These days, commentary about bankers, politicians, or school systems is almost invariably accompanied by a call for “increased transparency.” And it’s not different for us in medicine. Spurred by electronic technologies, black boxes are being torn open right and left, bringing disruptive changes to both doctors and patients. We applaud these changes and argue that attendant benefits will far outweigh risks. And whether you agree or not, it’s probably futile to try to interfere with an unstoppable progression.
Few patients read their doctors’ notes, despite having the legal right to do so. As information technology makes medical records more accessible and society calls for greater transparency, patients’ interest in reading their doctors’ notes may increase. Inviting patients to review these notes could improve understanding of their health, foster productive communication, stimulate shared decision making, and ultimately lead to better outcomes. Yet, easy access to doctors’ notes could have negative consequences, such as confusing or worrying patients and complicating rather than improving patient–doctor communication. To gain evidence about the feasibility, benefits, and harms of providing patients ready access to electronic doctors’ notes, a team of physicians and nurses have embarked on a demonstration and evaluation of a project called OpenNotes. The authors describe the intervention and share what they learned from conversations with doctors and patients during the planning stages. The team anticipates that “open notes” will spread and suggests that over time, if drafted collaboratively and signed by both doctors and patients, they might evolve to become contracts for care.