Great point. To add to that, a patient is often not the only reader on the "patient" side: their close family (spouse, parents etc.) will also be reading them, especially if they're helping with the therapy, and they'll also have their own sensibility to how it's presented.

I think in most open record systems there's provision for retaining info from the patient in case it could objectively lead to negative consequences, but this is indeed a complicated choice that arises patient by patient.