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My Book About You

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You have a legal right to read the notes your doctor writes regarding your office visits and your treatment, but few people do it and physicians and clinics aren’t always eager to share. But a test project is underway this summer to break down some of the barriers to doctor / patient communication by making the notes more accessible. The Open Notes Project was described in a Wall Street Journal article yesterday.

Imagine sitting down at the computer a few days after your last appointment so you can explain to your spouse EXACTLY how sick you are by reviewing your doctor’s notes together. Fun! With each passing day, prime time TV fades as an entertainment choice.

Doctors’ notes are said to be as varied as any other kind of writing, sometimes terse and puzzling, other times quite detailed and descriptive, occasionally funny, barbed and lyrical. At the Columbia University College of Physicians and Surgeons there is a technique called the “Atchley History”, which, according to the Annals of Internal Medicine, commands that the doctor’s description be so complete that each patient should “leap off the page”. Leaping off the page might be asking a bit much, especially if you’ve got a new hip or problems involving dizziness. But one thing is clear – If you’ve been to the doctor a lot, there is a hidden book about you, and you’re entitled to read it.

That may be a risky choice. A person’s writing can be revealing in unintended ways, and both patients and doctors have voiced concerns that “Open Notes” could lead to misunderstandings and resentment. But the evidence so far indicates that this level of communication is helpful for both parties.

I’m not so sure. I haven’t seen my doctor’s notes, but I hear he’s a frustrated novelist.

Spawning symptoms and complaints the way a summer thunderstorm drops tornadoes, D trudged into my office today to ask that I examine his eye. His gloomy profile darkened the office door with a heaviness that spoke of larger issues. “Clear my calendar,” I told the receptionist. “It’s going to be a long afternoon.”

They eye was clearly infected. I asked if someone had stuck a finger in there and he proceeded to unpack a tale of woe related to work and God knows how many years of thankless labor with early hours sacrificed in the name of blah, blah, blah.

While he was busy talking I nodded in false agreement and casually examined his mouth. Discolored teeth, too-thin lips and a plump, dappled tongue spat myriad worries in my lap – needless concerns about aging and hairline and skin, skeletal problems, cognitive lapses, and something about a toenail.

I scribbled meaningless squiggles on my pad to reassure him, and then beneath that rat’s nest of illustrated ennui I drew a pirate’s chest, a saltwater soaked lockbox covered with barnacles and seaweed with a big rusty iron padlock, a place to put D’s demented ravings where they could be promptly and permanently forgotten.

It seemed that his infected eye had swollen to twice its original size while we had been sitting there. “You’re going to die,” I wanted to tell him. “We all are. Get over it.”

Would you want to read your doctor’s notes about you?

75 thoughts on “My Book About You”

  1. Good Morning, Babooners!

    This will be a tough one, Dale. And I wonder if some people would want to see their doctor’s notes. “This is all very interesting, Doctor Kingsley, and your development of the central characters is strong. I just wonder . . . WHO is this fat woman who whines so much about petty body issues?”

    I don’t have to pretend my doctor is a novelist. Tim Rumsey IS a novelist, or was. His debut novel, Pictures From a Trip, was a national sensation. Three young men take off for the Great Plains to look for dinosaur fossils. Two are brothers with a complex relationship. Their blind friend Ben comes along “to do the night driving.” It is great read.

    Alas, when Tim went to write his second novel, it wasn’t there. He felt he was trying to milk a stone. One day, to his enormous relief, he announced, “I’m JUST a doctor after all,” and he has gone on to be an exceptionally popular and effective family doc.

    I highly recommend his book, which has long been out of print but can be found here and there. And that obnoxious character with an STD . . . that ain’t me, folks! I didn’t know Tim when he wrote his novel, honestly!

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    2. I’ve read this book, Steve! My brother-in-law raved about it, the music references for one thing, and I finally borrowed it from him. HE’S your DOCTOR??

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      1. Yup. The sweetest doctor in the world. He’s also just a little timid and cautious about certain topics, so I don’t feel I’ve had a good office visit if I don’t embarrass him at least once.

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  2. oh, Dale – if only the many notes i’ve read were as entertaining as yours! thanks.
    nah, i don’t want to read my chart (or now, e-chart). our doctor is pretty open – we talk about cars, politics, and occasionally our health.
    i haven’t seen much humor in chart notes, but one i remember for a hospital patient with a loooong list of possible diagnoses – all quite serious and often abbreviated. the last on the list was GOK. i didn’t know that one. i looked and looked for this mysterious condition – trying to avoid asking the doc (too proud). finally, i gave up and asked and the answer was “God Only Knows.”

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    1. We had a psychiatrist at our agency who would sometimes refer to certain unsavory clients or their significant others as “worthless turkeys”. I don’t think he ever put that in the chart and we never could find the DSM code for that diagnosis.

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    2. Happy belated Anniversary Barb and Steve! I’ve been searching for the perfect gift to complement the new toilet and came across a cute wall hanging. Hope you like it! (I also hope to hell I’ve got this html figured out.)
      privy art

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      1. Dang – I didn’t mean to send double. I forgot to delete the URL I’d copied and pasted beforehand. Maybe the goats would like the second one for their bathroom?

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  3. Rise and Shine Babooners:

    Lovely day out there!

    JS presented in the office complaining of her sad life… the Sacro-iliac pain resulting from an injury in the Boundary Waters 30 years ago, her osteo-porosis, her weight. I said to JS with impatience, “You know the way you are?”

    “Yes?” she replied uncertainly.

    “Well, don’t be that way. I don’t have time for this. You are 56 years old and this stuff happens. Now be off with you. I have insurance forms to complete and they are more important than your trifling life.”

    I exited the examining room, leaving JS to shiver inside the paper robe, tears leaking from her eyes. The nurse soon came to find me at the computer terminal signed on to the insurance site.

    “She won’t leave!” said the nurse. “She removed the robe and is threatening to run down our hallways naked until you address her concerns. She says that will scare anyone. How can I get rid of her?”

    Stay tuned until the next appointment. With psychiatry, of course!

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    2. Thanks STeve. I’ve also been thinking lately Dale, there has to be a novel in this website experience…

      Brilliant, funny, unemployed writer/broadcaster starts a website that attracts quirky baboons. Website takes on a life of its own. The writer’s life unfolds in parallel story lines with a few quirky baboon blog participants. The writer finds a satisfying, lucrative life as a writer/blogger (c’mon, it’s fiction) and writes best-selling novel based on the experience of losing job and the blog that results.

      And they all lived happily ever after.

      Now, I must walk the dog.

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    3. i think a sick blog for those folks exactly would be a huge smash hit. i was in an inlaw situation where prevention magazine and the medical reference books lying about were the status quo. there are people who would love to talk about their ailments and listen to others misfortunes from sun up to sun down. if the doctor didn’t want to listen to peoples whining about their ailments there are lots of options for him/her. filling out insurance forms is not doctoring it is a job for office interns (not medical students but vo tech wannabes)

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      1. A friend on the East Coast met a doctor at a party who told a fascinating story that begs to be made into a movie. He is a black man, very dark in fact, and he looks like a football linebacker. He set up a private practice in a suburb that is almost totally Jewish. Everyone told him, “Bill, that’s suicide. They aren’t going to go to a brother when all the other docs out there are Jewish.” Then Bill began getting patients who were rabbis. They had the same medical problems as other people, including a few they didn’t want publicized, so they were more comfortable with someone outside “the community.” Word got around that Bill was a good doc with religious leaders. Priests and nuns were next, and conservative Jews. Soon Bill had nuns coming in by the busload. He found it was like treating anyone else except these religious folks were mighty slow when it came to getting their clothes off! I think there must be a movie in that.

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  4. Good Morning Notables,

    I didn’t know about doctors notes or that I have the right to see them. My doctor might think some of the things the Dale thinks his doctor might write, but I don’t expect he would write down these thoughts. I would like to see my doctors notes because there might be something there that I didn’t understand or that he didn’t take time to tell me.

    Are there any other situations where I could look at notes that people write about me? Perhaps I should ask to see anything about me our government might have filed away. I hear that since 9/11 there has been a massive increase in so called intelligence collecting. There probably is some interesting reading about all of us in some files created about each of us by agencies that are watching us.

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      3. According to what I heard, the massive increase in “intelligence” gathering in recent years would make J. Edgar’s effort look very small. It is way our of control.

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      1. you are safe then! i did stop for a while on some super liberal blogs calling out for the bushies to be dealt with just because i was concerned about the ramifications. then i decided if i was allowing them to censor me they were winning. now i say whatever stupid stuff comes to mind and if that keeps me from being president so be it.

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  5. my doctor is a homeopathic practiioner who before the first meeting has you fill out a questionaire that asks stuff like would you prefer living by the mountains or by the ocean and insightful stuff like that. the questions she asks when we meet are intended to give her an insight as to issue behind the issue. i would like to look at the notes form the last 25 years to recap the life of tim in a nutshell from a health perspective. that and a dream journal should be about all iwould need to have a clear recollection of what was going on with me at the time.
    i meet with her every 2 or 3 years or on an as needed basis and we talk on the phone regarding symptoms for me or my kids. after spending lots of time at the pediatrician with my two oldest kids 20 years ago we switched to the homeopath and have found ourselves to be the health models for the universe (knock wood) the approach is very nice and works well for us.

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  7. I have frequently had clients who request their records for one reason or another. Sometimes what I have written isn’t particularly flattering, either. I would be paralyzed doing case notes if I worried about the client reading what I had to say.

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    1. I should add that my main goal while doing notes is to justify the treatment as medically necessary so insurance will pay its portion of the bill.

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  8. Here’s a woman who consumes too much coffee, sugar and Leinenkugel, and whose breasts have an inferiority complex.

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  9. I don’t think I really want to know what my doc says about me. Better I continue in my delusions that she thinks I’m a swell human being, if a bit heavy, who only needs to see her very occasionally, and generally with minor complaints (well, except for the toe I broke fighting ninja pirates).

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  10. My favorite doctor (alas, now retired) was a pretty laid back guy, and I’d love to read his notes. He’s the least pompous MD I’ve known, and if he didn’t have an answer to a my question would just say “I dunno.” I was refreshing – must of ’em needed to make up an answers…

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    1. wow, the typos. Last sentence should read: It was refreshing – most of ‘em needed to make up an answer…

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  11. Hello dear Babooners, I’ve missed you!

    I have read oodles of doctors notes and I have never seen one that doesn’t begin “So-and-so is a pleasant __-year-old “. Never.

    (Given the NYT article about misdiagnoses in breast cancer yesterday, that is quite understandable.)

    I am in Malaysia visiting my folks and am finally over the jetlag. The time difference is exactly twelve hours. It is also durian season, which made me think of you all! And in case you are wondering — all we have unpacked in Sudbury are our clothes, toiletries and the bed.

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    1. don’t forget wdwn in there, MN-TX – well developed, well nourished (and just what is that, anyway??)
      and Donna – if you see that your doc has written SOB in your chart – don’t worry. it’s short of breath (well, actually that WOULD worry me more than the personal opinion on my personality 🙂

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    3. what more do you need
      thank you for checking in. i was afraid the websites in sudbury were all broadcasting in canadian eh
      enjoy malasia on your visit.
      are you going to add a durian recipe to the new recipe blog?

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    4. I wondered what happened to you! Thought you were unpacking boxes on the border, being inspected and repacking the car. Then you are Malaysia.. My, My.

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  12. oh, no, really would not want to read the doctor’s notes—falls under the “too much information” category in my world.

    besides, it would probably read something like this:
    highly sensitive patient says she is quitting smoking….again…i think that makes about 12 times…sigh.
    says life and work and current world situation are causing increased depression and anxiety; thinks perhaps an increase in meds is in order. duh.
    otherwise she seems fine…for now!

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  13. I posted this late last night when we found out about my sister-in-law in such tough shape and whom we will go see Friday: five months always in a hospital, a few operations, several bad bleeding incidents, other traumatic moments. Just yesterday a pharmacy tech pointed out she was still being give three blood thinners. Apparently she was all the way through it.

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  14. From the case notes of novelists who were frustrated doctors:

    Orthopedic surgeon:
    It was the best of spines, it was the worst of spines.
    Psychiatrist:
    Patient reports last night she went down to somewhere named Manderlay
    Pediatrician:
    When he was nearly thirteen, my patient Jem got his arm badly broken at the elbow.
    Sports physiologist:
    The knee is a foreign country.
    Psychologist:
    It is a truth universally acknowledged, that a single man in possession of a good fortune, must be in want of a wife–and a good shrink.
    Internist:
    It was a dark and stormy gall bladder.
    General practitioner:
    Elmer Gantry was drunk.
    Physician who does not accept insurance:
    Mrs. Dalloway said she would pay for the procedure herself.

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    1. There used to be a compnay called the Journal of Academic T-Shirts and I may have mentioned this before. (I am not responsible for my mind today.) It had/has fun things on shirts for academics. It had one I used to have that was “The World’s Shortest Novel” composed of famous first and last lines of novels. Started with “In a hole in the ground” and ended with “and so to bed.”

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    2. wow, i wish my goats had a billboard – they do love those high places. thanks for sharing, Steve! we used to live near Roanoke – hearing the farmer speak made me miss the folks down there…..

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  17. Commencement in the Cornfield

    Biking my way into work today,
    I passed a cornfield along the way.
    The tassels erect did now standout,
    Seemingly overnight had begun to sprout.

    Often I had seen tassels in rows,
    But limp and flaccid had hung low,
    From square sides of mortarboards,
    On students now free of umbilical cords.

    So I stopped and stepped into the corn
    The leaves were dry in the early morn,
    And rattled as I stepped through,
    Like paper old and of a yellow hue.

    My commencement address was brief
    So the farmer did not think me a thief.
    “Spread wide your pollen on the winds,
    Forgive self and others for any sins.

    Your life I know will not be long
    But with rain, sun, and earth you will not go wrong.”
    Little more I thought to speak,
    My words may as well have been in Greek.

    A blessing I wish to give
    On all good things God made to live.
    “Grow down roots deep and strong,
    And let wind also carry you along.
    Stand your tassels for all to see,
    And follow your path whatever it may be.”

    On my bike I rode away
    To face another new day,
    What more ever could I have to say.

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    2. excellent clyde,
      your inspiration comes form where you are and this is yet more proof. nice gleening and nice thoughts. well done

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  18. Hello all… I had a dreadful day but reading through all today’s comments have lightened my spirit a little thanks.

    First… I’m sure every doctor I’ve ever seen would have written “Why does she ask so many questions?” on my chart.

    Second… MnTx. A durian recipe would be fabulous as I’ve decided to take your word that they actually taste good. Can you even find durian in a place like the Twin Cities?

    Clyde… if you’re looking for good intelligent t-shirts, try mentalfloss.com, cafepress.com or neatorama.com. I got a great sweatshirt last fall that says “I Survived the Large Hadron Collector. Hooray, no black holes! Go Science!” It’s my favorite.

    Barb — do you think the ihop goats are people-watching?

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  19. Y’all are really on a roll today. Dale’s hilarious poke in the eye bit – a classic case of lemons-into-lemonade, making a great story out of an all too real situation; Jacque’s story; Steve’s story; Lisa’s frustrated doctor novelists; the t-shirts; tim’s athiest dyslexic quip; and the list goes on. Especially good read this late evening while I wait for the rain and slap the mosquitoes that came in with the dogs after dinner.
    Thanks for the entertainment, sorry I have so little time and wit to join in.

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    1. Hi, Connie.
      Tomorrow I have a stupendous announcement on my research into the history of Ol’ Blevens, the namesake of our baboon.

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  20. i think its ok to put it on for us latenighters and then do a cut and paste in the morning. i often read the day befores close while i am digesting the new morning topic but i know not everyone does and sometimes when time is of the essence i don’t either. a skim and smile … respond to today and blow happens on occasion i admit but as a rule it is a slow wake up and opening to the new day reviewing the previous evenings thoughts from this gaggle of blevens or would it be a pride of bevins i know there are options for baboons (troop, flange, congress, tribe) but do we get to pick the group name for a group of blevens? slew,rumpot, covey, kaboodle, bevy ? i do digress. see you in the am

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