Why you need to check after-visit medical summaries

On a recent visit to a local specialist in Marin, I arrived home to an email that my after-visit note was ready for me to view. These days, most health care systems have portals that patients can access to ask questions, check test results, manage appointments and yes, read their after-visit summaries.

Curious like most of us are about what my medical record says, I signed into the portal and read my information. There, I learned that I’d just undergone a thorough evaluation typical of this specialty (I had not), had been advised with regard to my diet and exercise routines (I had not), and had a couple of new diagnoses in my patient history that I had not mentioned and did not have.

I would say that the inaccurate information surprised me, but it did not. Many times, I’ve checked after-visit summaries and other notes and found interesting misstatements, wrong diagnoses and even claims about exams that weren’t conducted. In one case for a family member, there was documentation of having been seen by two doctors whom we’d never laid eyes on.

Instances like these are common enough that in one 2016 study, 29% of patients reviewing their information found errors.

Some of these errors are the result of the quirkiness of electronic health records charts. Elements sometimes are completed by rote whether they took place during a brief clinic visit or not. An example is the repeated note I see in my medical records that I’ve had many, many discussions with clinicians regarding my diet and exercise practices. I have not.

As for the routine exams that never happened, complete with reports of how I fared on them — that explanation is a little less forgiving. The misdiagnoses could be a problem with hearing or interpretation (I perhaps am a low talker), leading to repeated wrong entries regarding, for example, the history of my (long-gone) thyroid.

In some cases, I follow up. I send a note clarifying diagnoses, in particular, because I want my medical record to be accurate. I don’t want someone thinking that my thyroid disease was a case of underactive thyroid when it was hyperactive, because the causes and effects in the long and short term are different between them, as are risks for other conditions.

Calling out entries for exams that never happened or doctors I never saw is a different matter. I’ve consulted with clinician sources about what might explain these situations. They suggest various potential reasons, from the casual oversight to the potentially criminal.

My reason for reviewing my health records isn’t just because I am looking for opportunities to find errors. As these records increasingly come into sync with each other across systems — a slow process as rickety as some electronic health record systems themselves — health care providers will be able to review my history while considering new health problems that may have brought me to them. I don’t want discrepancies between what I’m telling them and what that record says because, well, my error could be chalked up to a lack of understanding of medical terms, a fading memory, or a misunderstanding of my own history. For me, that means that the time for corrections is as soon as they enter the record.

Despite the potential for misunderstandings and errors, though, a 2019 study found that only about two-thirds of people reviewed their after-visit summary after getting a notice that it was available. These summaries could fill the gap in communication between doctor and patient, which studies suggest commonly leaves with one or the other coming away from a visit with a misunderstanding.

This process has become increasingly important to me as I age and accumulate, let’s say, related issues (lumbar spine, I am looking at you, or would, if you would let me). It applies for anyone. I’ve encountered similar issues in the health records of my children, including vaccine histories that didn’t make it during one merge between electronic health record systems, incorrect medications listed and an allergy that was misstated.

When I have found factual issues, a simple email through the portal has almost always been a straightforward way to get the record updated. The portal we use most often now offers us the opportunity to review our overall medical record and flag anything that is no longer current or that is incorrect.

It can be difficult to remember to follow up on these after-care summaries in the middle of dealing everything else in our busy lives. But as tempting as it may be to rely on professionals to never misstep, they are busy and overwhelmed these days, too. In the end, we are responsible for curating our own records and making sure that they are up to date and accurate.

Emily Willingham is a Marin science journalist, book author and biologist. Her Healthbeats column runs monthly. You can find her on Bluesky @ejwillingham or Instagram at emily.willingham.phd.