Problems with the problem list: challenges of transparency in an era of patient curation

Area of Science:

• Medical Ethics
• Health Informatics
• Patient Advocacy

Background:

• The OpenNotes movement promotes medical record transparency, empowering patients.
• Increased patient engagement leads to more frequent requests to modify clinical Problem Lists.
• Traditional medical paternalism is declining in favor of collaborative healthcare models.

Purpose of the Study:

• To examine the ethical and practical implications of shared decision-making in defining a patient's Problem List.
• To investigate the shifting power dynamics between patients and clinicians in delineating clinical identity.
• To propose a research agenda addressing the evolving roles in patient health narrative construction.

Main Methods:

• Qualitative analysis of ethical frameworks and healthcare policy changes.
• Exploration of case studies illustrating patient-clinician negotiation of Problem Lists.
• Conceptual analysis of physician roles and patient autonomy in the digital age.

Main Results:

• Clinicians face challenges in balancing patient requests with clinical judgment.
• The definition of a patient's clinical identity is increasingly a shared responsibility.
• Physician's role is evolving towards a consultative partnership with patients.

Conclusions:

• Shared decision-making in Problem List creation redefines patient-clinician relationships.
• Understanding these power dynamics is crucial for maintaining physician relevance.
• Further research is needed to navigate the complexities of transparent medical records and patient-centered care.