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THERE could be significant benefits for both patients and doctors if recording consultations became more open and transparent, experts say.
According to Professor Cameron Stewart from the University of Sydney’s Law School, recording consultations could improve the entire patient experience.
“Once something is recorded, then people want to perform better,” he said.
Specifically, Professor Stewart thinks increased recordings highlight the importance of building a relationship with patients rather than just getting informed consent.
“By relying on forms, we’ve underplayed the importance of speaking and listening. If there was a recording of a conversation, I think it would bring it back to what’s important,” he said.
“Doctors who get themselves into trouble are the ones who have poor records. A massive chunk of complaints about doctors … are about poor communication and record-keeping. We can really up the ante and fix a lot of that with recordings,” he said.
Professor Stewart was commenting on an Ethics and Law article published online in the MJA which discusses legal scenarios involving overt and covert recordings of health care consultations in Australia.
UK research has previously found that 69% of patients wanted to record their consultations. Reasons for recording a consultation are diverse. Patients traditionally have an inaccurate recall of health care events and diagnoses, particularly when receiving bad news.
Dr Megan Prictor, a lawyer and Research Fellow at the University of Melbourne, and co-author of the MJA article, explained:
“It’s particularly problematic in settings where people are receiving difficult diagnoses. They might be stressed or upset by what they’re hearing about their health and not take anything else in beyond those words ‘you have …’ whatever the condition is,” she said in an exclusive InSight+ podcast.
Having a recording can help empower patients and assist with their decision making, wrote Prictor and colleagues.
Patients may also want to share their consultation with family and friends so they can help provide support and understanding.
Head of Research, Education and Advocacy at Avant, Georgie Haysom told InSight+ that when a patient asks for a consultation to be recorded, it might be a sign that communication could be improved.
“Ask the patient why they want the consultation to be recorded. They might want to share that information with their family, or it may be a sign that the doctor might need to take a bit more time to explain things to them,” she said.
Despite the benefits, Ms Haysom said doctors were usually concerned that the recording might be used inappropriately.
“When they don’t know what the purpose is, that’s why doctors get concerned. These days it’s really easy to promulgate information via social media and the internet.”
If doctors were asked by a patient to record the consultation, Ms Haysom recommended discussing its intended purpose.
“Clarify with the patient that it is for medical advice but not for wider publication. We say it’s wise to have the patient agree to that in writing. Confirm the details of the file you’ve provided and the limits of its use,” she advised.
The MJA article also highlighted concerns about the use of recordings in legal proceedings. It reported that there was no evidence that audio or video recordings of consultations increased litigation.
Smartphone applications, such as Second Ears are being developed to address these legal concerns.
Second Ears was developed by the Victorian Comprehensive Cancer Centre in 2018 and was designed to make recordings available to both the patient and the hospital health management service. Patients are given one opportunity to listen back to their consultation recording.
It’s currently a prototype and isn’t yet publicly available but is showing promise, wrote Prictor and colleagues.
“We think it’s a good idea that apps like that have very clear information and consent mechanism built into them so both the doctor and the patients know what the expectations are around the recording,” Dr Prictor told InSight+.
According to Professor Stewart, the usefulness of apps like Second Ears was the ability to link it with a patient’s medical record.
“It shouldn’t be scary. We’ve got the technology to store these things and keep records and back them up. It could even be linked to the My Health Record,” he said.
One of the big sticking points when it comes to the legality of recording consultations are the current conflicting laws across Australia.
In some states, patients can record their consultation legally without the clinician’s consent. In others, two-party consent is required before a consultation can be recorded.
According to Ms Haysom, consistent laws across the country would be ideal.
“There should be consistent rules on a lot of things in health care in Australia. Nationally consistent legislation is much better for everybody.”
Prictor and colleagues concluded that to avoid any confusion “expressly articulated permissions around the act of recording and the extent of sharing recordings are desirable.”
Dr Prictor said that although there could be benefits to recording consultations, it didn’t change the immediate quality of care.
“If the doctor has done something wrong, there’s been a medical error or they’ve failed to communicate information, that’s happened whether or not the recording is there or not.”
As recording consultations becomes more common, doctors will need to rethink their approach and upskilling may need to be an option.
“Communication skills training may be a way to alleviate concerns about being recorded,” Prictor and colleagues concluded.
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“Recording consultations: why it might make you a better politician / public servant …”
….Let’s record all conversations between politicians, and all conversations between ministers and their heads of departments ; and all conversations between one head of govt department and another head of government dept.
The Coate inquiry would have been saved a lot of work if these recordings had taken place.
I believe there is a saying about sauce for the goose and gander ……”What’s sauce for the goose is sauce for the gander”
I believe all consultations should be recorded as a matter of course. There is always emphasis on a patient’s privacy but little to safeguard a doctor from unfounded accusations. The Medical Board is able to take action on a whim even without evidence or even in spite of evidence contrary to the allegations. A doctor in this situation has no support whatsoever – the Colleges have no power or desire to get involved and we have no union to protect us. To have records of the consultation would offer peace of mind and a legal channel for recourse to both doctors and patients alike if issues do arise. De-identified recordings could also be used as a learning tool for students and trainees.
Conditions may be applied if a re cording is requested by the patient e.g. sole property of mr/mrs…. not to be used for any other than personal reasons of mr/mrs….. We would need legislation to cement such a condition.
I am concerned when we suggest to make something mandatory before it has been rigorously tested and the outcomes compared to writing a letter in front of the patient summarising the consultation.
There are some occasions where i would have benefited greatly by having the whole patient experience in the practice recorded. It would have been useful to document the rude, aggressive individual who wont listen and then says the doctor did not tell him anything.
Some consultation details are deliberately omitted from written records, either at the patient’s request or the doctor’s discretion. I have several Workcover patients who are transgender, currently undergoing medical and surgical treatments, who have requested confidentiality.
Their anaesthetic allergies or the pro-thrombotic effects of oestrogen therapy are relevant to their hand surgical treatment, but their overall gender reassignment is not the business of the insurer which is dealing with their fall at work.
Similarly, I have had patients admit they were hung-over when they had their car crash, that they took off the machine’s safety guard, or that their accidental fall was a deliberate punch. They need appropriate treatment for alcoholism or appropriate antibiotics, but it is not the doctor’s role to inform the employer that their employee is a violent drunk (unless it’s a specific notifiable case such as a drunk/suicidal pilot ). Our role is to treat the patient before us. We ask candid questions about illegal drug use, reassuring the patient we will not tell his work, his spouse or the police, but an employer like Westpac (reeling from a massive fine for not disclosing potential criminal activity) may not be so tolerant.
There are also clinically relevant details like the patient who is planning to change jobs to one which is more or less manual, or the professional athlete who does not want the team doctor to know she plans to change clubs or retire next year. This may make a major difference to the timing of surgery, either delaying or expediting.
If recordings form part of their overall medical record, they are probably the property of the insurer which funded the consultation, and certainly discoverable under subpoena. Other prospective employers including police and armed forces request copies of all records relating to injuries from decades ago. If my written notes indicate ‘consultation recorded by patient’, and he ‘loses’ the recording, that in itself looks suspicious.
As with the previous comment about concealing domestic violence, I am concerned that recording may make consultations less candid, and therefore less effective for patient care.
Only investigative processes [ like police interactions – taking statements , body cameras etc ] require interaction recording – lawyers do not record the interactions whilst taking instructions , barristers do not record their interactions. Professional interactions should not be routinely recored.
Recordings are used for specific outcome in mind – and when recorded conversation is used it becomes stilted and is bad medicine – don’t forget -the adage -‘ disease declares itself in parentheses’
The free advice from an academic lawyer on how to practice a profession other than law should be taken as non expert commentary that is how a court would treat it .
After 30 years as a forensic examiner I am very experienced in the recording of appropriate consultations.
The article mentions recordings in the setting of legal proceedings – see below:
“The MJA article also highlighted concerns about the use of recordings in legal proceedings. It reported that there was no evidence that audio or video recordings of consultations increased litigation.”
One situation where recordings would be very helpful is in psychiatric consultations in personal injury and worker’s compensation cases and similar circumstances. One of the most common criticisms by patients caught up in this process is that the ‘independent’ or non-treating psychiatrist did not report the presence or full extent of the patient’s mental health injuries because the doctor did not take a comprehensive history covering these aspects. A recording of the consultation would make the nature of the examination transparent and allow clarification of the competing views of the patient and reporting psychiatrist. I believe this would improve the quality of psychiatric medico-legal reporting. The courts could make a recording of consultations in this legal situation compulsory as part of the conditions of the Expert Witness Codes of Conduct.
Consultations with solicitors should be recorded as this is likely to expose ignorant and arrogant lawyers.
I am concerned about the effect on the patient’s privacy and confidentiality and the consequences for effective assessment and treatment. Once a recording exists there is a possibility that people other than the patient and the patient’s medical professionals may access it. Once it is known that patients’ consultations are frequently recorded then abusive partners and others may demand the recordings from the patient. If the consultation is not recorded then an abusive person in the patient’s life may become more suspicious and possibly violent.
Consequently the patient will be inhibited from fully disclosing the content needed for effective assessment and treatment.
Doctors may experience threats and demands for the recordings from non patients.