Physicians are trained to formulate a full roster of possibilities, known as the differential diagnosis, and then to work down the list systematically. But greater record transparency can create greater patient anxiety.
viewership in their districts. They also found that exposure on C-has no measurable effect on legislative efforts—perhaps because such efforts often require detailed deal-making and uncomfortable trade-offs that are easier managed in quiet backrooms. C-, therefore, might not be showing us lawmakers in the wild so much as encouraging them to grandstand to the camera in ways that can be antithetical to the actual work of governing.
“There is a standard view that transparency is all good—the more transparency, the better,” the philosopher C. Thi Nguyen, an associate professor at the University of Utah, told me. But “you have a completely different experience of transparency when you are the subject.” In a previous position, Nguyen had been part of a department that had to provide evidence that it was using state funding to satisfactorily educate its students.
Finn Janning, a Danish philosopher based in Barcelona, studies the gap between self-knowledge and self-deception. Under the guise of transparency, he told me, we can deceive ourselves, reasoning that we are good because we are open about what we are doing. He also noted that transparency is not necessarily a positive motivating force. “Transparency does not lead to you acting better,” Janning said. “On the contrary, you try to fit into the norm. You act in a predictable way.
Medicine is a highly specialized field, and like philosophy it involves the challenge of bridging the gap between experts and nonexperts. Regulations coming out of the Cures Act prohibit “information blocking,” and in effect require that test results and doctors’ notes be released immediately to patient portals. In practice, this means that patients often see results before their doctors do and are presented with a fire hose of raw data, shorn of context.
There are strong ethical reasons, therefore, to pursue transparency in the medical record. But, as Pozen points out, we should not be lulled into treating transparency as a first-order good, like compassion, respect, avoiding harm, or putting the patient first. In a recent survey of more than eight thousand patients conducted by OpenNotes, nearly all the respondents said that they preferred immediate access to their test results, even if their doctors hadn’t yet reviewed those results.
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