Is it providence or paranoia? While numbers are hard to acquire on prevalence, an article published online March 12 in JAMA explored the potential benefits and pitfalls of patients recording what their physician says without the doctor's knowledge.
Author Michelle Rodreguez, JD, of the University of Texas Health Science Center in San Antonio, and colleagues wrote that changing technology has opened the door for previously private conversations between physicians and patients to be recorded without providers being aware. Smartphones, they wrote, have the capability, but whether or not this is a growing problem is unknown.
Physicians, however, should be aware of the possibility. Federal and state laws make recording a person without his or her consent a murky proposition. According to federal law, recording a private conversation is prohibited without at least one party consenting to the recording, although that implicit consent can be with the person doing the recording. Few states require all parties to consent to the recording.
On the side of providing benefit, patients recording physician conversations can get a better understanding of information given at a critical time or when recall is difficult—such as when patients are under stress, have cognitive impairment or patients’ families are tasked with patient needs. “Recordings could potentially improve accuracy, adherence, and personal engagement by providing opportunities to review conversations at other times, from the comfort of home, and in conjunction with other family members or caregivers,” Rodriguez et al wrote.
As an example of when patients and their families might best be served by recording information provided by a doctor, Rodriguez et al cited the intensive care unit. “Recordings of the visit can give families the opportunity to review what the physician said at a time when they are better able to understand and process complex or stressful information.”
However, recordings, taken out of context may also be used against physicians, a possibility Rodriguez et al suggested physicians be aware of. And, should physicians suspect recordings of taking place without their knowledge they may feel defensive about the future encounters.
“This can threaten the integrity of an existing patient-physician relationship and predispose a physician to assume a posture of distrust toward future patients.” Physicians may end up being more inclined to order more testing than they otherwise would have, second guessing assessments and recommendations and looking at future encounters through a lens of outside, legal scrutiny.
Rodriguez et al suggested to combat a potentially distrustful relationship, physicians approach each interaction with the possibility that it could be recorded. They suggested that this should be an incentive to be compassionate, efficient and effective in all communications with patients.
“If the possibility of recording causes physicians to refine their skills and, in their intimate moments with families, to pause and reassess their choice of words, then physicians should consider this possibility as an opportunity to grow as health care professionals and strengthen patient-physician relationships,” they wrote.
They offered two suggestions on how physicians could handle patients recording conversations. First, physicians can ask a patient if they will be recording a conversation and offer tips on how recordings may be helpful, along with reminders on the privacy rights of all patients. By opening this as a line of communication with patients, physicians offer an honest, open relationship to the patient about future recordings. This may help to avoid future legal issues and act as physician consent.
Alternately, physicians may simply choose to ignore the suspicion and act normally “without letting the possibility of recording affect either attitude toward the patient or medical decision making” if they are confident that care and communication are appropriate regardless.
Good relationships, they wrote, with compassionate, competent care and effective and professional communication trump motives patients and families may have for recording visits.