The process is mostly invisible to us when we see our doctors, but the documentation of a patient visit–the recording of the visit’s findings and the doctor’s recommendations–takes about twice as much time as the visit itself. This is because of the way American health care is reimbursed. The more complex the visit, the more complicated the note, and the more the doctor gets paid. As a result, American clinic notes are about four times the length of clinic notes in other developed countries:

Annals of Internal Medicine

Add in the complexity of navigating electronic health records (EHRs), and you have a recipe for physician burnout and patient dissatisfaction. That patient dissatisfaction only compounds when the patient doesn’t believe the note accurately reflects the visit or is outright offended by the content. To get around this, many doctors have resorted to having “scribes” in the exam room, a workaround that seems crude by 21st-century standards but which is generally viewed neutrally or favorably by patients.

But what if we’re overlooking a vast resource in the generation of a comprehensive, accurate clinical record? As we’ve blogged about before, patients now have a legal right to see their medical records free of charge, thanks to the 21st Century Cares Act. Is it possible that we, the patients, could write much of our clinical notes ourselves?

A new study suggests that contributing to your own medical record may not only make you happier but may help your doctor as well. And, if the study’s findings on engagement during clinic visits are to be believed, it may actually make you healthier (although the study is careful not to jump to that conclusion).

Here’s how it went: before visits with their primary care practitioner, a patient portal asked patients in several clinics to submit an unstructured “interval history” of what had happened since their last visit, up to 2000 words (How have you been since your last visit?). Patients were also asked to set an up-to-300-word agenda for the encounter (What are the most important things you would like to discuss at your visit? [list up to 3]). The EHR invited practitioners to incorporate patient submissions into visit notes.

Only about nine percent of visits had patient-generated data at the end of the pilot, but those who did resulted in happy patients. More than 80 percent of patients found the questions “not difficult” to answer, and over 92 percent thought sending answers before the visit was a “good idea.” Most importantly, 68.8 percent thought that submitting responses to the questions helped them prepare for the visit.

Seventy percent of physicians in the study reported that they “usually” or “always” incorporated the responses into visit notes, and almost 90 percent said that the pre-visit information either saved time or was time-neutral for the visit’s length, presumably including documentation time.

I think this has the potential not only to spread out the burden of documentation (something that seems unfair to patients who already pay outrageously high prices for their health care) but to bring the doctor’s goals for a visit more in line with the patient’s. The setting of the agenda for a visit is a sneaky cross-current interfering with the conversation and examination in the exam room. I’ve had patients deny that I’d ever informed them of their thyroid cancer diagnosis, even after multiple visits, surgeries, and treatment with radioactive iodine. I can only guess that this was due to some combination of my own shortcomings and the patient’s distraction by other issues during the visit. And most doctors have had patients slip in covert requests for tranquilizers or narcotics at the end of a visit, only after discussing several other items–an average of three, and rising–during the scheduled time. Such short-circuited behavior, intentional or not, tends to sabotage the entire therapeutic relationship.

To make self-documentation really work, though, it stands to reason that increased healthcare literacy (“the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions”) is a prerequisite. Most Americans are not health literate, but research indicates that people can become so if given the proper tools. One tool we offer at KBGH is Quizzify, a gamified method for increasing patients’ knowledge of health care and their ability to make critical decisions. If you’re interested in learning more, let us know!

As the Medical Director of the Kansas Business Group on Health, I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.