Audio-recording your consultations with NHS doctors

[nolegion]

Just to add to what has already been confirmed. Yes, a doctor would need a patient's express consent to take an audio recording of a consultation - other than in the most exceptional circumstances (e.g. as part of a process relating to the detection and prevention of crime given a specific authorisation under the Regulation Of Investigatory Powers Act 2000).

 

Even the GMC manages to spell this out e.g. here:-

 

"…you must not…make, or participate in making, recordings against a patient’s wishes…"

 

(see para. 9 of;-

 

http://www.gmc-uk.org/static/documents/content/Making_and_using_visual_and__audio_recordings_of_patients_8_May_2013.pdf).

 

 

This prohibition would not be affected by a patient's taking a recording himself or herself.

 

Further, the relevant provisions of the Data Protection Act 1998 (that ensure the legality of a patient's recording) are not a "two-way street", as explained here:-

 

· On a point of detail, I would like to nail one legal technicality. The principal reason why a patient's taking an audio recording of a consultation (overtly or covertly) will not fall foul of the provisions of the Data Protection Act is indeed the 'section 36 exemption'.

 

Itis one of the shortest sections of the Act and reads:-

 

"36 Domestic purposes.

 

Personal data processed by an individual only for the purposes of that individual’s personal, family or household affairs (including recreational purposes) are exempt from the data protection principles and the provisions of Parts II andIII."

 

In other words, it is a 'purpose-based' exemption (not a 'premises-based' one),and it thus doesn't matter whether the recording is taken by a patient in a doctor's consulting room or in the patient's home.

 

Please note that recording by a doctor of a patient would not fit within the section 36 exemption because that would be being done for the purposes of the doctor' sbusiness or profession, not for the purposes of the doctor's "personal, family or household affairs."

 

From: http://www.gponline.com/News/article/1219685/Patients-record-GP-visits-without-consent-solicitors-warn/Comment 13. (In connection with which article it is interesting to note one GP poster there specifically raising the 'broken down relationship' argument, pointedly now squashed by the subsequent article - from the MDU - linked earlier- published just a few days later.)

 

Would I give my consent to a recording by a doctor if a doctor asked me for it (because I was recording)? Well, I would give it some thought, but probably only for about 2 and a half seconds, before saying no. It's the hoop-jumping and palaver factor referred to earlier that I don't trust, and I wouldn't want to set a permissive precedent which I later regretted.

 

In a report published this week concerning medical assessments for benefits entitlement, the (statutory) 'reviewer' (Litchfield) says that the recommendations of an earlier 'annual review' to enable claimants to obtain an audio recording of their medical examinations, if they wish, are now "fully implemented."

 

And that is the sort of tripe written by 'experts' who believe what they are told on paper but don't make a thorough and independent evaluation of the facts. Claimants have been and continue to be, routinely and extensively, bullied out of the right to a recording by the disingenuous procedural and practical hurdles created by the DWP with precisely that aim in mind.

[nolegion]

I sincerely hope the venerable Private Eye won't mind my giving one of their recent articles an airing while I try to get the hang of adding PDF attachments to posts.

 

It touches on the angles of quite a number of current threads in this forum.

 

'Hard Truths' article attached below, I hope.

Edited December 13, 2013 by nolegion

[nolegion]

Isabel Sitz brought proceedings against the bank which once employed her claiming sex discrimination, and won. Until I read a short article in today's Times, however, I hadn't taken on board an important feature of her case.

 

Her evidence included extensive transcripts of covertly recorded conversations.

 

"Andre Pungeri, one of her lawyers, said: 'We might have been able to win without the transcripts but the likelihood is that we wouldn't have brought the case at all.' "

 

(From The Times 16 12 13, but I can't link because it's behind a pay-wall)

[nolegion]

Here's an odd case, reported at the GMC website today, re Dr Andriy Denezh, who obviously seriously piddled off some other doctors:-

 

"The Panel has borne in mind the facts which you have admitted and those which it has found proved. It has noted your use of disrespectful, inflammatory language and the aggressive tone of your written communications in which you made accusations of fraud, unlawfulness, deception, professional incompetence, lying and a lack of integrity. "

 

Including saying to one doctor:-

 

“Your behaviour is the best described by one Ukrainian expression: One can *iss at her/his face but she/he would still say that it is raining".

 

Yet:-

 

"In all the circumstances, the Panel is not satisfied that your fitness to practise is impaired by reason of misconduct."

 

So Dr Denezh walks free.

 

Between Dr D, the other doctors concerned, and the GMC, I find it difficult to decide whose side I am on.

 

Contemplation for a rainy day, perhaps, and full case report for insomniacs:-

 

http://www.mpts-uk.org/static/documents/content/Denezh.pdf

Edited December 18, 2013 by nolegion

[nolegion]

Can't say I know much about Swedish health services, but the viewer who sent me the link below clearly does.

 

Many of the comments attached to this short 2011 article (from an English-language Swedish magazine) could have been written by patients about our NHS today.

 

http://www.thelocal.se/20110831/35880

[My Turn]

Here's an odd case, reported at the GMC website today, re Dr Andriy Denezh, who obviously seriously piddled off some other doctors:-niacs:-[/font]

 

http://www.mpts-uk.org/static/documents/content/Denezh.pdf

 

That document makes fascinating reading. Every single allegation (and there are over a dozen) was found to be true and yet the doctor was not struck off. So what was the purpose of bringing the case before a GMC "Fitness To Practise" panel if it couldn't strike him off even though it found him guilty on every single count?

 

The GMC needs shaking up. My memory may be wrong but didn't Dame Janet Smith propose some changes to the way the GMC was run in her inquiry into Harold Shipman but they weren't implemented? http://news.bbc.co.uk/1/hi/health/4081425.stm Correct me if I am wrong about the non-implementation.

[Zonker]

I think the GMC has to consider harm to the public. The case seemed to be a person demonstrating his emotions in an unexpected fashion to members of his profession. So I will hazard a guess that even tho it was misconduct the public / patients had not been exposed to it. Of course there are redacted elements of it, so we will never know the full extent.

[nolegion]

Following on from My Turn's last post:-

 

"Having examined the evidence, I have been driven to the conclusion that the GMC has not, in the past, succeeded in its primary purpose of protecting patients," Dame Janet said. "Instead, it has, to a very significant degree, acted in the interests of doctors."

 

The GMC said it had pu tin place the biggest reform programme in its 150-year history, with big changes to the way it investigates and disciplines doctors brought in last month, andnew five-year checks on doctors to come in next April.

 

But Dame Janet said the reforms did not go far enough. "I am by no means convinced that the new GMC procedures will adequately protect patients from dysfunctional or under-performing doctors," the report states. "I have concluded there has not yet been the change of culture within the GMC that will ensure that patient protection is given the priority it deserves."

 

( Dame Janet Smith, Shipman Inquiry ) See e.g:-

 

http://www.independent.co.uk/life-style/health-and-families/health-news/shipman-report-finds-doctors-put-own-interests-ahead-of-patients-24077.html

 

One of the 'big reforms' was purportedly to separate the roles of GMC as 'prosecutor' and 'judge' – the latter function now being excercised by the 'medical practitioners tribunal service'. That supposed change didn't in fact take place for many years (in 2012), and as someone who has studied many decisions under both regimes, I see absolutely no improvement in impartiality, rigour or transparency. The GMC continues to look after its own as 'prosecutor' – both by declining to prosecute and by dilute, lame, flabby efforts when it does; and the 'mpts' acquits when thrown soft balls..

 

As Zonker points out, on account of suppression of disclosure of evidence, agreed to by the mpts, we cannnot really see why the tribunal declined to take any action against a doctor whom several other doctors apparently thought well out of line – including when dealing with patients. But what if the 'accused' had been right, and protecting patients against a cadre of self-serving, malpractising 'seniors'? We should know.

 

I don't, personally, think that is likely from my reading of such information as can be gained from GMC\mpts website info. It could be, for instance, that 'mitigation' has been accepted e.g. on the ground of health or personal circumstances . The practitioner concerned has had temporary supervisory conditions attached to his 'registration' ( = licence to to practise), by the GMC. But we should know why.

 

If you are caught shoplifting and want to plead schizophrenia you will need to do so in open court. In my view, the same principle should apply to doctors

Edited December 29, 2013 by nolegion

[nolegion]

Nice one from a U.S website back in 2012:-

 

"…what does any surgeon have to hide, or fear, from a recording if they properly discuss the risks and benefits of a procedure to a competent patient or caregiver? The recommendations, above, from the official malpractice insurer of surgeons, can easily be spotted as attempts to protect the surgeon from malpractice lawsuits, rather than ways to, “…ensure confidentiality and privacy (of other patients).”

 

http://www.currentmedicine.tv/2012/02/20/how-social-media-is-threatening-surgeons/

[Sali]

I have alot of posts to catch up on.

 

My turn. Two recordings. Now that's canny.

 

 

I sincerely hope the venerable Private Eye won't mind my giving one of their recent articles an airing while I try to get the hang of adding PDF attachments to posts.

 

It touches on the angles of quite a number of current threads in this forum.

 

'Hard Truths' article attached below, I hope.

 

I've always thought Private Eye was a humorous publication, but clearly not. However, I wonder whether the author has actually been the victim of (or the family of one) shockingly poor and dangerous hospital care. Trying to get somebody - anybody! - to listen and act is like being pitched into a pin ball machine - you just end up dizzy, disorientated and sick. But it's the absolute despair and hopelessness that overwhelms you.

 

 

Did you hear of the chap who sued a solicitors for illegally cold calling him. I don't believe the case went to court (shame) but he received a £5k out of court settlement, which is, in my view, admission of guilt. He believes (and I'm sure he's right) that this was only because he had recorded the 'phone calls.

Edited December 30, 2013 by Sali

[nolegion]

HAPPY New year to all Caggers.

 

Yes, I did hear a brief radio item, around Christmas, about the chap who managed to get compensation from nuisance phone-callers he recorded. Excellently well done.

 

After several years of relative freedom from this (using the 'telephone preference service' and reporting any cold callers) I am now getting some telepesting from a company called TNS (or TMS, can’t quite catch it on the phone.) Duly reported, but I have now made a new year resolution to go look up the current law relating to recording telephone calls. There used to be some wrinkles in it – not applicable to covertly recorded conversations in person - which could restrict subsequent disclosure to third parties (including 'evidentially). I don't remember any concerns about this being raised in the broadcast though. High time I researched the up-to-date law UK law. (All or any - legally -specific and fully-referenced - contributions welcome.)

 

………………………………………….

 

Here's a case the full details of which only appeared online shortly before the end of 2013.

 

Dr Inayat Inayatullah has had a chequered career as a GP.

 

Between 2002 and 2004, he behaved lamentably towards several patients and their families, and treated the GMC's eventual, lame, response to their complaints with contempt. For this egregious behaviour, he earned a period of suspension (a whole 2 months) and was then allowed to practise subject to some not-particularly-onerous supervisory 'conditions'.

 

When that imposition of conditions came up for review in 2009, the GMC allowed Dr Inayatullah to resume practice on an unrestricted basis, despite there being 'negative' commentary in one of the assessments of his performance, and there being a number of further complaints from patients (which the GMC decided were not worth following up).

 

Then in November 2011 he was suddenly suspended from practice again. He has never resumed it, and the GMC finally ordered his erasure from the medical register on 27 September 2013. (It appears he may now be appealing that decision to the High Court. In my view, he hasn't a prayer.).

 

(All of the above info can, with patience, be quarried from the GMC's online register of doctors).

 

So why did the GMC suddenly 'see the light'?

 

Evidence is the answer. Dr I.I. was one of the GP subjects of a "Dispatches' TV program, and was covertly video-recorded conducting some utterly disgraceful consultations with reporter 'patients' primed by a competent doctor to present 'red flag' symptoms. I remember watching the documentary back in October 2011. It had some really jaw-dropping moments in it, and I am glad that the "mpts" has at last posted the minutes of the final disciplinary proceedings.

 

I cannot find any link to the original broadcast, but here is a brief newspaper article about it:-

http://www.mirror.co.uk/3am/celebrity-news/gp-misses-signs-of-cancer-in-dispatches-82596

 

and here is a link to the September 2013 decision of the mpts:-

 

http://www.mpts-uk.org/static/documents/content/Inayatullah.pdf

( inc. "The Panel has had the benefit of viewing the footage of the consultations and has also been provided with an agreed transcript of the recordings.")

 

People may remember that it was only last decade that the GMC tried not to proceed with some disciplinary hearings because crucial evidence had (shock-horror) been covertly recorded by a newspaper reporter; and that, they said, was unfair to the doctors concerned – a species of 'entrapment'. Fortunately, the High Court ordered them to change their partisan minds. Without that judicial intervention, I suspect that the likes of Simon Robinson (the 'sex-romp' GP ) and I.Inayatullah would be practising with impunity today.

 

When Dame Janet Smith said that the GMC acted in the interests of doctors rather than patients, she was dead right.

[Sali]

Mangoes? Really? Prunes, surely.

 

I'd look behind the reasons why Mr (he doesn't deserve the title of doctor despite what his certificate says) Inayatullah's errors. Was he truly ignorant of the classic signs of bowel cancer? Many laymen know the signs. Where did he train? Who checked his credentials and fitness to practise? Or did he fail to refer this faux patient (and the other genuine patients) to a consultant because there was a financial penalty to the practice?

 

It is not just the individual who should be hauled infront of a judge here, but every organisation and person who contributed towards these gross failures.

 

I think of Dr Ubani. A lone practioner in Germany, who had seemingly not participated in general practice for some time, instead concentrating on money-making cosmetic procedures, was registered by the GMC. With this authorisation the PCT (who just assumed he was a pukka professional) enabled his name to be selected by a money-spinning consortium of GPs called, I seem to recall, Take Care Now (ironic, eh?), who let him loose on the general public without proper supervision. His ignorance and arrogance killed a man. Kind colleagues took pity (none for the victim or his family) and sent him home to Germany, where he has eluded justice ever since.

 

I remember reading about a similar French case where the allegedly guilty doctor was effectively kidnapped by bereaved relatives and taken back to France to face justice. Do that here and you'd be the one on trial. I prefer the French system; pretend to toe the EU and human rights line but then fling them the finger when it suits.

 

Many of us have been thinking and saying what Dame Janet Smith has (the GMC acted in the interests of doctors rather than the patient) for years now. She's in a better position to influence change than most of us.

Edited January 3, 2014 by Sali

[nolegion]

Agreed all round, Sali.

 

Got to say I am not sure I have quite cottoned the intended direction of travel in the recently-started blog of one Zoe Harris linked below, but with a title of 'audio recording for care' I guess Ms Google and I were bound to stumble across it eventually.

 

Perhaps some caggers would care to give it some support? Most blogs die swift deaths from lack of interest, and even comments which take issue with the blogger promote interest by debate, and keep the subject on the radar.

 

http://audiorecordingforcare.wordpress.com/

[nolegion]

Got to hand it to the people at GP online. At the end of last week they effectively beamed into every GP surgery in the land, a copy of Dr Zack's article about recording patients (first published in November 2013 by the Medical Defence Union – see post #668).

 

http://www.gponline.com/Education/article/1227228/Medico-legal---Patients-record-consultations/

 

I wonder if 2014 will, at last, be the year in which patients see 'permissive' notices starting to appear on waiting-room walls. Please keep your eyes out for any - and take a note of the text to post in this thread.

 

A bit like reporting the first cuckoo of Spring.

Edited January 20, 2014 by nolegion

[nolegion]

Charlatan Dr Daniel Ubani still unrepentant then:-

 

http://www.bbc.co.uk/news/uk-england-cambridgeshire-25810075

[Sali]

I read this article a week or so back and was fuming. This man Ubani has no shame. What kind of warped mind must he have to see himself as the victim and feel so little empathy for the family of the man he has killed. In my view he is not fit to be a doctor. However, I still think our own GMC, PCT and the GP practice that eventually employed him have questions to answer and to be made accountable for any wrong-doing. As sure as eggs are eggs, it will happen again. And that truly is a disgrace.

[Sali]

So I see Sainsbury's has started to take voice recordings of customers - hopefully just the abusive ones. I will look out for the warning signs now. It's unlikely that I would ever have noticed them - I'm too busy loading the conveyor belt and packing my bags with groceries. Personally, I've never seen a member of staff being verbally abused, but I guess it happens. Soon we'll all have these devices attached to us because we fear being falsely accused of wrong-doing. Too many cases are presenting where the law protects the perpetrator and demonises the victim (as was the case of the chap who broke the bones of two thieves robbing his landscape business).

 

http://www.dailymail.co.uk/news/article-2550738/Checkout-staff-recording-Sainsburys-staff-listening-devices-help-protect-abuse.html

[nolegion]

Now that's an interesting development,and thanks for the link.

 

I incline to the view that a large commercial enterprise probably wouldn't set about the expense and potential adverse publicity of equipping hundreds of staff with alarm-plus-audio-recording devices unless it thought that there was a genuine risk to some employees on some occasions - or at least a genuine risk to its balance sheet and image if it could later be held liable for not to have taken adequate measures to reduce that risk. No doubt, others will now follow suit.

 

Of course, these 'precautions' are subject to statutory data protection principles applicable to companies and organisations - such as telling people that they may be audio recorded, only processing data for the purposes declared, secure storage of data and not storing the same any longer than necessary.

 

So, how many people know that the NHS has been doing this for years? See, e.g.:-

 

" There is now a wide range of technology that can support lone workers as they go about their work. The NHSis providing trusts with the Reliance Protect Identicom lone worker solution. This device provides a discreet and simple way of raising the alarm if necessary and also helps to encourage a culture of dynamic risk assessment. It can also capture audio recordings of verbal or physical assault which can be used as evidence in court."

(From:

http://www.nhsbsa.nhs.uk/Documents/SecurityManagement/Improving_safety_for_lone_workers_-_workers_guide_FINAL.pdf )

 

 

 

 

 

[My Turn]

Got to hand it to the people at GP online. At the end of last week they effectively beamed into every GP surgery in the land, a copy of Dr Zack's article about recording patients (first published in November 2013 by the Medical Defence Union – see post #668).

 

http://www.gponline.com/Education/article/1227228/Medico-legal---Patients-record-consultations/

 

Hello Nolegion. I'm just catching up on the posts in this thread. I have to say that the article you gave a link to is very interesting indeed. In fact if doctors follow the advice then the main objective of this thread will have been accomplished.

 

Unfortunately I am far too much of a sceptic to think it will be plain sailing from now on. There are bound to be doctors who ignore it's advice.

[nolegion]

I agree, My Turn. It's 'turning the oil-tanker around' syndrome.

 

Still, I am much encouraged by recent developments, and you may be glad to spot from the following that "My Turn's Manouevre" has captured imagination of senior medical professionals as well as that of patients(!).

 

 

I am very grateful to Professor Glyn Elwyn for the sanity, clarity and good humour of his article published by the BMJ this week, printed below; and for his generous acknowledgment of this thread in its first footnote.

 

Ref:-

 

http://www.bmj.com/content/348/bmj.g2078

 

 

Patient Power

 

 

“Patientgate”—digital recordings change everything

 

 

BMJ2014;348doi: http://dx.doi.org/10.1136/bmj.g2078(Published 11 March 2014)

 

Cite this as:BMJ2014;348:g2078

 

• Article
  
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1. Glyn Elwyn

 

Author Affiliations

 

1. 1Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire 03755

1. glynelwyn@gmail.com

 

Patients’ recordings of consultations are a valuable addition to the medical evidence base

 

It’s 8.30 am, just before clinic opens. It is 2010. Dr Byte checks an online forum, and something catches his eye.

 

A female patient is complaining about a doctor. Her posting has led to strident reactions from other doctors. Patients are taking her side. It looks ugly.

 

It turns out that the patient had asked her family doctor whether she could use her smartphone to record the encounter. Her doctor was apparently taken aback and had paused to gather his thoughts. He asked thepatient to put her smartphone away, saying that it was not the policy of the clinic to allow patients to take recordings. The patient described how the moo dof the meeting shifted. Initially jovial, the doctor had become defensive. She complied and turned off her smartphone.

 

The patient wrote that as soon as the smartphone was turned off the doctor raised his voice and berated her for making the request,saying that the use of a recording dev ice would betray the fundamental trustt hat is the basis of a good patient-doctor relationship. The patient wrote that she tried to reason, explaining that the recording would be useful to her andher family. But the doctor shouted at her, asking her to leave immediately and find another doctor.

 

Some participants on the online forum expressed disbelief. But the patient then went on to state that she could prove that this had actually happened, because she actually had a recording of the encounter.Although she had turned off her smartphone, she had a second recording device in her pocket, turned on, that had captured every word.

 

Reactions on the online forum were coming in thick and fast. Doctors were mostly indignant, unable to quite believe that patients would be so underhand, covertly making a record of a confidential and privileged conversation.

 

Patients had entirely different perspectives. What did doctors have to hide? What was their problem? Many patients said that theywould love to have a recording, for many reasons. They wanted to listen againand also wanted to share the recording with their family. Others said that itwould be the evidence they needed if they were dissatisfied, saying that their efforts to get better care in the past had been a waste of time.

 

Dr Byte had to get on with his work, yet he kept thinking about the online forum and the potential that some patients might be recording his encounters covertly. He became more aware of how he was giving advice,explaining treatment options, referring patients to new sources of information,and making sure that he had time to research things where he was unsure and admitting that to patients. In short, he became much more careful, behaving in fact as if he were being recorded continuously. It slowed him down, of course.He had to adjust the timing of his clinic and to apologize to his colleagues that he could not keep to the same schedules. On the other hand, he was more confident that his patients were happier, if not even getting better care. He even considered offering each patient, if he or she wanted it, a digital recording of the encounter.

 

Over the next three years Dr Byte followed the online forum, a UK one, regularly. The thread continued. There were still examples of angry doctors who turned patients away from their clinic or threatened to report themto the police. But there was also evidence of a gradual change in the nature ofthe contributions—and evidence of changes in policy. Contributors from medical defense organizations demonstrated clear changes in policy. Accept that patients have a right to record, and welcome it when it happens, was their verdict.

 

The UK General Medical Council shifted its view, from refusing to accept recordings made by patients to viewing such evidence as admissible when assessing professional practice. Some organizations that had at first “banned” patients from recording their own clinic appointments did U turns and developed formal policies that encouraged patients to record their encounters.

 

A consensus emerged on the online forum: patients do not need permission to record their own encounters, as it is viewed legally as a formof note keeping. Clinicians, however, are never exempt from needing patients’consent to record clinical encounters. The online forum attracted legal contributions, debated the UK Data Protection Act and many other issues, and, when printed out, amounted to 300 pages of written material, documenting that it was not only legal for patients to record their own clinical encounters butthat they were not required to get permission. Covert recording may well undermine relationships if discovered, but it is not illegal.

 

Where does this leave us? It changes almost everything.It will be among the topics covered at a conference called “Keeping Patients inthe Dark” at the Dartmouth Institute, Hanover, New Hampshire, in June 2014 (www.siipc.org). Patient centeredness, built ona firm foundation of evidence based medicine and documented in searchable electronic records, is the unachieved ideal that Engel,1 Guyatt,2 Sackett,3 Weed,4 and countlessothers have envisioned. But we have never really been able to verify the content of clinical practice, never before been able to analyze what is said,what is claimed, and what is actually done. We have medical records, but theyare like the shadows on the wall of a cave, punctuated by codes and jargon.

 

Imagine being able to analyze all clinical encounters.How much shared decision making was really done? What was the connection between the history, the findings, the decisions made, and the evidence used?How much assessment could be achieved by speech analysis and natural languageprocessing? Although this might seem unrealistic, the research to achieve this goal has already been initiated.

 

There are, of course, many negative implications,including the concern that practice will become risk averse and defensive.5 6 Yet it isdoubtful to think that medicine could remain immune to our capability of creating a digital record of all transactions. Having a record of clinical encounters changes everything: we might want to make sure the change is fo rbetter, not for worse.

 

Notes

 

 

Cite this as: BMJ 2014;348:g2078

 

Footnotes

 

 

· Dr Byte is fictitious,but this article is based on data in an online discussion thread called“Audio-recording your consultations with NHS doctors” from the UK ConsumerAction Group consumer forum (www.consumeractiongroup.co.uk/forum/index.php).

 

· Competing interests: The BMJ is a sponsor and Glyn Elwyn is adirector of the 2014 Summer Institute for Informed Patient Choice, taking placein Hanover, New Hampshire, from 25 to 27 June. See http://tdi.dartmouth.edu/initiatives/informed-choice-dale/summer-institute-for-informed-patient-choicefor details.

 

References

 

 

1 Engel G. The needfor a new medical model: a challenge for biomedicine. Science1977;196:129-36.

 

.Abstract/FREEFull Text

 

2.Guyatt G, MontoriVM, Devereaux PJ, Shüneman, Bhandari M. Patients at the center: in ourpractice, and in our use of language. ACP J Club2004;140:A11-2.

 

Medline

 

3.Sackett D, Haynes H,Guyatt G, Tugwell P. Clinical epidemiology: a basic science for clinicalmedicine. Little, Brown and Company, 1991

 

4 .Weed LL. Medicalrecords that guide and teach. N Engl J Med1968 Mar 21;278(12):652-7.

 

5 .Thomas CM,McIntosh CE, Edwards JA. Smartphones and computer tablets: friend or foe? JNurs Educ Pract2014, doi:10.5430/jnep.v4n2p210.

 

6 Vox F. iPhone app makes doctors iRate. Reuters. http://blogs.reuters.com/great-debate/2010/03/15/iphone-app-makes-doctors-irate.

[nolegion]

Patientgate.

 

I am happy to say even I can observe online today that Prof. Elwyn's BMJ article (above) is making fine headway both in the secondary newsmarket of the blogosphere, and amongst the diffuse opinion-stalls of the twittersphere (which I am being very slow to come to grips with properly.)

 

 

Couple of points arise.

 

 

It may be that the article will cease to be available freely online from the BMJ shortly. I don't think it likely that I (or CAG) will collect any flak on copylefting scores thereafter (for the reprint in this thread), but, just in case, you may care to note there is currently an option to download a PDF (for personal use) at top RH-side of the BMJ page linked in my previous post.

 

 

Apparently, the paywall behind which the text would normally be lodged is only temporarily suspended. In connection with which, please note that also on the RH of the BMJ page is a "good idea\bad idea" survey in progress which you may only have access to for a very limited time. You need to scroll down carefully to find the right section of the column – but you don't need to be 'logged in', and I hope some caggers will express an opinion.

 

As I post, over 60% of the vote cast so far is in favour of patients being able to record; but beware the dark side of the force…

[**Margaret**]

: :whoo: :

 

Acknowledgement of all the contributions and hard work that have informed a discussion on the important topic of this thread.

 

Well done us.

[nolegion]

Aye, Margaret. I have got to admit I was distinctly 'chuffed' by the patientgate article and many thanks to all co-contributors here for keeping the topic alive at CAG.

 

I think that over the period this thread has been running, and indeed before, one can describe the reaction of most doctors to patients audio-recording consultations as similar to the now well-known '5 stages of grief' (a.k.a 'the Kubler –Ross model', see e.g. http://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model),

 

that is to say:-

 

1. denial

 

2. anger

 

3. bargaining

 

4. depression

 

5. acceptance

 

Looking at the (I am glad to note, extensive) continuing online response to the patientgate article, some clinicians at least have reached the 'bargaining' stage:' well if they insist then I should have the right to record the consultation as well.'

 

And one or two have even reached a species of gloomy acceptance.

 

After all, it’s a bit too late to say it isn't happening (e.g.'what nonsense' which was the simple responseof one GP when healthcare republic\GP Online first reported on the subject nearly 4 years ago). Or to attempt to psychopathologise the recording patient's wishes – which has certainly happened. Or just to declare 'outrage' – as the baby medics effectively did in a USA forum when discussing the Reuter's article on the subject (of March 2010).

 

The idea of doctors wanting to record consultations - in response to a recording patient - has of course been well aired here before, and the trouble is, on this side of the Atlantic at least, I just don't think the average doctor, GP or consultant, and the systems in which he or she operates, are yet equipped with the attitude and facilities to succeed in' bargaining' with patients on this issue; they can ask but, as the saying has it, ''a refusal often offends".

 

By way of contrast, let's imagine that this thread has become ancient history because the unilateral right of patients to take audio-recordings of consultations for their personal purposes is universally acknowledged (o happy day). And then, by surgery or hospital notice-boards perhaps, patients are requested to volunteer copies of recordings they may have for the purposes of 'peer review' or even 'performance-related pay'. I suspect that there would be a significant number of volunteers comprising both those who thought their consultations highly commendable, and those who were aggrieved by their treatment.

 

But how many doctors would want such an outcome? Certainly not the nearly 40% of those voting about the right of patients to record in thefirst place, in the BMJ poll referred to earlier. They don't want even to 'bargain': just to ban the 'unusual and unpleasant scenario' (Health Service Journal, May 2008. See ErikaPNP's post#12, this thread) and are thus still at stages 1 & 2.

 

They will be among the last, if ever, to put a notice on the waiting-room wall advising patients that they are welcome to audio record consultations overtly, and will therefore continue to be recorded covertly.

 

( For illustration of online reaction to 'patientgate', see e.g.:-

 

http://thehealthcareblog.com/blog/2014/03/13/patientgate-digital-recordings-change-everything/#comments )

[Clear33]

[nolegion]

So far, most of the letters which the BMJ has printed in connection with the 'patientgate' article have been largely or wholly supportive of its author's 'take' on audio-recording by patients, I'm glad to say. And they continue to arrive, even though access to the article at the BMJ site has now disappeared behind the usual paywall.

 

One from the contrary direction - from an expostulating surgeon from Sydney today, in fact – made me laugh, though. Mostly because, in general and in my view, it was a jumble of self-regarding, knee-jerk comments seldom, if ever, achieving anything that could be called rational argument; but, also in particular, because of this fatuous analogy-

 

"A healthcare consultation is confidential and such an environment is meant to encourage openness and honesty (though not as much sanctuary as a Catholic confession, how about a voice recorder in the box?)…"

 

I say 'fatuous' first because an analogy or comparison which has so many fundamental differences from the medical instances actually in issue isn't really worthy of much serious consideration; and secondly because, if or to the extent one can struggle and identify any similarities at all, they appear to work against the correspondent's afore-mentioning knee-jerking. That is to say, on the one hand this would be why the priest-doctor should NOT audio-record just because the confessional-patient does; while also, on the other - given the lamentable, and still-unfolding, histories of the priestly or medical institutions concerned towards so many vulnerable within in their 'confidential' pastoral care - representing one very good reason why the confessional-patient SHOULD indeed take an audio-recording of what is proposed by a priest-doctor behind closed doors.

 

(Here's yet another 'what goes on behind closed doors' case. Recently posted at the medical parctioners tribunal site and definitely not for the demure or faint-hearted:-

 

http://www.mpts-uk.org/static/documents/content/Ripley.pdf )