Should You Record Your Patient Encounters? An Interview With Dr James Ryan

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"I think recording is a very good idea from a medicolegal point of view, so there is no he said-she said."
"I think recording is a very good idea from a medicolegal point of view, so there is no he said-she said."

Advances in digital technologies are revolutionizing our society in multiple domains, and medicine is no exception. An increasing number of patients are openly or covertly recording their medical encounters, typically on smart phones, so that they can re-listen to the clinical discussion, revisit and clarify often-forgotten medical information, share the encounter with family members or caregivers, and monitor between-appointment progress.1,2,3

The opposite slide of the coin occurs when physicians create digital recordings of patient encounters. In what way might this be beneficial to physicians and patients? Are there any downsides?

To shed further light on this issue, MPR interviewed James Ryan, DO, a family physician in Ludington, Michigan, and co-founder/co-director of The Small Brain Records Project, an “open source, problem oriented, multimedia integrated, collaborative tool for clinicians who wish to explore” the integration of digital technologies into clinical practice.

Is the use of audio recordings during patient encounters a new phenomenon?

Audio recordings are not new. Personally, I've been offering to record visits since 2011. But increased use of this technology is definitely the wave of the future.

What are the main benefits of digital recordings of patient encounters?

The biggest and most important benefit is that recording a patient encounter is an opportunity to capture more accurate and complete information, which is what we ultimately can use to advance our knowledge of clinical science. As a field, we are moving at a fairly rapid pace towards greater reporting of measurements such as blood pressure, laboratory values and many others. This is a normal and natural evolution and is how we grow to understand more from a clinical point of view.

I regard clinical audio recordings as another type of data that is a more accurate, objective capture, compared to the writing of notes after the patient encounter is done. Historically, we include the most important aspects of the clinical encounter in our notes, which is appropriate, but we also lose what we don't deem to be important. We don't know whether any information told to us may turn out to be of value. Notes are often written in haste and under pressure, which can also contribute to the problem. So there can be a failure of our clinical records to relay as much information as they should, considering that we use them to advance our clinical knowledge. An audio recording is a natural use of a stable technology. 

Could you speak more to the potential role of these recordings in research?

We can form a much more complete understanding of the human condition if we can capture subjective data in addition to quantitative data. For example, mental health conditions and subjective issues such as pain can be understood and ultimately helped by an audio recording of how the patient describes his or her experience. With enough recordings we can start to understand how the way we express our feelings may impact what test may lead to an improvement of our health.  I hope it will also help us clinicians more effectively communicate to our patients some of the more complex aspects of clinical decision making.

For me as a PCP, patients with certain mental health conditions can be very challenging. If you tell someone that their blood pressure it out of range and such-and-such medication is effective for controlling it, and the individual is healthy when it comes to life management, the situation is relatively simple. I call in a prescription for that medication, it works or it does not, in which case it might be titrated until it works, or the person is switched to a different agent.

But for some people with mental health conditions, prescribing, monitoring, and remaining on top of adherence can be more difficult, and benchmarks of improvement are harder to quantify. Much more rests upon the patient's subjective experience. The journey towards controlling blood pressure can have many steps and with our current reporting process we fail to recognize small steps towards this valuable goal. So recordings can be an extremely helpful way of capturing the person's experience and also encouraging the patient to continue the regimen.

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