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Open notes in patient care: confining deceptive placebos to the past?
  1. Charlotte Blease1,2,
  2. Catherine M DesRoches2
  1. 1 General Medicine and Primary Care, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Charlotte Blease, General Medicine and Primary Care, Harvard Medical School, Boston, Massachusetts, USA; cblease{at}


Increasing numbers of health organisations are offering some or all of their patients access to the visit notes housed in their electronic health records (so-called ‘open notes’). In some countries, including Sweden and the USA, this innovation is advanced with patients using online portals to access their clinical records including the visit summaries written by clinicians. In many countries, patients can legally request copies of their records; however, open notes are different because this innovation offers patients rapid, real-time access via electronic devices. In this brief report, we explore what open notes might mean for placebo use in clinical care. Survey research into patient access to their clinical notes shows that increased transparency enhances patients’ understanding about their medications and augments engagement with their care. We reflect on the consequences of access for placebo prescribing, particularly for the common practice of deceptive placebo use, in which patients are not aware they are being offered a placebo. In addition, we explore how open notes might facilitate placebo and nocebo effects among patients. Bridging placebo studies with medical ethics, we identify a range of empirical research gaps that now warrant further study.

  • ethics-medical
  • informed consent
  • paternalism
  • personal autonomy
  • primary healthcare

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  • Contributors CB wrote the first draft. CMD contributed to revisions and additions.

  • Funding This work was supported by a John Keane Scholar Award and FORTE (the Swedish research council for health, working life and welfare) (‘Beyond Implementation’).

  • Competing interests None declared.

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