Open notes in patient care: confining deceptive placebos to the past?

Area of Science:

• Medical Ethics
• Health Informatics
• Clinical Pharmacology

Background:

• Health organizations increasingly provide patient access to electronic health records (EHRs) through 'open notes'.
• This allows rapid, real-time patient access to clinical visit summaries via online portals.
• While patients can request records, open notes offer immediate electronic access, differing from traditional record requests.

Purpose of the Study:

• To explore the implications of open notes for placebo use in clinical practice.
• To examine how enhanced transparency affects placebo prescribing, especially deceptive placebo use.
• To investigate the potential facilitation of placebo and nocebo effects by open notes.

Main Methods:

• Review of current practices and literature on open notes and patient access to EHRs.
• Analysis of survey research on patient understanding and engagement with open notes.
• Conceptual exploration bridging placebo studies, medical ethics, and health informatics.

Main Results:

• Open notes enhance patient understanding of medications and increase engagement with care.
• Transparency introduced by open notes may alter traditional placebo prescribing, particularly deceptive practices.
• Potential for open notes to influence the manifestation of placebo and nocebo effects in patients.

Conclusions:

• Open notes represent a significant shift in patient-clinician transparency with potential impacts on placebo use.
• Further empirical research is needed to understand the ethical and clinical consequences of open notes on placebo/nocebo phenomena.
• The integration of open notes necessitates a re-evaluation of placebo strategies and ethical considerations in patient care.