A systematic review of patient access to medical records in the acute setting: practicalities, perspectives and ethical consequences

Published in


D’Costa SN, Kuhn IL, Fritz Z. A systematic review of patient access to medical records in the acute setting: practicalities, perspectives and ethical consequences. BMC Med Ethics 2020;21(1):18.

  • 06 July 2023



University of Cambridge


Isla Kuhn

THIS Institute

Dr Zoë Fritz

THIS Institute

Why it matters

Allowing patients to access their medical records is seen as a way of encouraging them to be more engaged with their care and more informed. The UK government mandated that patients should be able to readily access their electronic medical record by 2018, but there have been logistical problems with fulfilling this. Internationally, patients are more readily able to access their medical notes. The use of patient ‘portals’ – an electronic route to targeted parts of the medical record – has recently become more common.

Research has been done on the impact of patient access to outpatient and primary care records, and to patient portals. However, there is a lack of research on access to hospital medical records in real time, and of ethical analysis of the issues involved in this and any unintended consequences.


Focusing on adult access to notes in the medical acute care setting, we reviewed literature relating to patient access and contribution to medical records, and considered the ethical issues raised by this proposed change in practice.

Our review set out to answer two questions:

  1. What studies have there been of sharing records with medical patients in hospitals, and what is known about the impact on trust and communication between patients and doctors?
  2. What are the ethical issues associated with sharing records with medical patients?

What we found

Our literature search found 18 relevant papers, representing 16 studies. Four main themes emerged: impact on patient care; conflicts between patient and physician perspective; divergent views on doctor and patient roles, and cultural differences and societal risks.

The review of these papers revealed that the current approach to giving information to patients almost exclusively verbally is insufficient, and that access to notes is a welcome next step for patient-centred care. However, simply providing full access, without explanation or summary, is not enough. We found several ethical implications that need to be considered:

Sharing notes can also have an impact on trust and medical practice:

Sharing information is a critical part of clinical practice and changing how it is done could have significant practical and ethical impacts. Our review highlights what those potential impacts might be.

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