The elderly woman’s right knee was bright red and twice its normal size. Her doctor explained that her prosthetic knee joint was infected and would have to be removed — antibiotics alone couldn’t cure her.
Her doctor (T.L.) began discussing treatment options, but the patient stopped him. “Do you mind if I record you?” she said, picking up her cellphone.
Surprised, the doctor leaned back in his chair.
This simple request can elicit starkly different reactions from patients and clinicians.
Many patients say they want to record clinical encounters. Doing this can lessen the anxiety of trying to remember and understand what was said. Most patients who are given a recording of a clinical visit share it with loved ones, suggesting that recordings can help patients better engage their support networks. One recent study even indicated that recording clinical encounters can help poor people living in rural areas feel less disenfranchised when seeking health care.
But doctors worry that recordings could undermine trust between them and their patients. Will patients be candid about health behaviors, including sex and drug use, if the conversation is recorded and potentially discoverable by others? Doctors also worry that recordings could be used against them in malpractice suits, or made public in some way. That fear is well-founded: A few clinical encounters have been widely — and embarrassingly — shared on social media.
Our hospital recently posted a sign saying, “Please Respect Our Patients’ Privacy — Recording Is Not Permitted.” While this sign was motivated by a concern for patient privacy, clinicians have good reason to wonder if their privacy is respected to the same degree. From 15 percent to 26 percent of patients admit to covertly recording their doctors.
Like all good medicine, patient recordings of clinical encounters have real risks, from undermined trust to violations of privacy. Fear of risk, however, shouldn’t distract us from realizing the very real benefits that can come from allowing or even offering patient recordings of clinical visits any more than fear of side effects should stop us from prescribing effective medications when they are needed.
And let’s face it: The technology is too ubiquitous and too easy to use. Patient recordings of clinical encounters are unavoidable unless providers want to get into the dubious business of temporarily confiscating their patients’ phones.
To embrace this new technology, and also to establish some control over it, one of us (G.E.) argues Monday in the Journal of the American Medical Association that clinicians should encourage their patients to record clinical visits and that we should develop guidelines for their use.
Such guidelines can clarify when it is OK to record encounters and when it isn’t. Guidelines can mandate that patients ask permission to record, congruent with the law in many states. Patients recording an encounter should keep the recording device in plain view, and everyone should expect to hit pause when a delicate topic like sexual health comes up.
We can also agree on times that recording is forbidden, such as during the physical examination or when the privacy of other patients would be compromised. Placing limits on sharing recordings of clinical visits on social media would also be a good idea.
Beyond ensuring consensual and prudent use, providers should harness the power of patient recordings in shared decision-making. We can encourage patients to review recordings after a clinical encounter and help them tag portions of it for future discussion.
Institutions, too, can incentivize the use of patient recordings and help protect clinicians from undue malpractice risk. The Barrow Neurological Institute in Phoenix, for instance, provides extra support for malpractice defense for clinicians who agree to encourage patient recordings of clinical visits. In the rare event litigation arises, an accurate record of good medical care can serve doctors as well as patients, and patients say they trust providers who are transparent enough in their practice to encourage recordings.
So what did the doctor of the elderly women with the infected knee do? He agreed to let her record their conversation. They discussed the pros and cons of various treatment options, which she later shared with an out-of-state daughter. The patient ultimately chose to go through with joint surgery followed by intensive antibiotic therapy. En route to a cure for her infection, the patient was still fearful, and still in pain, but she and her daughter said that being able to record the complex conversation helped them make the best of a tough situation.
Tim Lahey, M.D., is a physician, researcher, ethicist, and associate professor at the Dartmouth Institute for Health Policy and Clinical Practice, where Glyn Elwyn, M.D., is a physician, researcher, and professor.