Essentially, having access to your own medical records is a good thing.

The government have made it clear that this is now a priority and intend to work to make online access for patients so that patients can freely access their own notes.

However: I think as it stands it’s unlikely to be very helpful. During consultations, I try and keep the screen facing both parties so that we can both see what’s been written; I often write referral letters (time permitting) when the patient is there, and not infrequently will print things out so that the patient has a copy of a useful document.

The security problem is probably one that can be overcome, but there is never going to be a no-risk situation, and so it’ll be very important that people can choose not to allow their notes to be accessible online, if their priorities are security before access. In any case, I think it’d be better to use memory sticks rather than internet access, so that the patient is in control of the data, rather than a third party.

The other problem is that currently, I am not writing up notes particularly for the benefit of patients. So I use abbreviations, I put in reminders for myself – often to do with risk-management, when I’m considering worst-possible diagnoses. I have no problem with patients reading what I’ve written – at all – but I would need to be able to explain what I’ve written and why. There are as many types of note writing as there are doctors, but I’m a bit worried that access to notes without on-hand explanation and discussion might cause unnecessary worry.

The way to do patient access properly is best seen in Renal Patient View, which is an exemplary example of patient access to notes. First, patients opt-in. If they don’t want access, their notes are not placed on web access. Second, it comes with full support – so that explanations are given, together with information about medicines and terminology. It’s a proper shared record, and it took time and effort to do (and cost minimal money, as it was set up by clinicians who realised what the priorities were and worked hard to keep costs down.)

The last problem is this. It’s rare that I have a patient who wants free access to their notes as a priority above other pressures, for example, shorter waiting lists, or prompt treatment in hospital. Most people are satisfied by the shared reading and recording of information in the consulting room. I’m concerned that this priority is political rather than clinical. I’m concerned that just as we are making drs and nurses redundant, we are putting resources to a media-friendly idea that may not be needed and which is a vote winner rather than a useful clinical service.