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Generalist physicians’ challenges in understanding specialists’ clinic notes
  1. Bryan S Lee1,2,
  2. Jared W Klein3,
  3. Natalia V Oster3,
  4. Joann G Elmore3
  1. 1 Altos Eye Physicians, Los Altos, California, USA
  2. 2 Department of Ophthalmology, University of Washington, Seattle, Washington, USA
  3. 3 Department of Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Joann G Elmore, Department of Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359780, Seattle, WA 98104, USA; jelmore{at}, jeadmin{at}

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Millions of patients now have online access to their full electronic medical record, including the clinic notes from general and specialty physicians.1–4 At our institution, all clinic notes have been accessible to patients via a secure patient portal since October 2014,5 Subsequently, some patients are now asking their generalist physicians to answer questions about subspecialists’ clinic notes.

We conducted the first known survey to assess general physicians’ self-assessed understanding of specialty ophthalmology clinic notes. While general physicians’ understanding of patients’ eye care issues has substantial clinical relevance, we hypothesised that eye clinic notes might be challenging for primary care providers to understand.

We administered a print survey to internal medicine interns, residents, fellows and attending physicians at the University of Washington. Participants were recruited at a grand rounds presentation and an outpatient clinic.

The survey included three questions about engagement with and understanding of ophthalmology notes and two questions self-rating their understanding of sample ophthalmology clinic notes.

Of the 59 responding physicians, the majority reported trying to …

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  • Contributors BSL and JGE designed data collection tools, monitored data collection for the survey, wrote the statistical analysis plan, cleaned and analysed the data and drafted and revised the paper. JGE is the guarantor. JWK and NVO acquired, analysed and interpreted the data. All authors drafted the manuscript. JGE and BSL obtained the funding. NVO provided administrative, technical and material support. JGE and NVO supervised the study. All authors contributed to the overall conception and design of the study and revised the manuscript for intellectual content.

  • Funding The University of Washington Department of Ophthalmology is supported by an unrestricted grant from Research to Prevent Blindness. JGE’s research is supported by the Robert Wood Johnson Foundation, Gordon and Betty Moore Foundation, Peterson Center on Healthcare, and Cambia Health Foundation.

  • Competing interests None declared.

  • Ethics approval University of Washington Human Subjects Division.

  • Provenance and peer review Not commissioned; internally peer reviewed.