• Ethics
• Ethics- Medical
• Primary Health Care
• Quality of Health Care

This article on the potential for patient online records access (ORA) to increase the likelihood of nocebo effects is timely,1 given the recent introduction of full prospective records access for primary care patients in England.2 Blease provides a convincing overview of the evidence for the nocebo effect and examines the complex interplay with health inequities. The article proposes two mechanisms for ORA augmenting nocebo effects through: (A) patients reading about possible negative outcomes of treatments and (B) a negative clinician tone or less supportive content in the notes diminishing patient trust and setting up negative expectations. Blease notes a small percentage of those who had used ORA at least once during the previous year in one study reported feeling more worried about their medications,3 and that those with mental health diagnoses were significantly more prone to this than those without such diagnoses.4

Clinicians are familiar with the ethical dilemma presented here—the need to balance ‘respect for honesty and transparency in patient care with the possibility of harm from nocebo effects’ (p1). The article does not, however, explore clinicians’ potential reluctance to downplay medication side effects for fear of damaging their credibility and negatively impacting on their relationships with patients. It also does not discuss the practice of …