The practice of collaborative note taking is viewed as being one of the more promising ways to address the power imbalances found in service user/ provider interactions. Despite being a Ministry of Health strategic action for many years the practice has not been widely implemented in clinical settings.
From a service user perspective there is certainly a need for improved access to our information. Despite the fact that there seems to be an awareness of the right to request one’s own patient records, it is not specifically encouraged, and the process is by no means straight forward.
Many service users may find that access is discouraged by difficult or obstructive attitudes. Copies of notes are not routinely offered, and response time frames too often reflect the statutory maximum even though digital technology enables a much swifter accommodation.
There is perhaps a perception amongst clinical staff that service users may find reading their notes distressing and that this risk is best mitigated by employing delaying tactics. However this position overlooks the fact that delayed access can be distressing in and of itself.
This perception is however quite revealing, and cuts to the heart of the matter. The way in which notes are currently produced is dis-empowering for service users. Diagnosis labels, amorphous notions like insight (or lack thereof) and references in the third person, all serve to reinforce a perception of unassailable inevitability. There is little scope for disagreement despite the highly subjective nature of these judgements.
Inaccuracies are inevitable when note entries are compiled after the fact yet patient notes are a permanent record. In light of this the ability to review information before it becomes record is a crucial safeguard.
There are certainly challenges ahead for clinicians in finding a new lexicon with which to communicate. Some believe that instead, collaborative notes and a separate set of clinical notes should both be employed, with differing rules and access for each.
Despite the attraction for clinicians of a multi layered record system this temptation is best resisted. There is little point in bringing openness to one setting if inscrutability is created elsewhere. In fact the illusion of transparency is perhaps more of a hindrance to progress than an obvious lack.
Collaborative note taking helps transform the service user from passive referent into an active participant. In the peer support setting where the practice is now most commonly found, the focus is on encouraging trust and mutuality.
This trust is a vital part of the therapeutic relationship. If we are to truly move away from the paternalistic approach of the past then services and clinicians need to allow mental health and addiction service users the same rights regarding their health information as are granted to everyone else.
‘Nothing for us, without us’ is the motto of the service user movement. And quite simply, nothing else will do.
To complete the collaborative note taking survey click here.