A No Cost Improvement to America's Healthcare System You Can Make
by Francis P. Koster, Ed.D.
In the world of medicine, a 3 year project has figured out that doing something simple increases patient health and satisfaction, while having the potential to reduce the annual cost to society for healthcare by billions of dollars. And wonder of wonders, this does not depend on computers, or insurance policies, or politicians of any stripe.
The concept, called Open Notes, is simple - after each visit to the doctor or hospital, the patient is given a copy of what the caregiver wrote in their chart. It is that easy.
Research shows that most patients forget more than three quarters of what the doctor tells them during the visit. And to top that off, the part they think they remember they often remember wrong. So they get home, their family member says "what did the doctor say?" and their reply is simply not accurate or complete. Open Notes demonstrated that if the patient is given a copy of what the doctor put in their chart, they can study it at home in their favorite chair sharing it with loved ones. Learning goes way up, as does family support for needed changes.
Or not. There you are be sitting robed in wrapping paper with the breeze blowing on your backside - not the best circumstances to learn complicated new stuff, and the doctor is giving you instructions like "Start with this many pills". Then "take this one with food" and "take this one before bedtime" and "don't take aspirin with this one" and "One soda a day gains you a pound a month". No wonder patients get confused and overwhelmed.
One study done on diabetics found that those who took their medication as ordered had to be hospitalized only one forth as often as those who took their medicne correctly 40% of the time!
The cost to patient and health system alike because patients do not follow orders is astounding. For example, one study tracked the percentage of patients who took their medication for diabetis (or not) compared to their hospitalization rate. Patients who took their medication as ordered only half as often as they were told to had hospitalization rates four times higher than those who followed instructions all the time.
Not following doctors orders has a huge cost. The Annals of Internal Medicine reported in 2012 that the cost to the American healthcare system because people with chronic disease did not take their medicine like they were told to is between $100 billion and $289 billion dollars annually! That is billion with a "b" dollars each year - more than 3 times the entire annual budget of the U. S. Marines! 
Before the Open Notes project started, only about half the patients on medications were taking them as directed. After the project started, 60% reported they did a better job following doctors orders when they had the visit note.
Results of another test of the concept published in 2013 found that when patients are given access to their notes electronically over the internet, 92% opened the note to read it. And to further demonstrate how valuable patients find this practice, another group of caregivers who used electronic records and granted access to patients found 99% of them wanted to continue to have this kind of access after a one year trial period. This is astonishing!
Nationally, the Veterans Administration recently granted access to visit notes to over one million of their patients. This will not only improve the health of our veterans, research shows it will help reduce costs for the VA system over time.
Now we just need to invent a better future for everyone.
Here is what you can do for yourself and your loved ones. Before your next exam, either call ahead and tell the doctor you will be asking for a copy of his notes, or ask them at the beginning of the examination. (My advice is to call ahead, so they don't feel caught by surprise.). Then observe how having that information changes your behavior. As your own health improves, you can tell them that they were right all along, and you had been not doing as well following guidance as you should have been. Then thank them for what they do.
Put your heart into it. The American healthcare systems costs much more per capita than what other advanced countries pay, yet our life expectancy is not as long as theirs. As we struggle to fix the system, we should pause and give our caregivers a hug....these are not easy times for them either. Maybe you can dispense a little care giving yourself.
 D.T. Lau, Diabetis Care, September 2004