Psychotherapy can sometimes be a little frustrating. You sit in an office, share your life with your therapist, but get only a small window into what your therapist thinks about you. They share their insights in little dribbles that come out from time to time.
When what we really want is the whole kit and kaboodle.
So an interesting experiment at Beth Israel Deaconess Medical Center in Boston is raising eyebrows — giving patients electronic access to their mental health notes.
Jan Hoffman over at The New York Times has the story about the experiment, which is only open to about 10 percent of patients who are seeing a psychiatrist or mental health professional at the hospital.
But not everyone is on board:
“Diagnostic language is used among doctors to describe features of a mental illness,” said Dr. Brian K. Clinton, an assistant professor at Columbia University Medical Center who has written about sharing records. “I would be willing to discuss with a patient what I think. It’s a better way to communicate than a note I wrote for other doctors.”
But Dr. Michael W. Kahn, an assistant professor of psychiatry at Harvard Medical School who wrote about the project in JAMA, said that if the therapist explained the diagnosis, some patients might feel relieved, knowing their behavior fits a pattern that others also experience.
What’s not mentioned is that most mental health progress notes are rarely as detailed or insightful as to what patients might expect — or want.
For instance, one common progress note format is called SOAP:
- Subjective – What’s the patient say he or she is feeling or experiencing in the past week
- Objective – What are the professional’s view of the patient’s mood, appearance, etc.
- Assessment – What’s the progress being made in the patient’s diagnosis and treatment? Side effects of meds? If weekly mood scales or other such measures are administered, they’re also noted here.
- Plan – What’s the progress being made on the specific goals and objectives in the patient’s treatment plan?
Another is called DAP:
- Data – What major topics were discussed in the session? Provide only generalities, not specifics.
- Assessment – What’s the patient’s current status and functioning?
- Plan – What’s the progress being made on the treatment plan? Any homework assignments? Any recommendations for the future?
You get the idea… a progress note for a person with a mental illness is not a free-form, insight-driven therapist rambling. Rather, it’s a medical note to help track a patient’s progress in their treatment.
At one time in history, progress notes may have been written solely so that other professionals could understand where that patient is at in their treatment. However, for the past few decades, most professionals are taught that progress notes are not just for other professionals, but for everyone — including the client.
As a rule, mental health professionals are taught to document the minimal necessary in the patient’s medical record. Progress notes can often be nothing more than a few sentences, covering the major bases of discussion. Rarely do they offer much in the way of therapy — or a therapist’s — insights.
So all of the hand-wringing and concern involved in giving patients access to their own progress notes is likely much ado about nothing. Few progress notes offer nearly as much information as patients believe they contain. Fewer still offer something that the patient themselves don’t already know.
These notes don’t offer access to secrets the therapist is holding back from their patient. They won’t tell you what your therapist is secretly thinking about you. Instead, they offer far more mundane details of the patient’s progress in their treatment, using well-worn formats that are designed to limit subjective information.
Of course patients should have ready access to their progress notes, no matter what their illness. It’s such a common sense idea, I’m surprised this is only an “experiment” at Beth Israel — and not already the status quo.
Read the full article: What the Therapist Thinks About You