A few years ago a Doctor (who is now retired) told me about a patient they discovered using a mobile phone to make a secret recording of their in office consultation. It was apparently quite easy to detect because although it wouldn’t be too unusual for a patient to be holding their mobile so prominently they also made some unusual elevation of their voice whenever they asked any questions they thought might be legally sensitive.
The Doctor told me he would have preferred more honesty from a patient who was asking for his help but he felt it difficult to bring up the issue because he didn’t know the patient well enough and it was clear the patient had decided to make this recording secretly. He only mentioned it to me because it had made him reflect on how easy it was for him to simply scribble a note about this behaviour in the patients written records – something that might be unworkable for Healthcare Professionals in the future as patient records would be digitalised and eventually shared openly with patients.
In 2012 this future has now pretty much arrived with practically every patient attending your clinic carrying an ever more capable video mobile and healthcare leaders like Google’s Chief Health Strategist positively encouraging patients to make audio recordings of consultations. As a result I find it hard to see how anyone can fail to find agreement with medical leaders like Dr John Bachman, Prof of Primary Care at the Mayo Clinic, who appreciate the urgent need for us to redesign the Doctor consultation process so that it’s fit for the digital era.
Although it’s in a read only format on the American Medical News website I think this article by Katalin Eve Roth, MD, JD, Associate Prof at the George Washington School of Medicine and Health Sciences, is one of the best I’ve ever read that summarises the “pros and cons of letting patients record doctor visits” while asking “What should physicians do if patients want to record their discussions?“.
After making the need abundantly clear:
Sample request from a patient’s relative: “Dear Doctor, my father always comes back from visits to you empty-handed. When I ask about what transpired, he says, ‘Nothing much.’ He doesn’t want me to accompany him. He accuses me of suspecting early dementia, but I am very concerned that he is forgetting your recommendations. Would you mind if he records your conversation on his smartphone?”
Dr Roth goes on to summarise the key challenges:
> “Information overload and the stress of the doctor’s visit may cause a patient to forget much of what transpired” a problem that is “amplified when the medical situation is complex or unsettling or the news is bad“.
> “The likelihood for miscommunication is further intensified when our patients are challenged — by visual, hearing or cognitive impairment. Low literacy may render written “take-home” materials unhelpful. Finally, distraction due to depression can compound information overload”
> “Recording undermines the privacy of the visit. Knowing that the conversation is recorded might inhibit the free flow of information between the doctor and patient. The patient might be less likely to admit to problems (e.g., a recent fall, getting lost in the car, or a new girlfriend) if he knew that his daughter would be “listening in.””
> “Could a surreptitious recording be used against the doctor in a malpractice suit? Such suits have been brought”
> “general adoption by patients of the practice of recording or taping office visits could exacerbate physicians’ temptation to practice defensive medicine. Or a doctor might wish to stipulate, when consenting to a recording, that it not be used in a lawsuit”
> “A surreptitious recording would constitute deceit on the part of the patient and undermine trust — a pillar of the physician-patient relationship… …When the patient deceives the doctor, suspicion is cast on all the information the patient has provided”
> “Confidentiality of the recording raises thorny issues. How protected is access to the recording? Could it be lost by the patient or doctor, or inadvertently posted on the Web and “go viral”? Is such a recording part of the medical record? If the answer is yes, should Health Insurance Portability and Accountability Act regulations apply? HIPAA regulations limit the sharing of patient information by physicians and other health care workers, but no such restrictions apply to the voluntary release of information by the patient. Might the doctor’s reputation be damaged by having his or her interviewing and examination skills posted on a public forum by a patient?”
> “Would doctors take more care and time with patients if they knew they were being recorded? This observational effect might contribute to a longer visit, in which the physician took time to answer all the patient’s questions to be sure that he or she was understood”
> “Complex medical decision-making may be promoted when patients are able to review their doctor’s conversation…. …it could be highly beneficial to the mutual goals of both doctor and patient”
> “Using a recording device might free the patient from the tedium of taking notes”
> “A video or audio recording could complement this excellent new patient tool, especially in cases where a patient’s literacy was limited”
> “The ease of recording any encounter through technology with smartphones and tablets makes this question pressing and inevitable. Likely as not, these recordings are already taking place more than we realize”
> “recordings offer a fantastic opportunity to improve patients’ adherence and informed decision-making, and these beneficial effects should be applauded”
Obviously there is an urgent need for Doctors to start using effective documentation processes. While Dr Roth may be right that “Doctors will need to develop policies to limit the distribution of these recordings to protect themselves and to protect the privacy of the patient-physician encounter” I’m surprised that the response is so reactive to this inevitable new situation and that there is no mention made about opportunities that Doctors have to prevent patients feeling the need to make their own recordings of consultations in the first place.
I think the big opportunity we have right now is not in encouraging or even helping our patients to create unedited video or voice recordings to work around our basic failure to provide them with the documentation they need, but in letting patients help us document their history and the questions they have so that at the conclusion of our consultations with them they can have comprehensive written digital records of the information that was shared and actionable take away advice that obviously includes the provision of trusted links to sources of rich video content…