Abstract
A 31-year-old woman with a nursing background and loin pain-hematuria syndrome undergoes a renal auto- transplant. During her recovery and prolonged hospitalization, her care team becomes increasingly concerned about a factitious disorder. With the roll-out of the 21<sup>st</sup> Century Cures Act Final Rule, which involves direct sharing of medical records with patients in real time, multiple inpatient care teams leave their clinical suspicion out of their progress notes for fear of damaging the therapeutic relationship.
Highlights
In 2016, expansive healthcare legislation known as the 21st Century Cures Act was passed in the United States
We present a patient with chronic pain secondary to loin pain-hematuria syndrome (LPHS) along with suspected comorbid factitious disorder who openly viewed and discussed her electronic medical record clinical notes during her hospitalization
While clinicians may express concern about disruptions to the therapeutic alliance, many patients articulate significant increases in satisfaction associated with the “Open Note Rule” [7,8]
Summary
In 2016, expansive healthcare legislation known as the 21st Century Cures Act was passed in the United States. While many clinicians recognize that the ruling may improve patient participation, self-advocacy, healthcare literacy, medication adherence, and even accuracy in charting; at the same time, unintended negative impacts on patient outcomes are of concern [1].
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