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Digital dilemmas - Patients recording consultations

MPS advisers answer real dilemmas from the advice line

A patient asks to record my consultation on their smartphone – What should I do? 

Dr Nick Clements, MPS head of medical services (Leeds), shares his advice

It is becoming common for patients to ask to record a consultation on their mobile phones about a proposed treatment or condition. MPS has also seen cases where patients are not seeking consent and are making covert recordings. In a recent case in the USA, doctors were sued after a patient’s mobile phone recorded them having an unprofessional conversation about the patient whilst he was under anaesthesia.

So what should you do if a patient asks to record a consultation with you? It is common courtesy that somebody wishing to make a recording should ask permission. If you feel uncomfortable at the prospect then you should express that discomfort and tell the patient that you would prefer the consultation not to be recorded.

If you would prefer not to be recorded, but the patient is insistent, you still owe a duty to the patient to assess their condition and offer any necessary treatment. It would be inadvisable for you to refuse to proceed with a consultation because the patient wishes to record it, otherwise the patient might come to harm if they were suffering from a serious or urgent condition.

If the consultation is recorded, it would be sensible to ask for a copy so that it can be placed in the patient’s notes to form a permanent record. Modern medical records are in a variety of formats, including text messages and emails to and from patients, and recordings could become part of this mix.

If you would prefer not to be recorded, but the patient is insistent, you still owe a duty to the patient to assess their condition and offer any necessary treatment

Secret recordings

Technology makes it increasingly easy for patients to secretly record consultations. Most mobile phones and smartphones have record functions which can easily be activated without a doctor or nurse realising. Even hand-held games consoles can record conversations.

A patient does not require your permission to record a consultation. The content of the recording is confidential to the patient, not the doctor so the patient can do what they wish with it. This could include disclosing it to third parties, or even posting the recording on the internet. So what does this mean for doctors?

The content of the recording is confidential to the patient, not the doctor so the patient can do what they wish with it

Protection

Smartphone use in the consultation room should not affect the way you deliver your care. Doctors should always behave in a responsible and professional manner in consultations and consequently, any recording will provide concrete evidence of that. Such a record would inevitably be more complete than a traditional note and MPS experience is that detailed record keeping is an invaluable tool in protecting doctors against unsubstantiated complaints or legal action.

A recording would potentially provide even more detail to support the doctor’s professional position. There should be no reason therefore why you should have anything to fear from such a recording.

Whilst doctors may understandably feel that being recorded during a consultation may impair the doctor– patient relationship, this may well simply be a matter of adapting to current cultural and societal norms where it is becoming commonplace for the public to record and publish on the internet all sorts of pictures, recordings, etc, relating to their private lives.

Many will remember similar concerns being expressed when computer systems were first being introduced in general practice – that they were intrusive, inhibited communication and adversely affected the doctor–patient relationship. However, they are now an accepted part of general practice.

The future?

Technological advances will undoubtedly bring further changes and it may well be that in 20 years’ time, recording of consultations, with copies being held by both doctor and patient, will be commonplace.