Clinical ethics consultation documentation in the era of open notes.

BACKGROUND: In 2021, federal rules from the 21st Century Cures Act mandated most clinical notes be made available in real-time, online, and free of charge to patients, a practice often referred to as "open notes." This legislation was passed to support medical information transparency and reinforce trust in the clinician-patient relationship; however, it created additional complexities in that relationship and raises questions of what should be included in notes intended to be read by both clinicians and patients. MAIN BODY: Even prior to open notes, how an ethics consultant should document a clinical ethics consultation was widely debated as there can be competing interests, differing moral values, and disagreement about pertinent medical information in any given encounter. Patients can now access documentation of these discussions through online portals which broach sensitive topics related to end-of-life care, autonomy, religious/cultural conflict, veracity, confidentiality, and many others. Clinical ethics consultation notes must be ethically robust, accurate, and helpful for healthcare workers and ethics committee members, but now also sensitive to the needs of patients and family members who can read them in real-time. CONCLUSION: We explore implications of open notes for ethics consultation, review clinical ethics consultation documentation styles, and offer recommendations for documentation in this new era.

An Essential Hospice Experience Course for Preclinical Students.

This article proposes an undergraduate hospice experience course as a new model of experiential learning, one that would provide effective preparation for students entering medical school and that would help them become better doctors. Medical humanities scholars scrutinize narrative models for inspiration and understanding, in order to develop teaching strategies that recognize the importance of the end of life and caring for patients appropriately. The written narrative, however, should not stand alone: the spoken, or shared narrative-the story as it is told by patients, friends, and family members-is equally important. Therefore, the authors urge that undergraduate premedical students spend time with patients who are dying. The Medical Humanities program at Indiana University-Purdue University Indianapolis (IUPUI) offers an experiential learning course that couples student volunteer hospice service with reflective analysis of the relationship between the end of life, medicine, and patient care and that emphasizes the value of the shared story. This article examines the development and implementation of the upper-level undergraduate Hospice Experience course as an invitation to a larger conversation about this important topic.