Accessible Unlicensed Requires Authentication Published by De Gruyter April 30, 2019

Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety

Charlotte R. Blease and Sigall K. Bell
From the journal Diagnosis


Error resulting from missed, delayed, or wrong diagnoses is estimated to occur in 10–15% of ambulatory and inpatient encounters, leading to serious harm in around half of such cases. When it comes to conceptualizing diagnostic error, most research has focused on factors pertaining to: (a) physician cognition and (b) ergonomic or systems factors related to the physician’s working environment. A third factor – the role of patients in diagnostic processes – remains relatively under-investigated. Yet, as a growing number of researchers acknowledge, patients hold unique knowledge about themselves and their healthcare experience, and may be the most underutilized resource for mitigating diagnostic error. This opinion article examines recent findings from patient surveys about sharing visit notes with patients online. Drawing on these survey results, we suggest three ways in which sharing visit notes with patients might enhance diagnostic processes: (1) avoid delays and missed diagnoses by enhancing timely follow up of recommended tests, results, and referrals; (2) identify documentation errors that may undermine diagnostic accuracy; and (3) strengthen patient-clinician relationships thereby creating stronger bidirectional diagnostic partnerships. We also consider the potential pitfalls or unintended consequences of note transparency, and highlight areas in need of further research.


We thank Catherine DesRoches, Jan Walker, Tom Delbanco, and the clinicians and patients who shared their insights on sharing notes. We also thank the three reviewers and the editor for helpful feedback on an earlier draft of this paper.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: CB was funded by the Irish Research Council-Marie Sklodowska Curie Global Fellowship, Grant Number: CLNE/2017/226. SKB was funded by: Robert Wood Johnson Foundation (Grant #73038); Gordon and Betty Moore (Grant #4926); Peterson Center on Health (Grant #16019); Cambia Health Foundation (Grant 28584).

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


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Received: 2018-12-14
Accepted: 2019-04-08
Published Online: 2019-04-30
Published in Print: 2019-08-27

©2019 Walter de Gruyter GmbH, Berlin/Boston