by talking about his technique and little flaws. I don’t mind doing things like that, whatever it takes to win games of cricket.”I’ve never really respected a guy who’s been a ‘nice guy’ on the field. I want opposition to be hard, to play to win games for their team. Off the field, I try to be a good human being and it’s got nothing to do with cricket. I know my role in the side and that’s to win games for my team. A lot of times I don’t have to be a nice guy to do that.”advertisementDe Villiers said he tries to be a good human being off the field.Also read: It’s advantage India for second Test, says Pujara”Off the field, I try and be a good human being. It goes a lot deeper than that; it’s got nothing to do with cricket.”Talking further about his 100th Test, the South African said he would have been happy to play the match at any venue across the world.”I’ve never been very fundamental about these kinds of things. I don’t care where I play my 100th Test. I would have been okay had it been in Bangladesh as well. I didn’t mind where I played my 50th; I don’t mind where I play any of my Test matches,” de Villiers said.”Representing my country is a great honour. But I have to add that playing in Bangalore is really special for me. I love coming here. I enjoy touring India in general. I love coming here for the IPL,” he said.Asked about comparisons with West Indies batting legend Viv Richards, he said he never puts himself “up on the pedestal”.”I have watched him (Richards) play a little bit, some of the highlights, and he was an incredible player. I don’t like to be compared to other players. I never put myself up on the pedestal. I just enjoy the game of cricket. I know I’ve been playing well this year and I’d love to extend that run of form. But more importantly, I’d like to have an impact on us winning cricket games.”I’d like us to win this Test. That’s the only focus I have at the moment. I know it’s my 100th Test match. My current form … people are comparing me to other players, but all I really want is for us to win games of cricket.”The explosive batsman said he has many special moments to savour in his illustrious career.”My mind goes to a lot of series victories away from home — couple of times in England, couple of times in Australia. We’ve had a few good Test series here — haven’t won it yet but a couple of draws which was big time against what people expected us to achieve.”Lots of Test matches come to mind, obviously the Sri Lankan Test series win as well.”Lots of away victories. At home, it’s also special to play in front of your home crowd, but people don’t expect you to do well away from home and we’ve had a really good record,” he said.”It tells a story about the character we have in the side, the resilience — not only as a cricket team but a nation as well. Makes me very proud to have been part of a Test cricket team touring all over the world and winning games. We’re in India now and it would be another good story to come back from this (with a win).”Asked about his uncanny ability to switch from one from of the game to another, de Villiers said he never found it tough.advertisement”I’ve never thought about it too much and I’ve never found it that difficult. I like the challenge of changing. I’ve always enjoyed challenging myself, adapting to different conditions — challenges in life and cricket. I don’t mind change. I believe it brings out the best in people if you’re accepting it. I like changing formats and the challenges it brings to your mental strength. That’s what it’s all about.”last_img read more