The DOI matches its Crossref record; 41 of the 41 references it cites were found in a registry or an index; none of the 21 sources its claims cite is checked for support yet.
When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship
Open accessAbstract
Background: Patient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals. Methods: Presurveys and postsurveys from 99 volunteer doctors at three US sites who participated in OpenNotes and postsurveys from 4592 patients who read at least one note and submitted a survey. Results: Patients read notes to be better informed and because they were curious; about a third read them to check accuracy. In total, 7% (331) of patients reported contacting their doctor's office about their note. Of these, 29% perceived an error, and 85% were satisfied with its resolution. Nearly all patients reported feeling better (37%) or the same (62%) about their doctor. Patients who were older (>63), male, non-white, had fair/poor self-reported health or had less formal education were more likely to report feeling better about their doctor. Among doctors, 26% anticipated documentation errors, and 44% thought patients would disagree with notes. After a year, 53% believed patient satisfaction increased, and 51% thought patients trusted them more. None reported ordering more tests or referrals. Conclusions: Despite concerns about errors, offending language or defensive practice, transparent notes overall did not harm the patient–doctor relationship. Rather, doctors and patients perceived relational benefits. Traditionally more vulnerable populations—non-white, those with poorer self-reported health and those with fewer years of formal education—may be particularly likely to feel better about their doctor after reading their notes. Further informing debate about OpenNotes, the findings suggest transparent records may improve patient satisfaction, trust and safety.
Overview
CoChat Summary
TL;DR
In an OpenNotes study at three US sites, sharing visit notes with patients did not harm the patient–doctor relationship and was associated with perceived relational and safety benefits. Most patients felt the same or better about their doctor, while about half of doctors reported increased patient satisfaction and trust after a year.
Key findings
- Of 4592 patients who read at least one note, 37% felt better about their doctor, 62% felt the same, and ≤1% felt worse; 7% (331) contacted the doctor’s office about their note, 29% of those perceived an error, and 85% were satisfied with resolution.
- Patients who were older (>63), male, non-white, had fair/poor self-reported health, or had fewer years of formal education were more likely to report feeling better about their doctor; 42%–44% in each of these categories reported feeling better.
- Before OpenNotes, 26% of doctors anticipated documentation errors and 44% thought patients would disagree with notes; after a year, 53% believed patient satisfaction increased, 51% thought patients trusted them more, and none reported ordering more tests or referrals.
- 97% of patients found notes somewhat/very easy to understand, and 95% reported notes always/usually accurately described the visit.
Methods
- Pre- and post-intervention surveys from 99 volunteer primary care doctors at three US sites who completed both surveys, plus post-intervention surveys from 4592 patients who read at least one note and submitted a survey during the 2010–2011 OpenNotes intervention.
- Patient sample was restricted to those self-reporting reading at least one note, verified by portal tracking data; analyses used descriptive statistics stratified by site.
- A multivariable generalized linear model with log link and binary error examined predictors of patients feeling better about their doctor, adjusting for provider and site; SAS V.9.3 was used.
Limitations
- The paper states voluntary doctor participation, limited patient response rate, only three US regions, and predominantly white and female patient respondents, limiting generalizability; one safety net hospital contributed few participants, biasing toward an educated sample.
- The paper states portal data were limited to whether patients clicked to view a note at least once, and number of notes read could not be reliably tracked at all sites.
- The paper states actual claims or lawsuits could not be measured during the study period; the text also makes evident reliance on self-reported survey responses and volunteer participation.
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Integrity signals
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Claims the paper makes
0 Valid · 0 Not valid · 14 Not checked · 62 Own results and interpretations
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Across the three sites, 97% of patients found it ‘somewhat easy’ or ‘very easy’ to understand their notes.”
§ When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship > RESULTS > Reasons for reading notes and contacting the doctor’s office
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“‘To know about my health’ (58%)”
§ When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship > RESULTS > Reasons for reading notes and contacting the doctor’s office
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“‘To be sure I understood what the doctor said’ (55%)”
§ When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship > RESULTS > Reasons for reading notes and contacting the doctor’s office
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, 85% of patients were satisfied with the resolution after contacting their doctor’s office.”
§ When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship > RESULTS > Reasons for reading notes and contacting the doctor’s office
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In total, 18% decided not to contact the office fearing doctor anger or retribution”
§ When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship > RESULTS > Reasons for reading notes and contacting the doctor’s office
plainn = 129- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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Citations
Cites
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Inviting Patients to Read Their Doctors' Notes: A Quasi-experimental Study and a Look Ahead
Delbanco, T., Walker, J., Bell, S. K., Darer, J. D., Elmore, J. G., Farag, N., Feldman, H. J., Mejilla, R., Ngo, L., Ralston, J. D., et al. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-157-7-201210020-00002 · Cited by 685
Self-citationWhen Patient Activation Levels Change, Health Outcomes And Costs Change, Too
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Research works printed but not linked: 2
- 10.1136/qshc.2003.009001 · doi:10.1136/qshc.2003.009001 · Paper page
- Kataf M . Transparency in doctors’ notes helps prevent medical malpractice says malpractice insurance broker. PR Log Press Release Distribution. 6 February 2012. https://www.prlog.org/11791823-transparency-in-doctors-notes-helps-prevent-medical-malpractice-says-malpractice-insurance-broker.html (accessed 12 May 2016).
Cited by
Walker, J., Leveille, S., Bell, S., Chimowitz, H., Dong, Z., Elmore, J. G., Fernandez, L., Fossa, A., Gerard, M., Fitzgerald, P., et al. (2019) · Journal of Medical Internet Research · doi:10.2196/13876 · Cited by 309
Self-citationFrequency and Types of Patient-Reported Errors in Electronic Health Record Ambulatory Care Notes
Bell, S. K., Delbanco, T., Elmore, J. G., Fitzgerald, P. S., Fossa, A., Harcourt, K., Leveille, S. G., Payne, T. H., Stametz, R. A., Walker, J., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.5867 · Cited by 238
Self-citationPerspectives of Patients About Immediate Access to Test Results Through an Online Patient Portal
Steitz, B. D., Turer, R. W., Lin, C., MacDonald, S. T., Salmi, L., Wright, A. T., Lehmann, C. U., Langford, K., McDonald, S., Reese, T. J., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.3572 · Cited by 165
Transforming concepts in patient safety: a progress report
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Metadata
- Authors
- Bell, S. K., Mejilla, R., Anselmo, M., Darer, J. D., Elmore, J. G., Leveille, S., Ngo, L., Ralston, J. D., Delbanco, T., & Walker, J.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Chief Medical Officer at Medicalis, San Francisco, CA
- University of Washington (US)
- Group Health Cooperative (US)
- Corresponding author
- Bell, Sigall K
- ORCID
- Venue
- BMJ Quality & Safety
- Publisher
- BMJ
- Published
- 2016-05-18
- Volume
- 26
- Issue
- 4
- Pages
- 262-270
- ISSN
- 1475-3898 (ISSN-L)
- 2044-5415
- 2044-5423
- PMC
- PMC7255406
- OpenAlex
- W2396305291
- Semantic Scholar
- 3297a7d542080d36cee9b3f5e9dc0552fea6d338
- Cited by
- 213
- References
- 41
- Citations by year
- 2026: 11 · 2025: 22 · 2024: 26 · 2023: 21 · 2022: 25 · 2021: 29 · 2020: 27 · 2019: 20 · 2018: 19 · 2017: 9 · 2016: 4
- FWCI
- 19.22
- Type
- journal article
- Language
- en
- Open access
- green
- pmc.ncbi.nlm.nih.gov
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Cancer Institute (K05CA104699)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- OpenNotes, patient access to medical records, electronic health records, physician-patient relationship, documentation errors, patient trust, patient satisfaction, defensive medicine, health information portal, vulnerable populations, patient perspectives
- MeSH terms
- Female, Humans, Male, Middle Aged, Physician-Patient Relations, Surveys and Questionnaires, Information Dissemination, Electronic Health Records
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- CoChat. (2026). Citation check: When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship. https://app.cochat.ai/papers/10.1136/bmjqs-2015-004697
- The paper
- Bell, S. K., Mejilla, R., Anselmo, M., Darer, J. D., Elmore, J. G., Leveille, S., Ngo, L., Ralston, J. D., Delbanco, T., & Walker, J. (2017). When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship. BMJ Quality & Safety. https://doi.org/10.1136/bmjqs-2015-004697
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
