the Double-Edged Sword of Open Notes: A Clinician & Former Patient’s Outlook on Mental Healthcare Clarity
The push for patient empowerment in healthcare has led to a significant shift: open notes. The idea – granting patients full access to the clinical documentation of their care - seems inherently positive. But as both a Licensed Clinical Social Worker (LCSW) and someone with lived experience navigating the mental healthcare system, I’ve come to understand that this transparency is a double-edged sword, notably when it comes to mental health.
My own journey involved sixteen hospitalizations. I was, as I painfully admit, a “professional patient,” trapped in a cycle I feared would define my life. The thought of accessing my records during that period fills me with dread. What if I’d been confronted with the clinical narrative framing my struggles? Would it have fueled a self-fulfilling prophecy, solidifying the very label I desperately wanted to escape? thankfully, I only gained access to those records after significant progress, after building a life beyond the hospital walls, and with the emotional resilience to process potentially damaging interpretations.
My experience isn’t unique. Increasingly, research highlights the potential harms of unrestricted access to mental health records. A recent study revealed that a staggering 55% of healthcare providers (HCPs) report clients experiencing significant distress after reading their notes. Even more concerning,29% reported clients terminating treatment,and 21% observed negative or self-destructive behaviors following record access. These aren’t just statistics; they represent real people grappling with vulnerable details, often lacking the context or support to process it constructively.
The Shifting Power Dynamic & The Therapeutic Alliance
The core of the issue lies in the inherent power dynamic within the therapeutic relationship. Traditionally, clinicians hold a certain level of expertise and obligation in interpreting and documenting a client’s experience. Open notes challenge this,potentially shifting the balance and,in some cases,eroding trust.
Research confirms this. One study exploring the impact of open notes on clinical documentation found that while many HCPs strive to create more patient-friendly notes, the implementation leads to both objective and subjective changes in documentation practices.The good news? Clinicians are generally attempting to be more mindful of language and presentation. The potential downside? A fear of misinterpretation can lead to overly cautious documentation, potentially hindering the richness and accuracy of the clinical record.
This shift also impacts the therapeutic alliance – the crucial bond between client and clinician.Some clinicians view open notes as an opportunity for collaboration,fostering a more equal partnership. Others fear it could unravel the therapeutic process, particularly if clients misinterpret clinical observations or diagnoses. The study highlighted that open notes are empowering clients, but also affecting how clinicians build and maintain that vital relationship.
Navigating Transparency Responsibly: A Clinician’s Approach
as an LCSW, I believe in transparency, but also in responsible clinical practice. My approach to note-taking is guided by objectivity and a commitment to avoiding assumptions. I focus on documenting what the client states, rather than interpreting why they feel a certain way.
Such as, I would write: “The client stated that she felt sad upon the loss of her cat.” Instead of: “The client was feeling anxious because she had a physics final the next day.”
This distinction is critical. the first statement is a direct quote, reflecting the client’s own experience. The second is an interpretation, potentially inaccurate and potentially harmful if the client doesn’t share that anxiety.
This isn’t about withholding information; it’s about presenting it in a way that minimizes the risk of misinterpretation and preserves the client’s agency in understanding their own experience.
Open Notes Are Here to Stay: A Call for Judicious Use
Open notes are becoming increasingly commonplace, driven by legislation and a growing emphasis on patient rights. Ignoring this trend isn’t an option. Rather, we need to embrace a nuanced approach that acknowledges both the benefits and the risks.
As a clinician, I’m committed to crafting clear, objective, and patient-friendly notes. As a former patient, I understand the potential for harm and the importance of accessing records with support and a degree of emotional stability.
Ultimately, the success of open notes hinges on judicious use. Clinicians need to be mindful of their documentation, and patients need to approach their records with a critical eye, seeking clarification from their providers when needed.
Let’s harness the power of transparency to empower patients, but let’s do so responsibly,
