越來越多的病人開始讀懂醫生的潦草字跡

A DOCTOR who sees a child with an odd appearance might write “FLK” in his notes. Short for “funny-looking kid”, it is meant not as an insult, but as a reminder to watch for slow growth and mental retardation, which can accompany physical abnormalities. Later he may add “FLD”: funny-looking dads tend to have funnylooking offspring. But such candour may become a thing of the past as more hospitals and clinics make doctors' notes available to patients and their guardians.

面對一個長相奇特的孩子，醫生會寫下“FLK”的字跡。“FLK”是“長相滑稽的孩子”的意思，此意並非是一種人身攻擊，而是暗示身體生長緩慢或智力發育緩慢，也會伴隨生理異樣。之後他加上“FLD”：長相滑稽的父親更易育有長相滑稽的後代。但隨着醫院和診所要求醫生以病人和其監護者能讀懂的方式書寫，這種直白會成爲過去式。

The trailblazers see open notes as a way to engage patients in their treatment, and to keep their other carers informed. A study in 2012 in the Annals of Internal Medicine of 105 American doctors who shared their notes with 20,000 patients backs this position. Over four-fifths of the patients who visited their doctors in the following year had looked at their notes. In a survey, about three-quarters said they felt more in control of their care. Few said the notes were confusing, offensive or worrisome; nearly all wanted access to continue.

病人的首個醫生將病歷上的信息視爲參與治療的一種方式，讓之後的醫生獲得信息。2012年，《內科醫學年報》做了一項調查，105名美國醫生有這種行爲，涉及20，000個患者。一年內再次就診的患者中，超過五分之四看到了首位接待他的醫生寫下的信息。一項調查表明，約四分之三的患者稱，這種信息共享讓他們更感安心。很少有人認爲醫生的字跡難以辨認、有冒犯性或是令人不安的。幾乎所有人都想繼續治療。

The doctors who took part reported little change in their behaviour and little extra work, though some did alter the way they wrote about charged topics such as cancer, mental health, substance abuse and obesity. As for FLK and other medics' slang, Tom Delbanco, one of the study's authors, says: “Good doctors don't label things; good doctors describe things.”

參與該調查的醫生，很少特意改變行爲和畫蛇添足，雖然在涉及癌症，精神病，藥物濫用和肥胖等問題時，確實有部分醫生會換個寫法。該調查的作者之一湯姆·德百考稱，對於FLK和另外的醫學俚語，“好醫生不是給事情定義，而是描述事情。”

Some 3m American patients now have easy access to their doctors' notes, including those at leading institutions such as the Cleveland and Mayo clinics, and 1m of those cared for by the Department of Veterans Affairs. This is good business as well as good medicine. Patients with Kaiser Permanente Northwest must register on its website in order to read their doctors' notes, which makes their care easier to manage and lowers the chance that they will switch to a competitor.

如今，300萬名美國病人能夠輕鬆讀懂醫生的字跡，其中包括像Cleveland 和 Mayo 診所這樣的領先診所的醫生的字跡。他們當中，有100萬名病人由退伍軍人事務部照顧。這對商務和醫學都是好事。凱撒醫療機構的病人需在網站註冊，才能讀醫生的字跡，這使得他們可以更輕鬆的掌控他們的治療，降低他們流失到競爭對手的醫院去的機率。

Health administrators elsewhere are watching with interest. Some British doctors have already opened their notes and more are likely to follow suit if the National Health Service keeps its promise to give all patients online access to their records by next year. The next step, says Dr Delbanco, is getting patients to contribute to their records. Funny-looking doctors take note.

海外的醫療管理者頗有興趣的關注此事。一些英國醫生已開放他們的字跡，如果國家衛生服務局明年承諾讓所有的病人看到他們的醫學記錄，那麼更多的醫生將開放字跡。德百考說，下一步是讓更多的病人看到他們的醫學記錄。記錄長相滑稽的醫生可要注意了。