British midwives don’t “take a patient’s medical history” they “listen to her story”. As Certified Nurse Midwife Holly Kennedy, president of ACNM, highlighted in her qualitative study of “normalized birth” in the UK, this simple semantic difference can lead to a dramatic change in how care is perceived by our clients.
Midwives in the US listen to their client’s stories, but do our clients get the opportunity to review what was “heard” and reflect on their own progress? By sharing a brief summary of their visit, the midwife gives her client an opportunity to review clinical assessments and clarify shared decision making.
This ongoing review of the provider’s narrative not only provides transparency and deeper understanding of the plan of care, but also allows for corrections and clarifications that the client may perceive from her own experience.
Liability and Logistics
Some issues keep many providers from moving towards this model. For instance, regulatory or certification requirements that the midwife retain a complete copy of a medical record for years after care. Also, concerns about the record being used as a legal document leads many providers to be very careful about what gets documented.
This fearful view of the power of the chart, along with the practical use of the chart to provide verification of procedure codes for billing purposes, can be an obstacle to re-imagining what the Institute of Medicine names as the fundamental purpose of the health record-to improve outcomes for the patient.
Sharing That’s Secure And Easy
Though midwives can elect not to use it, Private Practice has based its entire charting management system on the concept of transparency and shared decision making with clients. The collaborative tools like Messages, To-Dos and File Sharing combine in the heart of the system, the Progress Notes (see video below).
Midwives add their notes, include any specific files related to the visit and mark off discussion and decision “to-dos” right in the note. When they post their note to the system, they can send a message to the client or the client can simply log on with a secure account password to see the summary of their visit and expectations for ongoing care.
Clients can’t edit the medical record, but can send a message through the system with questions or clarifications that the midwife can add to the progress note. The culmination of care results in a collaborative document that is greater than the sum of its parts. Not just a clinical reflection of a job for the midwife or a delivery for the mother, but a summary of an experience based on partnership, empowerment, and satisfaction for everyone.
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How to create and share a progress note with clients and colleagues.