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Open notes and broader parallels in digital health: a commentary on C. Blease’s ‘Sharing online clinical notes with patients’
  1. Sarah Chang,
  2. John Torous
  1. Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to John Torous, Harvard Medical School, Boston, MA 02115, USA; jtorous{at}

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With more countries implementing Open Notes, the practice of providing patients with unhindered access to their clinical visit notes, research on this practice is finally increasing. Many studies report positive findings, especially around self-reported outcomes, such as feeling more in control of one’s care, increased medication adherence and a strengthened patient–doctor relationship.1

However, comparatively less research has been done on the potential ramifications that may also arise from Open Notes. Blease’s recent article underscores this and demonstrates why Open Notes must also be considered in terms of nocebo effects, negative side effects that arise from negative expectations.2 The article presents a compelling and well-thought-out argument for how nocebo effects may vary across different populations by linking patient–clinician communication inequalities with and by presenting preliminary evidence of nocebo effects. Blease’s argument does not detract from Open Notes, but rather takes a balanced approach by imploring us to consider both risks and benefits while striving to minimise the former through clinician training.

The presented ethical implications regarding Open Notes are highly relevant to the entire space of digital health. With the rapid proliferation of health smartphone apps and wearables brimming with convenient health tracking technology, there is broad enthusiasm for using technology to increase quality of and access …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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