Audio-recording your consultations with NHS doctors

[Oomleeu]

That was indeed a very illuminative article by Professor Elwyn, followed by some very interesting comments on the forum.

The sad news, however, is that neither the professions nor their regulators will ever condone the principle of fully informed patients and irrefutable proof thereof.

 

A harsh statement which will probably result in a lot of indignation, but here are the facts:

 

I owned a dental practice in the UK for ten years. Around 2008 I felt the need to try and bring some honesty and openness into the interaction between service providers and patients.

 

Imagine this:

 

“…is Microsoft-based software that can be downloaded online. If the computer does not have a built-in camera, the only additional hardware one needs is a webcam.

It records and stores everything that is said in the surgery, and takes photographs at adjustable intervals as proof of who was talking to whom. The data is tamperproof, password protected, and compressed to such an extent that up to 500 hours can be stored on a single DVD. External hard drive and online storage are also options. The data is time- and date stamped, and can also be tagged by names or numbers for easy retrieval. Patients can obtain copies of their recording on request.

Everything is automatic - it starts and stops at pre-set times, backs up at pre-set times, and it runs invisibly in the background without interfering with the normal use of the PC or laptop.

 

The purpose of the system is that it keeps irrefutable records, and as such is a bilateral guarantee of honesty between any service provider and client/patient.”

 

It took five years to develop. In the last year of operation in my surgery, only two patients declined signing the consent form – the rest were very pleased to have it all on record.

 

I wrote numerous letters and Emails to the General Dental Council, CQC, Medical Protection, Dental Association and everybody I could think of. I did get some phone calls (all negative, some even threatening), but everybody bluntly refused to put anything in writing. Mostly my correspondence was simply ignored.

 

Imagine the quality of care if something like this was made mandatory. Half the regulators and half the litigators would be out of work. And patients will have the guarantee of honesty and openness.

 

It was a nice try, but a pipe dream. The society we live in is simply not based on honesty. There will be a lot of spin, but nothing will change.

[My Turn]

Hello Nolegion. As you say the letters in reply to the Patientgate article are generally supportive. However when I undertook that manoeuvre in 2006 there was nothing but widespread hostility from all sides. Some patients felt it was underhanded to record covertly at all and others asked "Why on earth would you need to record your consultation?". That really did surprise me.

 

-My Turn

[nolegion]

Welcome to CAG, Oomleeu. If the system\software you describe had got the recognition it deserved, I think the current debate would be significantly further advanced than it is today, to everyone's benefit.

 

You probably remember that the Bristol Royal Infirmary and the Royal Brompton Inquiries recommended that clinicians offer patients the option of recorded consultations, well over a decade ago. The Department of Health refused to go ahead on the basis that it would 'undermine trust'.

 

That was ever a specious argument by interests vested against candour, and the facility of pocket technology now exposes it starkly. What undermines trust is a clinician's refusal to be recorded.

 

Good to hear from you, My Turn. Snap. When I started out as a 'recording patient', early this millennium, I got raised eyebrows from a significant minority of other patients. Time revealed that that minority was populated by those who had not yet experienced grief at the hands of the NHS, either personally\directly or in connection with relatives, friends and indeed clients etc.

 

Of that minority who are yet living, few to none raise their eyebrows today.

[Oomleeu]

Hello Nolegion. This was about much more than just experiencing 'grief at the hands of the NHS'. Among others, it was also about patients getting ripped off by private practitioners. An excerpt from a letter (also no response) addressed to the Chief Executive of the CQC in 2011:

 

'However, in my humble opinion, the disconcerting tendency to “sell” treatment plans to patients, and the numerous courses and journal articles on the subject of “acceptance of treatment plans” may need to be addressed in order to better protect patients’ interests.'

 

The regulators don't really care two hoots about protecting patients. All they need to do is appear to really care, single out a suitable fall guy here and there, and happily steam forth in their gravy train.

[nolegion]

I have little doubt that identifying the current supposed 'regulators' as a major part of the problem with the NHS, rather than part of any possible solution, will strike chords with many a viewer here.

 

There is, in particular, something almost demonic in the bitterness, anger and resentment patients or their families and friends experience - and evince - when an utterly justifiable complaint to any such body is simply fobbed off with insulting, dismissive, delay, evasion and inaction, wretchedly compounding the miserable treatment suffered in the first place.

 

..............We appreciate this better

In the agony of others, nearly experienced,

Involving ourselves, than in our own.

For our own past is covered by the currents of action,

But the torment of others remains an experience

Unqualified, unworn by subsequent attrition.

People change, and smile: but the agony abides.

 

(T.S.E)

 

Meanwhile, that Australian surgeon, undeterred by a calm sea of more informed and rational voices at the BMJ , is back trying to whip up a storm today by force of simple ignorance e.g.:-

 

 

" As I understand:

 

 

Yes, people who are involved in private or public conversation can record the proceeding without consent from any party, covertly or openly

 

 

No, they do not necessarily have the freedom to release the recording to a third party without permission from all parties involved in the conversation. "

 

He or she (? 'Shyan Goh' ) 'understands' wrongly. In the circumstances under discussion, a UK patient does NOT need '"the permission from all parties involved in the conversation," before he or she can share a recording (overt or covert) with third parties.

[My Turn]

I owned a dental practice in the UK for ten years. Around 2008 I felt the need to try and bring some honesty and openness into the interaction between service providers and patients.

 

Hello Oomleeu. Good for you for at least trying to improve transparency.

[nolegion]

Transparency. Aye.

 

Clinicians sometimes claim, somehow imagining they are making a telling point: 'Ah, but I would behave differently if I thought I was being recorded.'

 

My response is always : 'good.'

 

Here's a couple of recording stories which have made at least local headlines very recently:-

 

Lynette Crook and Rita Page abusing a brain-damaged care-home resident in Manchester:

 

http://www.itv.com/news/granada/story/2014-03-24/care-assistants-admit-abusing-brain-damaged-patient/

 

and from Australia, a male general practitioner molesting a female patient behind closed doors:

 

http://www.medicalobserver.com.au/news/gp-guilty-of-sex-assault

 

It's difficult to see how either case would have been likely to achieve justice in the absence of covertly-recorded evidence.

 

In my view, the notion of the powerless vulnerability of patients is ingrained across all aspects of healthcare in this country, and elsewhere. Those taking advantage of that vulnerability need to think again – hard and now.

[Sali]

Congrats on Patientgate Nolegion.

 

It was heartening to read that some medics have already embraced audio recording in consultations. Still, we are in that half-way house where most patients don't quite know where they stand. Declaring, quite legally, the intention to record a consultation could result in an angry medic and sub-standard care. I wouldn't risk it. It's 'covert' every time.

 

 

So no stopping the digital tsunami now - if only it could wash away the GMC.

[nolegion]

Thank you, Sali. I value your congrats.

 

Much as I would like to see patients confident to record overtly and doctors confident to be so recorded, it seems to me that the logic of self-defence - after all it happens be one's life - which says don't risk overt recording so record covertly, is unimpeachable in this 'half-way house'.

 

The GMC is, of course, keeping its greasy fingers under its chubby thighs and looking the other way.

[nolegion]

Of course, it's not just clinicians who need to wise up. The fantastically self-important and inefficient bureaucracies which nourish them do as well.

 

Still leading the field for sheer breath-taking ignorance and arrogance, in my view, is the East London NHS Foundation Trust's 'Audio Visual Recording Policy', where about a dozen paragraphs comprising item 7 ("Recording by service users and members of the public") contain scarcely a sentence which is legally accurate.

 

Furthermore, in circumstances which include a patient's taking an audio recording of a consultation with a doctor, the Trust tells its staff:-

 

" If anyone is found to be making a recording without the permission of the Trust, the individual should be advised this contravenes the right to confidentiality of any individuals being recorded, their human rights and is against Trust policy.

 

The recording device should be taken from the individual and the recording destroyed. In some circumstances it may be appropriate to withhold the recording device."

 

The problem with this, or rather, one of major problems with this utterly erroneous claptrap, is that any member of staff complying with these instructions during or following a consultation would almost certainly commit more than one criminal offence against the patient concerned.

 

And incitement to commit a crime is itself a crime.

 

(http://www.eastlondon.nhs.uk/About-Us/Freedom-of-Information/Trust-Policies-and-Procedure/Information-Governance-Policies/Audio-Visual-Recording-Policy.pdf)

[arkadiygaydar]

It is very important to always record NHS doctors. I recently read a copy of the records from some medical appointments I attended - they are gravely inaccurate! Symptoms not recorded, or plainly changed, making a completely different picture to the real one. thank goodness we have their every word recorded to prove what indeed the symptoms were.

They cannot stop patients from recording, just do not tell them, enter the room with your phone. Every smart phone has a recording device in. Save your life.

[Oomleeu]

Hello Arkadiygaydar. Why not save everybody's life by making it mandatory for clinicians to record everything as I previously mentioned. Irrefutable tamper proof evidence of everything that transpired in the surgery. It will result in infinitely better treatment, total honesty, and put half the regulators and spin doctors off the gravy train.

[arkadiygaydar]

Hello Arkadiygaydar. Why not save everybody's life by making it mandatory for clinicians to record everything as I previously mentioned. Irrefutable tamper proof evidence of everything that transpired in the surgery. It will result in infinitely better treatment, total honesty, and put half the regulators and spin doctors off the gravy train.

 

Absolutely agree. and you have just described why it is still not done - because of the gravy train.

It is a great idea to record by 2 recorders, I did not think of that before.

[think about it]

I wouldn't have any reservations about a patient recording their consultation in my practice but I can perhaps go some way to explaining why it's not done routinely.

 

In terms of cost and logistics it would be completely prohibitive.

 

Let's put some scale on this, in primary care alone (so GP's and practice nurses) there are over 340,000,000 individual consultations every year. Each of those, on very broad average, lasts for around 10 minutes (some are less, some are significantly longer).

 

Then of course, the NHS would need to store that information for a period of time, now as it would form part of the medical record, that stays with you for life, it's reasonable to assume that this data would not be destroyed for potentially well over 100 years for someone born today. Because of course, even after death, your records are maintained for 10 years.

 

So, 3.4 Billion minutes per year recorded at 320kbps to ensure clarity would give 7,968,750Gb of datato store, let alone index.

 

So where to store it? Do we store it locally and risk its loss in a fire or catastrophic IT failure? Or, do we outsource storage to a data centre? Of course, data protection becomes an issue then in choosing a provider as does setting up a method of accessing recordings.

 

Secondary care, Hospital admissions, outpatients etc adds another 125million individual contacts to the 340 million in Primary, this presents it's own challenges. Some hospital stays last months, others - like my outpatients appointment today lasted about 15 minutes. So what do we record? The full duration of the stay or just interactions with a member of clinical staff? But, what about non-clinical interactions such as domestic / food etc?

 

I'm the biggest proponent of the work the NHS does, I should be, I work here. But, I acknowledge that at times mistakes are made, they're made because humans are treating humans. No one is infallible and no one can guarantee that a patient will agree with the clinical judgements made by their doctor / nurse.

 

Most of the complaints I've dealt with have been down to a difference in opinion and it's the very reason that people are able to seek a second opinion if they so choose. But, they are just that - an opinion / a judgement / an impression of the condition based on the past experience of the person making them.

 

Our clinicians are happy whenever someone brings in a list of issues from Google / Wikipedia because it gives them an insight into what the patient is thinking and what their true concerns are but they're limited by the constraints of working in a GP surgery, we don't have immediate access to advanced diagnostic equipment and they don't always assume the worst possible scenario. The reason they explore the more common problems first is because they're more common. The one in million diagnosis of some dreadful rare condition is only reached by excluding the likely causes.

 

If you've concerns over your treatment there's a few things you ought to consider:

 

Change your doctor.

Tell them your concerns.

Raise a complaint - us practice managers are not clinically trained so we go at complaints from the same starting point as a patient.

Request a second opinion.

Tell your doctor if you think their diagnosis is wrong and ask them to explain how they've ruled out your concerns.

Take support with you - family / friend / representative, all are welcome - we provide chaperones if patients request them

By all means, record your session but seek clarification on the points you're not happy with.

Ask for an appointment to go through your medical record or ask to see it / get a copy.

[nolegion]

Interesting recent posts. Arkadi, welcome back: long time no see.

 

T.a.i. Impressive stats, if I may say so, and sure, if one were to wait for the NHS as whole to get organised, uniformly, to record all consultations (to the extent that patients agreed) and provide copies to patients, likely another ice age would have passed.

 

But the situation looks a bit different when dealt with in smaller units. I have in mind developments where individual healthcare providers might decide they wanted to equip themselves to provide recordings: such as dental practices using systems like Oomleeu's, and one or two pioneering NHS oncology units noted in this thread before. These needn't await some glacial imprimatur. Do it, learn from it, improve on it – and keep on so doing. Others will catch on eventually.

 

After all, patients can do it, and increasing numbers are doing it, at the flick of a switch.

…………………………………

 

Recent legal development concerning the admissibility of covertly recorded evidence in civil legal proceedings. Helpful, but not earth-shattering.

 

Basically, an employee took secret recordings of both the course of a grievance and disciplinary hearing, and, without her being in the room, also some parts of discussions by the employer about the case. The earlier very similar case known as 'Amwell' admitted the former type of recording but excluded that latter from evidence.

 

The new case emphasises that this very much depends on what the second, 'bugged' type of recording is said to contain, and it may still be admissible. In some circumstances, as in the new case, the tribunal will have to listen to it to decide:-

 

Punjab National Bank & Others v Gosain

http://www.employmentcasesupdate.co.uk/site.aspx?i=ed21864

[nolegion]

My Turn's Manoeuvre prompts discussion in the BJUI = British Journal of Urology International (27 03 14):-

 

"Interesting story on how the doctor's behavior changed when he thought he was "off the record", which seems so obviously unprofessional and inexcusable."

 

Ex:

http://www.bjuinternational.com/bjui-blog/welcome-to-the-world-of-digital-audio-recordings-of-your-consultations/

[nolegion]

Here's a further, robust, recent article on the subject:-

 

"So do it! Plan to record your next visit…"

 

http://patients.about.com/b/2014/03/24/blistered-eyeballs-make-me-suggest-why-not-record-your-doctor-visit.htm

 

 

while even my extremely limited Spanish can discern patientgate is being summarised here:-

 

http://gestioclinicavarela.blogspot.co.uk/2014/03/puc-gravar-la-visita-doctor.html#more

[My Turn]

Of course, it's not just clinicians who need to wise up. The fantastically self-important and inefficient bureaucracies which nourish them do as well.

 

Still leading the field for sheer breath-taking ignorance and arrogance, in my view, is the East London NHS Foundation Trust's 'Audio Visual Recording Policy', where about a dozen paragraphs comprising item 7 ("Recording by service users and members of the public") contain scarcely a sentence which is legally accurate.

 

Furthermore, in circumstances which include a patient's taking an audio recording of a consultation with a doctor, the Trust tells its staff:-

 

" If anyone is found to be making a recording without the permission of the Trust, the individual should be advised this contravenes the right to confidentiality of any individuals being recorded, their human rights and is against Trust policy.

 

The recording device should be taken from the individual and the recording destroyed. In some circumstances it may be appropriate to withhold the recording device."

 

The problem with this, or rather, one of major problems with this utterly erroneous claptrap, is that any member of staff complying with these instructions during or following a consultation would almost certainly commit more than one criminal offence against the patient concerned.

 

And incitement to commit a crime is itself a crime.

 

(http://www.eastlondon.nhs.uk/About-Us/Freedom-of-Information/Trust-Policies-and-Procedure/Information-Governance-Policies/Audio-Visual-Recording-Policy.pdf)

 

Hello Nolegion. Sadly the East London Mental health Trust is the trust which Lovell Brian Dennis was being treated when he was fitted up by his local council in Hackney of a crime he did not commit. He's the man whose recording of his meeting with social workers proved his innocence and saved him from prison. If you recall his case was discussed much earlier in this thread.

 

This is a link to a newspaper article on his case. http://www.voice-online.co.uk/article/man-wins-compensation-after-recording-saves-him-prison

[My Turn]

I'm the biggest proponent of the work the NHS does, I should be, I work here. But, I acknowledge that at times mistakes are made, they're made because humans are treating humans. No one is infallible and no one can guarantee that a patient will agree with the clinical judgements made by their doctor / nurse.

 

Hello "Think About It". I don't think anyone is advocating the recording of consultations to support disgruntled patients making unreasonable complaints about honestly made mistakes (unless they involved negligence). Instead, a recording can be of use when the doctor starts to misuse their position of privilege with respect to a patient and perhaps even become abusive or deny a patient treatment which any other patient may have received. A recording can be very useful to prove what was actually said where a serious allegation is made.

 

You also raise the point about the difficulties of storing the information. I can't see storage space being an issue because medical images of patients (such as an MRI scan), ECG traces, ultrasound videos, etc are much larger than audio files and are routinely stored. Almost every formal consultation with a doctor takes place with a PC in the room and it would be trivial to bring up that patient's record and press a button, if it were implemented in the software, to start a recording. This would permit immediate filing of the recording. However I don't think all this is strictly necessary because if it is too much trouble for the NHS then the patient can do it; all that is needed is a cheap dictation recorder and a doctor who does not try to prevent the recording taking place.

 

One additional benefit we must not overlook is that patients, especially very ill patients, do not properly recall all that is said to them in a consultation and it would be a boon for them to have a way to easily recall everything they were told by the doctor.

[Sali]

I wouldn't have any reservations about a patient recording their consultation in my practice but I can perhaps go some way to explaining why it's not done routinely.

 

In terms of cost and logistics it would be completely prohibitive.

 

Let's put some scale on this, in primary care alone (so GP's and practice nurses) there are over 340,000,000 individual consultations every year. Each of those, on very broad average, lasts for around 10 minutes (some are less, some are significantly longer).

 

Then of course, the NHS would need to store that information for a period of time, now as it would form part of the medical record, that stays with you for life, it's reasonable to assume that this data would not be destroyed for potentially well over 100 years for someone born today. Because of course, even after death, your records are maintained for 10 years.

 

So, 3.4 Billion minutes per year recorded at 320kbps to ensure clarity would give 7,968,750Gb of datato store, let alone index.

 

I don't think storage space is the problem. In the last 5/10 years we have seen some technological leaps comparable with the industrial revolution - where once an SD card stored 128MB, now they hold 128GB and prices have dropped dramatically too. Scientists have already managed to store data on DNA (http://www.wired.com/2013/01/dna-data-storage-2/). The future in this field holds amazing possibilities.

 

So where to store it? Do we store it locally and risk its loss in a fire or catastrophic IT failure? Or, do we outsource storage to a data centre? Of course, data protection becomes an issue then in choosing a provider as does setting up a method of accessing recordings.

 

 

Well, logically on a digital cloud - frequently backed up, with regular disaster recover tests to verify data integrity.

 

However, there's a fly in the ointment - security. Quite frankly our data is not safe because the people who invent new security technologies are constantly being chased by those who wish to break it. More often though, it's lack of knowledge of those administering the system, poor and sloppy work practices, hacking and, increasingly common, people on the inside stealing data to sell.

 

Secondary care, Hospital admissions, outpatients etc adds another 125million individual contacts to the 340 million in Primary, this presents it's own challenges. Some hospital stays last months, others - like my outpatients appointment today lasted about 15 minutes. So what do we record? The full duration of the stay or just interactions with a member of clinical staff? But, what about non-clinical interactions such as domestic / food etc?

 

The logistics of recording a (voice or video) consultation are quite simple. It becomes more complicated if we decide to record interactions on wards, in care homes etc and then there's individual's right to privacy. Nothing is insurmountable though.

 

 

I'm the biggest proponent of the work the NHS does, I should be, I work here. But, I acknowledge that at times mistakes are made, they're made because humans are treating humans. No one is infallible and no one can guarantee that a patient will agree with the clinical judgements made by their doctor / nurse.

 

I think we all accept that humans make mistakes. My experience - and of so many others who visit this forum, stories I hear first hand, read or hear about in the media - is that there is a general reluctance to admit to those mistakes, apologise, try to put things right and learn by them. And then there is the incompetence, apathy and careless cruelty, none of which seem to be a disciplinary offence in the NHS.

 

 

Most of the complaints I've dealt with have been down to a difference in opinion and it's the very reason that people are able to seek a second opinion if they so choose. But, they are just that - an opinion / a judgement / an impression of the condition based on the past experience of the person making them.

 

Our clinicians are happy whenever someone brings in a list of issues from Google / Wikipedia because it gives them an insight into what the patient is thinking and what their true concerns are but they're limited by the constraints of working in a GP surgery, we don't have immediate access to advanced diagnostic equipment and they don't always assume the worst possible scenario. The reason they explore the more common problems first is because they're more common. The one in million diagnosis of some dreadful rare condition is only reached by excluding the likely causes.

 

If you've concerns over your treatment there's a few things you ought to consider:

 

Change your doctor.

Tell them your concerns.

Raise a complaint - us practice managers are not clinically trained so we go at complaints from the same starting point as a patient.

Request a second opinion.

Tell your doctor if you think their diagnosis is wrong and ask them to explain how they've ruled out your concerns.

Take support with you - family / friend / representative, all are welcome - we provide chaperones if patients request them

By all means, record your session but seek clarification on the points you're not happy with.

Ask for an appointment to go through your medical record or ask to see it / get a copy.

 

 

We can do all these things and still record our consultations, overtly or otherwise. As has been said before, it will enable us as patients to review the meeting in the quiet of our own homes, enabling us to hear things we missed in the moment and to perhaps prompt questions for future appointments. I am puzzled why any medic would object to this unless they are so insecure in their ability that they feel threatened by it.

[arkadiygaydar]

It is also very important to start recording when talking to the receptionist.

I once saw the situation when a pregnant woman(I know her), who was late to her appointment, (there was the road blockage in our town because of an accident, so this was not her fault) was trying to get a receptionist to ask a GP to have 3 minutes for her. The GP was present at the surgery , and his previous patient has gone already.

The receptionist insisted that the woman would not be seen. the woman insisted that she asks the receptionist to ASK the doctor if he agrees.

the receptionist declined.

The Pregnant woman stepped towards the room of the GP. The receptionist pressed the panic button!

The GP came out to see what happened. Seeing his patient, he smiled and of course agreed to see her. The woman spent 5 minutes with her doctor, asked all the urgent questions,and thought all was over.

A week later that woman told me, that the following day after the interaction with the receptionist a letter from the surgery arrived, accusing her of violence and aggressive behaviour towards the receptionist, and so the woman gets a warning that she would be struck off as a patient.

This pregnant woman did not record what happened. So, really, she lost the potential £5-6K of compensation for injury to feelings following the untrue and unfair accusations of violence.

The GP never lied to confirm violence, but never helped the woman to defend herself. he said " I did not see what happened".

This was the best GP in the surgery. The others are worse.

Edited March 31, 2014 by arkadiygaydar

[Oomleeu]

Dear Arkadiygaydar,

The expense of "compensation for injury to feelings"? Add to that the expense of a hearing and you'd probably be looking at tens of thousands of pounds in wasted time and money. There are lots of people out there on the gravy train earning a good living off incidents like this.

Had the patient, receptionist and doctor been aware that this was all being recorded, there is no doubt in my mind that incidents like this would never happen. Millions of pounds more that could be spent on better patient care instead of caviar on the gravy train.

[nolegion]

I couldn't agree more about the potential for recordings in the hands of patients to reduce NHS costs.

 

It seems to me that this works at many levels, including litigation, complaints, and rectification of inaccurate\falsified medical records – as well as self-defence against false accusations made by doctors or staff.

 

It might even, eventually, induce badly-behaved clinicians (and their managers) to shape up or ship out.

 

As regards litigation, there is the 'dynamite' principle (see post #42 this thread).

 

As regards rectification of medical records – well it's often dramatically easy with a recording and very difficult indeed without. Been there, done it .Succeeded big time, with recordings, on my own behalf and for others; struggled to make much headway, without.

 

On this last point – about medical records –which are frequently in issue e.g. in disciplinary proceedings at the GMC, I think a penny may be about to drop, very slowly, amongst general practitioners. You see, it remains at least half-possible that the current government will, before the end of its current term of office, do what it said it would do at the beginning of it i.e. make individual patients' primary care records readily accessible to patients online. (Nothing to do with the disastrous 'care.data' fiasco currently in the long grass).

 

This could mean that a patient, having finally managed to secure a GP appointment, only to be treated rudely, obstructively, and dismissively by a GP, will, at the end of the same day look to see what the GP has said about it. Surprise ,surprise the highly unsatisfactory nature of the consultation is blamed on the patient; symptoms presented, with difficulty, are not recorded; the patient is alleged to have said things she didn't; medical advice is recorded as given when it wasn't; a note suggesting possible future 'banning' from the practice is included for good measure – and all the rest.

 

And when this can all be demonstrated to be thoroughly deceitful, by virtue of the recording device in the patient's pocket, retribution can arrive swiftly and in earnest. Deliberate falsification of medical records has, in the past, been difficult to establish, but it is most certainly a disciplinary offence which can lead to sanctions, including erasure from the medical register.

[nolegion]

" Another contentious question is whether patients should be allowed to record their consultations. In the UK, opinion has swung in favour, even going so far as to approve of patients recording consults covertly, according to a BMJ editorial."

 

This much my limited IT skills can extract from an Australian article published here, today:-

 

http://www.australiandoctor.com.au/opinions/journal-talk/setting-the-record-straight-on-a-resonant-issue

 

Anybody here have better skills – or even the required registration - to see what else, if anything, Dr Kate Kelso had to say on the subject?

[think about it]

On this last point – about medical records –which are frequently in issue e.g. in disciplinary proceedings at the GMC, I think a penny may be about to drop, very slowly, amongst general practitioners. You see, it remains at least half-possible that the current government will, before the end of its current term of office, do what it said it would do at the beginning of it i.e. make individual patients' primary care records readily accessible to patients online. (Nothing to do with the disastrous 'care.data' fiasco currently in the long grass).

 

Just a note, this is already quite possible dependent upon which clinical recording system your surgery uses.

 

As we change from one version of our software to another in Autumn 2014 it's something we'll be looking into.

 

Key concerns just now are the lack of interpretation on results if they're displayed instantly etc. Quick example (using me as the guinea pig):

 

Recently I had a series of blood tests, one of which is a CRP (C-Reactive Protein). My results for that came back from the lab waving every 'abnormal' red-flag imaginable - it's one of many indicators that look for inflammation that may be present due to any number of causes but it flags up especially during infections, Crohn's disease and cancer amongst many others.

 

I saw my 'values', the actual numerical results, and had a bit of a flap. Only when I sat with one of my GP colleagues did they explain it in relation to a well managed condition I have and in the context of the other results. The 'Google' of "elevated CRP" did little to calm my concerns.

 

So, would I want someone who couldn't get instant access to the interpreted results to see those 'abnormal' flags from the lab?

 

I'm not sure is the honest answer.

 

It's the reason we ask people to call us to get their results, and even if they've arrived that morning and have yet to be reviewed we won't give them. Why? Because neither me or any of my colleagues in reception are qualified to interpret them.

 

How we eventually present the record in a manner that's acceptable and easily interpreted I'm not sure. It's the reason I now offer anyone who requests a copy of their records a half hour appointment with the clinician of their choice so they can review it together and ask any questions that arise from it. I've been around clinicians all of my life from months spent in children's hospitals to friends and family and still the terminology occasionally gets the better of me and I know, along with the rest of my non-clinical colleagues, that it's vital that I understand and respect the limits of my knowledge.

 

All of that said, ask your practice if they use EMIS Web - if they do, then the patient access is an available function if it's been enabled by your health board / practice. https://patient.emisaccess.co.uk/Account/Login?ReturnUrl=%2f