BACKGROUND Internationally, patient access to notes is increasing. This has been driven by respect for patient autonomy, often recognised as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care. While research has been conducted on the impact of patient access to outpatient and primary care records and to patient portals, there is no such review looking at access to hospital medical records in real time, nor an ethical analysis of the issues involved in such a change in process. METHODS This study employed a systematic review framework in two stems, to integrate literature identified from two searches: Medline, CINAHL and Scopus databases were conducted, (for (1) hospitalised patients, patient access to records and its effects on communication and trust within the doctor-patient relationship; and (2) patient access to medical records and the ethical implications identified). The qualitative and quantitative results of both searches were integrated and critically analysed. RESULTS 3954 empirical and 4929 ethical studies were identified; 18 papers representing 16 studies were identified for review (12 empirical and 6 ethical). The review reveals a consensus that our current approach to giving information to patients - almost exclusively verbally - is insufficient; that patient access to notes is a welcome next step for patient-centred care, but that simply allowing full access, without explanation or summary, is also insufficient. Several ethical implications need to be considered: increased information could improve patient trust and knowledge but might transfer an (unwelcome) sense of responsibility to patients; doctors and patients have conflicting views on how much information should be shared and when; sharing written information might increase the already significant disparity in access to health care, and have unforeseen opportunity costs. The impact on medical practice of sharing notes in real time will also need to be evaluated. CONCLUSIONS The review presents encouraging data to support patient access to medical notes. However, sharing information is a critical part of clinical practice; changing how it is done could have significant empirical and ethical impacts; any changes should be carefully evaluated.

中文翻译：

---

对患者在急性情况下获得医疗记录的系统评价：实用性，观点和道德后果。

背景技术国际上，患者对笔记的访问正在增加。这是由尊重患者自主权推动的，患者自主权通常被认为是医学伦理学的主要宗旨：患者应该能够访问其记录以充分参与其护理。尽管已经进行了有关患者访问门诊和初级护理记录以及访问患者门户的影响的研究，但尚无这样的审查来实时查看医院医疗记录的访问，也没有对此类变更涉及的问题进行伦理分析进行中。方法本研究在两个词干中采用了系统的审查框架，以整合从两次检索中确定的文献：进行了Medline，CINAHL和Scopus数据库的研究，（针对（1）例住院患者，患者访问记录及其对医患关系中沟通和信任的影响；（2）患者获取病历和所确定的伦理含义）。两次检索的定性和定量结果均经过整合并严格分析。结果确定了3954项实证研究和4929项道德研究。确定了代表16项研究的18篇论文进行审查（12项经验和6项伦理）。审查揭示了一个共识，即我们目前向患者提供信息的方法（几乎全部是口头的）是不够的；以患者为中心的护理是下一步以患者为中心的护理的可喜步骤，但是仅仅允许没有解释或总结的完全护理也是不够的。需要考虑几个道德问题：增加信息可以提高患者的信任度和知识，但可能会使患者产生（不受欢迎的）责任感；医生和患者在应共享多少信息以及何时共享信息上存在分歧。共享书面信息可能会增加在获得医疗保健方面本已巨大的差距，并带来无法预料的机会成本。还需要评估实时共享笔记对医学实践的影响。结论该评价提出了令人鼓舞的数据，以支持患者获取医学笔记。但是，共享信息是临床实践的关键部分。改变其完成方式可能会产生重大的经验和道德影响；任何更改都应仔细评估。医生和患者在应共享多少信息以及何时共享信息上存在分歧。共享书面信息可能会增加在获得医疗保健方面本已巨大的差距，并带来无法预料的机会成本。还需要评估实时共享笔记对医学实践的影响。结论该评价提出了令人鼓舞的数据，以支持患者获取医学笔记。但是，共享信息是临床实践的关键部分。改变其完成方式可能会产生重大的经验和道德影响；任何更改都应仔细评估。医生和患者在应共享多少信息以及何时共享信息上存在分歧。共享书面信息可能会增加在获得医疗保健方面本已巨大的差距，并带来无法预料的机会成本。还需要评估实时共享笔记对医学实践的影响。结论该评价提出了令人鼓舞的数据，以支持患者获取医学笔记。但是，共享信息是临床实践的关键部分。改变其完成方式可能会产生重大的经验和道德影响；任何更改都应仔细评估。还需要评估实时共享笔记对医学实践的影响。结论该评价提出了令人鼓舞的数据，以支持患者获取医学笔记。但是，共享信息是临床实践的关键部分。改变其完成方式可能会产生重大的经验和道德影响；任何更改都应仔细评估。还需要评估实时共享笔记对医学实践的影响。结论该评价提出了令人鼓舞的数据，以支持患者获取医学笔记。但是，共享信息是临床实践的关键部分。改变其完成方式可能会产生重大的经验和道德影响；任何更改都应仔细评估。