Intended for healthcare professionals

Rapid response to:

Head To Head

Should doctors encourage patients to record consultations?

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.g7645 (Published 08 January 2015) Cite this as: BMJ 2015;350:g7645

Rapid Response:

Dear Editors

Again the issue of recording of a consultation has resurfaced as a periennal topic in the BMJ.

It is always interesting that the premise of this situation is that it is almost always the patient who wants to record the consultation, not the physician.

Traditionally the medical consultation comes from the basic concept that it is a private discussion of a patient's health issues and mutually agreed actions upon suggestions/recommendations by a care-giver AKA physician (as a professional learned in healthcare issues) in an joint effort to address the patient's concerns.

The physician as a memory aide for future reference, writes down notes that help expediate the resumption of care if future reviews occurs with the same patient for a similar problem. The patient is aware and primed to the fact that the physician will make appropriate notes about the consultation for this purpose. The medical record is ultimately the private property of the physician not the patients.

Two events have seen a change in how this concept is perceived:

1. More than one physician may be needed in the care of the patient, especially if the original physician becomes unavailable. As a result, the quality and interpretation/conclusions of the medical record need to be consistently accessible by any physician reading the notes. Furthermore as there are significant difference in routine or practice of medicine, the completeness of information needsto be of acceptable standard.

2. The care of the patient is renumerated by not the patient directly but another entity, like the government. Furthermore there may be the arrangement in which the government hires the physician as the designated delegate to provide care on the behalf of the government and as such the ownership of the records in in the grey area, but often considered as being owned by the government. The perception of this relationship/medical consultation being publicly funded brings about similar assumption that the relationship between the physician and the patient can be in the public domain in some cases.

Furthermore, the rise of the awareness of patient's rights (but not responsibilities) and the increasingly ubiquitous devices for voice recording promote the 'need' to own part of the consultation content just like the traditional ownership of medical records by the physician.

Hence we come to these questions.

Does the patient have the 'right' to record the consultation?

Various juristriction in different countries may suggest that:
it can be illegal to record a conversation without the explicit permission of all parties, or
it can be illegal to record a conversation covertly, but OK to record it openly without consent from all parties or
it is legal to record a conversation under any circumstances

I am uncertain where UK actually stands on this even if recordings have been admitted as evidence by the UK General Medical Council (but does not imply it is an acceptable practice protected from legal action)

Does the recording have the same status or integrity as the medical record?

Like the paper medical records (and in some cases electronic records), voice recording can be compromised by post-event editing or quoted parts taken out of context in a long recording.

In most cases for electronic records or voice recording, with adequate and judicious inspection and analysis, it is possible to detect post-event admentment.

Thus the voice recording offer no worse protection from editing than paper records.

Is voice recording as complete as it can be as in paper records?

Most conventional recording device are voice activated to save power, as result certain words or even phrases may be missed, particularly when the device is not in direct line of sight (eg clandestine recording) and therefore cannot be assured that the recording involves all words and phrases and sounds being made during the consultation.

Does the awareness of recording the consultation change what is being said?

Both Glyn Elwyn and Laurence Buckman concede it does. But for better or for worse?

Open recording may unintentionally lead to longer consultation, and in some cases a more defensive posture. Concerns that patients will hold the physicians to a sound bite, will lead to consultation with messages with less confident or certainty.

Speaking slowly in an attempt to ensure the recording is clear, may unintentionally portray a condescending manner, particularly when the message is being repeated several times during the consultation.

Furthermore if the patient openly records the consultation, despite reservations voiced by the physician, or the physician finds out the patient has recorded the consultation covertly, this compromises the trust between the physician and the patient.

When the recording is performed with a certain intention, the way the patient interacts will be altered as well, and in some cases, less candid and open as the patient realises whatever he or she says may potentially be open to scrutiny.

As for my opinion:

I believe any recording of the consultation should be open, with the permission of all parties and both parties are given copies of the recording.

I hope my analysis of the situation helps your readers to understand the concerns and issues.

Competing interests: Only the fact that I am one of the stakeholders potentially affected by the practice of recording by patients

12 January 2015
Shyan Goh
Orthopaedic Surgeon
Sydney, Australia