How do your patients feel about being recorded?
I leave it up to the individual patient whether or not to be recorded. Most of my patients are comfortable. I would estimate that perhaps 5% or less refuse. For some patients, becoming comfortable can be a large shift, but the history of medicine is filled with advances that challenge the prevailing culture. For example dissections were prohibited, leading to extremely restricted anatomical knowledge. That changed as people gradually overcame the fear, and then an entirely new dataset was available that went on to change the concept of the physiology in the human body.
Certainly, we shouldn’t just rush in like unruly children, but if we don’t move forward, we won’t grow through this change.
What types of recordings do you create, and how are they used?
When I am recording, I have a large screen in each room. I am most interested in problems and task management in chronic complex care. Everything is broken down into problems, and tasks to manage those problems. When patients and caregivers log in, we have messaging that follows those problems or tasks. If the patient is in the system the screen will clearly indicate that the visit is being recorded. There is a pause button that can be pushed in case they don’t want to have something recorded.
What are the nuts and bolts of the recording process?
The real question is how to maximize the utility of recording and minimize the disruption that it could introduce into the doctor-patient relationship, so that is not a one-size-fits-all.
Our system is Web-based and the recording occurs in the browser and is securely uploaded into their chart. Patients are shown how to log in when they wish to access a copy of their recording as it is integrated into their clinical chart.
It is the same interface that we use when we are actually in the room during their appointment on the screen. So when they see me, they can watch me click into a problem called, let’s say, knee pain and read the sentences I write. Whatever orders or recommendations arise are also added into the problem. Patients can access the whole visit, but since the recording is annotated, they can go directly to the discussion of a particular problem or task. Accessing the system is particularly helpful when patients have out-of-town relatives who collaborate with their care – especially in the case of the elderly – who can log in to the system and hear the entire appointment.
Are there any down sides to recording patient encounters?
Audio files are larger and so they cost more to store, but, technologically we are at a fairly good curve in the slope and the cost of storage is diminishing as this becomes more popular.
Are there any privacy concerns in recording patient encounters?
All electronic records must have the technology to ensure privacy and audio recordings are no exceptions. The same methods that protect written documentation within the patient’s electronic record will protect audio as well.
Are there any medicolegal concerns in having patient encounters recorded?
I would be very concerned as to why any physician would not want to be recorded if he or she is practicing appropriately. In fact, I think recording is a very good idea from a medicolegal point of view, so there is no “he said-she said.” Every discussion is documented more thoroughly than it would be in a hastily written note by a busy physician. If you have warned the patient about a potential negative outcome of a procedure, for example, or adverse effects of a medication or risk factors for a disease, it is easy to forget to document those details. But an audio recording would capture all of those discussions.
- Elwyn G, Barr PJ, Piper S. Digital clinical encounters. BMJ. 2018 May 14;361:k2061.
- Elwyn G, Barr PJ, Castaldo M. Can Patients Make Recordings of Medical Encounters?: What Does the Law Say? JAMA. 2017 Aug 8;318(6):513-514.
- Rodriguez M( Morrow J, Seifi A. Ethical implications of patients and families secretly recording conversations with physicians. JAMA. 2015 Apr 28;313(16):1615-6.
This article originally appeared on MPR