Audio-recording your consultations with NHS doctors

[Sali]

I thought all court proceedings were recorded (by the court authority) one way or another and that it should be possible to obtain copies. Not that I've tried.

 

****

 

I was wandering through Google trying to find out my own Trust's policy on digital recording by patients, but the topic never seems to be mentioned, unless it is buried half-way to Australia. I know I could enquire, but I don't like to mark myself out as a target.

 

Whilst I was browsing, I came across an old BMJ discussion (http://doc2doc.bmj.com/forums/off-duty_news-media_should-patients-right-record-consultations#plckforumpostonpage=1&plckpostid=&plckforumpostshowfirstunread=&plckfindpostkey=) asking whether patients should have the right to record consultations (and may well have already been referred to in this thread).

 

One contributor called Dutchcloggie commented:

 

If your first response is: Why should a patient want to record me talking? Then your focus is not on the patient but on yourself. If a patient wants to record your conversation, it might be because last time you spoke, they did not understand. Or last time you spoke, they had so many questions. Or last time you spoke, there was too much information for them to write down. Or last time you spoke, the news was so bad, they were unable to take it in.

 

Well said.

 

Another contributor called JimO also gets my vote. An excerpt from one of his posts (but all of them are a good read):

 

I see that this Spring entitles this topic\thread to call itself a 'hardy perennial'. Quite right, too. Sometimes mountains of machinery can be made to move on small and simple pivots, and I think the recording devices in patients' pockets are going to stay pivotal.

 

He also reminded me of the Granary Care Home/Shaw Healthcare decision to ban covert surveillance. Does anyone know what happened following the public backlash?

[nolegion]

Audio-recordings of proceedings in civil courts. Good subject - and thank you, Sali, for a post I have been looking forward to following up. Under some personal pressures for a while, I have still only had a chance for a very hurried look at the up-to-date wider position on this at this directly myself so far, but I have had a quick conference about it with someone still practising law.

 

My impression so far: the chances of most mortals (legally) getting hold of an audio-recording of most legal proceedings are minimal. This comes about because:-

 

1. Many legal proceedings aren't officially audio-recorded in the first place. This, it seems, is the case in e.g. most County Court proceedings and most first-tier tribunals

 

2. If there has been a recording at a more senior level e.g. High Court then there will be an 'official transcript' of the proceedings as a whole. All or parts of this written record (usually compiled mostly on the strength of the 'official audio-recording' itself) may be obtainable, eventually, on application to the court\tribunal concerned subject to detailed and procedural delays\ obscurities\discretions\conditions varying with different court\tribunal\panel rules, etc– and above all subject to formidable expense per page of ink.

 

3. If, and only if, you have already obtained such a transcript, then you could think of making a further application for a copy of the audio-recording itself. However…

 

4. … only people officially approved to prepare the transcripts above referred to (usually specialist private sector businesses) are normally to be considered eligible to receive such copy recordings!

 

5."In exceptional circumstances", and subject to any further conditions the court may choose to impose (e.g. totally forbidding any squeak of onward transmission of the audio-recording to anyone else under the sun at risk of contempt of court), then perhaps a lawyer might obtain some or part of an official audio-recording on rare technical grounds to be fully explained on application and subsequently deemed justified. Yet formidable further charges (to be passed on to the client, of course), will then be incurred for the grant of such privilege.

 

As regards written authority for at least the tenor of the foregoing, this recent 'Practice Direction' under the hand of the Lord Chief Justice is a pretty good, if in my personal opinion disgraceful, steer:-

 

Ref: http://www.familylaw.co.uk/system/uploads/attachments/0008/3677/PD_of_14_February_2014.pdf

 

If just a shade of rancour has crept into my perspective here, it may at least partly be because when I attended a species of medical tribunal in support of a severely ill close relative (as next-of-kin, not in any other legal capacity) a few years ago, I was forbidden by the tribunal in question to take a single written note of the proceedings for myself and family.

 

A radical judicial re-appraisal of the current position is required a.s.a.p, I respectfully submit, m'lud.

………………………….

 

Still many points of Sali's last that I would like to invite more discussion about, and yet further recent commentary in the BMJ on our subject is worth some scrutiny. I'll get there, I hope, but, please, let nobody wait on me.

[Sali]

Well, I've only been in a court once when I did jury service and I presumed that all court proceedings were recorded one way or another and that (surely) this would be available to concerned parties for a minimal fee (in most cases). And to prevent an individual directly involved in the case of a relative taking notes is quite bizarre. After all, they cannot erase your memory before leaving. The more I learn, the more I wonder what kind of country I am living in. Still, I suspect there's loads of people secretly recording court proceedings who never get caught.

 

****

 

I see that members of the RCN have voted overwhelmingly in favour of banning covert filming in care homes (where abuse is suspected) and the union may lobby for the CQC policy to be revoked (although it wasn't so much a policy as a 'guideline).' This on the same day that the CQC reminds us that the standards in 6 out of ten care homes is below par.

 

One RCN rep suggested that relatives should raise their concerns with managers instead. When did the RCN become so self-absorbed? Do they really think relatives haven't been down that path or perhaps may be leery of treading it because in that place or at another time, their trust has already been tested/broken. The vulnerable and elderly in care-homes are not pieces of luggage to be moved around at will.

 

One other point I'd like to make is that the nurse recently convicted of poisoning patients in Stepping Hill hospital was eventually caught with the help of video cameras installed in order to catch the culprit. If those cameras had already been in place, he would have been caught sooner and lives would have been saved.

 

****

 

I also read that the man who recorded the derogatory remarks of medics carrying out his colonscopy (mentioned in previous posts) won $500,000. I still don't quite understand how he managed to take his smart phone into the theatre - apparently the phone was secreted in his trousers (the article said pants, but I assume (well, I hope) that means trousers), beneath him on the operating table.

[My Turn]

Audio-recordings as evidence. Under English law recordings are classed as 'hearsay' and arguments can be made against their admissibility as evidence before a court in some circumstances. However, in civil actions, courts\tribunals etc have a wide discretion to admit such evidence, and it is established law that where a recording is genuinely relevant to matters of contested fact, that discretion should be exercised in favour of recordings being admitted for consideration as the general rule.

 

Hello Legion. 'Hearsay' doesn't sound like it is a very high standard of evidence.

 

If a patient was present at a consultation and used the recording to remind him of what was said then is that still hearsay or does that represent more direct evidence? Presumably the recording would enable his memory of the consultation to be more accurate meaning that the credibility of his first hand account is enhanced.

[nolegion]

Royal College of Nursing & The colonoscopy patient. (Sali's post 24 06 15)

 

Excellent spots for this thread. For any others who like me may be playing 'catch-up' just at the moment, perhaps I could take the liberty of adding a couple of links.

 

RCN

http://www.telegraph.co.uk/news/nhs/11692288/Covert-filming-should-be-banned-from-care-homes-as-spycams-puts-nurses-off.html

 

It's seems to me that the RCN is producing non-arguments of Buckman-level fatuity – and that's pretty desperate.

 

Incidentally, the update on the protesting relatives of those resident at the Granary care home goes like this. The family leading the counter-attack consulted the CQC. The CQC already knew about the matter from the publicity. The brief dialogue that the family then pursued with the CQC included the question, 'Is this "policy" actually, currently in operation?' The CQC went to ask Shaw Healthcare (head office) about exactly that. The CQC then reported to the family concerned that Shaw Healthcare had now confirmed that the most offensive part of the policy i.e. 'cell-tossing' to search for devices without the resident's consent or that of their family on their behalf, had been WITHDRAWN.

 

Sounds good so far. However, when a relative at the most recent 'relatives meeting', last month, asked about the matter, the local management of the home said it knew nothing of the purported 'change of policy'. The family have asked the local team to clarify the position in writing. No such clarification has materialised so far. I have feeling this matter may yet get to court.

 

COLONOSCOPY

http://www.washingtonpost.com/local/anesthesiologist-trashes-sedated-patient-jury-orders-her-to-pay-500000/2015/06/23/cae05c00-18f3-11e5-ab92-c75ae6ab94b5_story.html?postshare=3181435122381625

 

My conjecture, only last month (22 05 2015), that this case must by now have settled out of court in a fashion we would probably never learn about proves wrong, I am very glad to say. Serves the medical staff concerned right, and let that be a lesson to the rest of 'em!

[nolegion]

Hearsay etc. (My Turn's last post)

 

The idea behind the original common law rule 'against hearsay' was that the statement alleged stemmed from someone not available for cross-examination in court. However, it grew to have so many 'exceptions' i.e. admitting such evidence after all, that it was reversed by statute. Section 1 of the Civil Evidence Act 1995 now stipulates that in civil proceedings 'hearsay' evidence is generally to be considered as admissible.

 

There are exceptions, discretions and indeed matters of 'weight' to be considered (as set out in that Act – and yet further can be dreamt up by lawyers) but they are pretty much as one would expect. Particularly in the case of recordings, perhaps, the questions of reliability, accuracy, completeness, non-manipulation would all be relevant.

 

For the purposes of recording patients, though, the case of Amwell View School v Dogherty which I mentioned soon after starting this thread is particularly useful. In that case, the Civil Evidence Act wasn't of much use to the defending employer – it just indicated that the recording which the disgruntled employee had obtained covertly was not to be excluded on the grounds of hearsay alone – as indicated above. But the tribunal also reviewed other sources of law e.g. of E.U origin and in no instance was any valid objection to be found. Since then a further EAT case has now ruled that the Amwell review is to be considered 'established law'. And that is a pretty 'knock-down' piece of legal argument in favour of the lawfulness and admissibility of recordings by individuals, including of course, patients.

 

For the sake of completeness, I should add that the Employment Appeal Tribunal in Dogherty did manage to dream up one objection to a part of the claimant's recording - which captured the deliberations of the original disciplinary hearing while she was out of the room, but that exception is narrow and has itself been called into question by subsequent case law; also the further case I mentioned (Vaughn v Lewisham 2013) found grounds to exclude because the claimant had not identified with sufficient particularity the extent to which the voluminous evidence (39 hours-worth of covert recordings!) would actually be relevant to her case. Inadmissibility because of lack of relevance is a principle which can be applied to any evidence at all - not just to recordings.

 

As I say, I mention these 'qualifications' by way of completeness; do not let them distract anyone from the idea that in civil case in England and Wales your recording primarily falls to be considered as ADMISSIBLE unless specific argument can be found against it, 'technically hearsay' notwithstanding.

 

And obviously, to return to My Turn's original question, if one uses a personal recording when compiling notes – or indeed witness statements – well, that will just make those statements all the more accurate.

 

As a footnote (i), I observe from both past and more recent chats in person, and from the net, that people are becoming increasingly 'bullish' about their rights to record. Even in defiance of the law - but recognising that such recordings may never see the light of day, evidentially. I include in my thinking here those in some of the (minority of) American States which have local laws prohibiting recording without the other party's (-ties') consent They are saying – So what? It's my health and I am promoting that interest over the possibility that the physician will refuse consent. And they go on to record covertly.

 

In other contexts, where recording by individuals is forbidden, I am sure similar conclusions are being reached by people with very reasonable motives. In the UK, I have no doubt, for instance, that Sali is right in suggesting earlier that despite risking the potentially severe consequences of contempt of court people are recording court proceedings in which they are involved, every day. Even, dare one think it, some lawyers, perhaps.

 

As a footnote (ii), that last consideration of mine, law-abiding citizen that I am, does not represent a path I chose to go down, when the panel which had prohibited my taking notes on a previous occasion had to meet again in respect of the same relative some months later – albeit with different panel members. This time I was warned and prepared - and still angry. I told them that the 'Practice Direction' on which such prohibition appeared based conflicted with the relevant statute and regulations and I wished to argue these procedural points before them in some detail with a view to appeal to the Court of Protection should the same 'rule' be announced at the instant hearing. Shouldn't take more than about 25 mins, I said. Funny ol' thing, they then promptly decided that on this occasion they would permit me to take notes, without further ado.

 

I hope it may be perceived that I do not relate this anecdote to make myself out as some clever-clogs, but to lament the consequences of overweening officialdom. I was very keen to make sure I accurately recorded the dense medical details and predicted sequelae relating to a horrible disease which doctors and others were describing to the panel and about my own sister – for my own knowledge, and so I could report faithfully to other very concerned family members. I found a way to persist. But I think of the many others who would wish to take equally careful notes in such circumstances but don't happen to be a cranky (yet, I claim, tenacious) old git of a retired lawyer with internet access. What would they do? I think they would find the answer in their pockets, no sweat.

[nolegion]

Here's a short story I much like, from a June 2015 publication of the Medical Protection Society:-

 

"In the context of a complaint or claim, a recording may provide information beyond what is in the records that can be of assistance to the doctor, but this is not always the case. MPS dealt with a case of a sessional GP working in the out-of-hours setting who accident[al]ly prescribed Penicillin to a Penicillin allergic patient. Unfortunately the patient had an anaphylactic reaction which required in-patient hospital treatment and a claim ensued.

 

The sessional GP had not recorded a history of allergy, but was adamant that their usual practice would have been to enquire about allergies before issuing a prescription and that the patient must not have given any indication that they were allergic to Penicillin. The triage telephone recordings were reviewed, from which it was clear that the patient (without any prompting) volunteered that they were allergic to Penicillin and on this basis the claim was settled." (Emphases mine)

 

Source:-

http://www.medicalprotection.org/uk/practice-matters-june-2015/risks-of-telephone-consultations

[nolegion]

Glaswegian GP Dr Margaret McCartney got a piece published in the British Medical Journal earlier this month and I have been meaning to get round to posting a link to it here ever since. It's about recording by patients and entitled 'Trust the Patient'. It appears to be 'open access' and so I hope the link below will lead you to the article itself not to some £subscription log-in page.

 

Dr McCartney strikes me as a cheerful and enthusiastic soul whose commentary here , and elsewhere, has been, apparently at least partly, on the side patients who wish to record their consultations. She was one of the doctor's involved in the Radio 4 discussion (which starred My Turn) last July, and there she said:-

 

"…it’s been pretty uncommon really and I can absolutely concur, there’s lots of evidence out there, that says that people find it quite difficult to retain all the information that they’re given really quite intensively over just 10 or 15 minutes in the consulting room. So I think absolutely I can see why it is that many patients might find it to be useful to have a permanent record of what the consultation was."

 

BUT also:-

 

"… to me it’s about intention – who are the doctor and patient on the side of? If they’re on each other’s side perfect – doctors and patients working together, the information from the consultation being used to benefit the patient and possibly their family as well – perfect. I think when many doctors might get concerned is if the doctor and patient are actually on different teams and if perhaps there is some kind of other intention with the recording to sue doctors or to make a legal case against them somehow. I think that kind of thing will inevitably make many doctors, including myself, quite frightened about it…"

(http://www.bbc.co.uk/programmes/b048l0sm)

 

Now she manages a similar sort of ambivalence in the BMJ, I think. I particularly quarrel with her closing paragraph. Perhaps, however, people would like to read her new commentary uncluttered by my comments first:-

 

http://www.bmj.com/content/350/bmj.h3181

 

Any views?

[nolegion]

Before I forget, there was a point mentioned earlier about not wanting to probe various form of health provider\body for information, for fear of singling oneself out for unwelcome attention during one's actual healthcare. That is a very real consideration, in my view.

 

I think the way forward is to use the WhatDoTheyKnow website, and raise a freedom of information request. It's dead easy. Even I got the hang of it quite quickly. The recipient of the request in the first instance never gets to see even your email\ISP address at all.

 

Strictly speaking, for a FoI request to be 'valid' it should be made by someone under a 'real name'. That could cause problems on appeal to the ICO against a refusal to provide the information sought. They will, for instance, require a postal address to which to send their response. But for at least a 'round 1' enquiry, if you don't actually call yourself "M. Mouse" the bald truth is the ultimate recipient of the request has no way of knowing how close the name used is (or is not) to an actual name.

 

Alternatively, one can perhaps find a friend with whom to swap FoI favours (through WDTK or otherwise). I persuade a friend and former colleague or two to ask in their own real names so as not bring my real name into the line of fire on matters which could, for instance, explode my 'handle' in this forum. In return, I raise queries for them where they would like their heads below the parapet. We have all subsequently pursued appeals for others involved without difficulties.

 

It's 'on my list' to ask the trust which runs Derriford hospital what, if any, recorded policy in place which might have a bearing on the way the doctor I recently named the Derriford Dork behaved towards Mr Michael Valentine – and report the outcome here. That FoI will go in, probably via WDTK and under a real name – but it won't be mine.

[nolegion]

Fine BMJ blog article, published today, from a medicolegal adviser to the Medical Protection Society, Marika Davies. "Standing up to disrespectful doctors"

 

"…the risk of covert recording is rising with advances in technology and the increased prevalence of smartphones. Encouraging patients to be open about their wish to record consultations is one way to avoid the secrecy and distrust that comes with covert recordings…"

 

In some quarters at least, the penny really is dropping about our subject. Truly encouraging.

 

Going to alert some co-conspirators to see if they will add some congratulatory comments under the blog item. Anybody here feel like adding a comment or two there themselves?

 

http://blogs.bmj.com/bmj/2015/07/02/marika-davies-standing-up-to-disrespectful-doctors/

[Sali]

Yes, I recall hearing Dr McCartney on Radio 4 when she spoke of doctors and patients sometimes being on different 'teams.'

 

I do not believe overt recording should mean that medics practise 'cover-my-back medicine', sending patients for tests and treatments which they know are of no benefit. That would unprofessional and irresponsible.

 

The number of complaints to the GMC and litigation against hospitals has been rising for some time, and is not, I believe, linked to the growing popularity of recording consultations, overtly or otherwise.

 

The internet, which provides us with information that would have been previously difficult to obtain, has empowered us. Forums that enable us to share knowledge and experiences and a demand for greater transparency generally has made us more mistrustful. We are becoming more confident to challenge decisions, much to the ire of those in charge.

 

Of course there will be a few rogue patients that misuse the recordings, but there are a few rogue medics out there too. Neither are labelled. It will be a first-hand bad experience and how a complaint is dealt with that alters us forever and turns us into hardened cynics. As it stands I believe that the GMC, the CQC and ombudsman are all too willing to limit their investigations and believe the doctor/hospital over the lowly patient or their loved-one. Video/sound recording evidence is difficult to deny and is therefore my weapon of choice - one which I hope to never have to use.

[My Turn]

.... Now she manages a similar sort of ambivalence in the BMJ, I think. I particularly quarrel with her closing paragraph. Perhaps, however, people would like to read her new commentary uncluttered by my comments first:-

 

http://www.bmj.com/content/350/bmj.h3181

 

Any views?

 

 

You asked for views and here are mine.

 

Essentially, the author Margaret McCartney says trust is a two-way street: the patient should be able to trust the doctor and the doctor should be able to trust the patient.

 

If I were to play devil's advocate I might ask what difference does it make if the doctor is not able to trust the patient? Does the author's suggestion indicate that such a patient is to be provided with fewer rights than one who can be trusted? I hope not!

 

Remember that trust or mistrust is subjective and no evidence is needed for some to have a feeling of trust (or mistrust) about someone else.

 

Furthermore, what if no doctor can be found anywhere who trusts a particular patient? Does that mean such a patient does not get the rights awarded to a person who is trusted.

 

As it happens, I for one can't be trusted to NOT record a consultation. I am the patient Glyn Elwyn wrote about in his BMJ article called "Patientgate" and discussed in this thread. My doctor was being abusive to me in an consultation while I was in an exceedingly fragile state of mind where I lacked full capacity. She asked me to turn off my recorder which let her give full vent to her extraordinarily unprofessional abuse. (I do not use the word "abuse" to mean abusive language but to mean withdrawal of medical services, striking off a GP's list, etc for no good reason.) Yes, I did turn off my recorder at her request but I had another one running which recorded all her abuse. Am I now a patient not to be trusted and one who does not get accorded the full rights of one who receives abuse from their doctor without recording it?

 

 

My Turn

[Sali]

How does a doctor know when a patient trusts them? How does a patient know when a doctor trusts them? And, as you say, My Turn, what does it matter? Does the doctor's expertise increase in the warm glow of a patient's trust? Perhaps trusting your doctor brings psychosomatic benefits.

 

Was it a first appointment with this particular doctor, My Turn? What made you think of taking two devices into the consultation, one of which was hidden? Were you anticipating the response you received?

 

It's a fair cert that if you had complained about the doctor without your recording as evidence, your concerns would have been dismissed and you would have been labelled a vexatious patient.

 

Does your reputation (as a digital recorder of consultations) follow you? Do you feel you are treated differently now? Better? Worse?

 

What happened to the doctor?

[nolegion]

I wish I'd been able to find more time over the last week to catch up with the conversation here. Perhaps by now it is best for me just to say that, for whatever it be worth, those last few posts from Sali and My Turn are going into to my next 'PPG' meeting as copied down text, not just NL paraphrase. Seems to me they hit nails on the head, one after the other. I want them further respected.

 

I am quietly confident that MT will be along to pick up the story ere long

 

My inboxes tell me that the last couple of weeks week has been busy with documentary on this thread's subject, all over the shop. From which I select this recent press release from a medical insurer. It is rehash of what it said at the end of last year, but nevertheless an emphatic 'rehash':

 

PRESS RELEASE

 

For immediate release: Thursday, 2 July 2015

 

Doctors are warned that the law offers little or no protection from patients covertly recording consultations.

 

However, UK-wide medical defence organisation MDDUS believes doctors who find themselves in this situation should avoid defensive reactions and simply accept that the prospect of covert recording is a product of the digital age.

 

The increasing use of smartphones makes it easier for patients wishing to make an audio – or in some cases a video – recording of a medical appointment with their doctor. MDDUS has encountered calls from distressed members who have discovered a consultation had been covertly recorded by the patient.

 

“While it may be unsettling to discover a patient has recorded your conversation, there is nothing to legally stop them from doing so,” says MDDUS medical adviser Dr Mary Peddie.

 

“Patients don’t need a doctor’s consent to record the consultation as section 36 of the Data Protection Act 1998 considers that the information in the recording belongs to them.

 

"Some doctors may believe that recording consultations is intrusive, shows a lack of trust and is damaging to the doctor/patient relationship. However, patients have the right to record a consultation and then use the information obtained as they choose.”

 

Whilst sometimes the patient may try to use the recording to challenge the doctor, it is our experience at MDDUS that the majority of recordings support the actions of the doctor and confirm that they acted in an appropriate manner, both personally and clinically.

 

“In an ideal world, patients would not feel the need to covertly record a consultation and would be open about it,” says Dr Peddie. “However, doctors should not necessarily feel threatenedwhen they become aware of a recording.

 

“Indeed, a recording may be helpful in avoiding misunderstandings. We are all aware that patients often do not understand a doctor’s best attempts at explanations in layman’s terms. It is worth considering whether there may be a genuine and positive reason for the patient recording the appointment.

 

“Doctors should discuss these reasons with their patient,” says Dr Peddie. “Patients may not feel confident of remembering or fully understanding complex instructions from their doctor or they may wish to share the information with their family to help them reach a decision on treatment options.

 

“Of course, there will be occasions when a dissatisfied patient uses a recording to pursue a complaint or

claim as, even if obtained covertly, recordings can be admissible evidence in court.

 

“Doctors acting professionally should have nothing to fear from an audio or video recording, covert or otherwise, but this will be no substitute for keeping clear, comprehensive and accurate written records of consultations which will help protect them if the patient attempts to use the recording to support a complaint.”

 

Ends

For further information contact Richard Hendry on 0845 270 2034 or 07976 272266, or email [email protected].

Note to editors

MDDUS (The Medical and Dental Defence Union of Scotland) is a medical and dental defence organisation providing access to professional indemnity and expert medico- and dento-legal advice for doctors, dentists and other healthcare professionals throughout the UK.

For further information on MDDUS go to www.mddus.com.

 

FROM;-

http://www.mddus.com/media-centre/press-releases/2015/july/doctors-should-not-fear-covert-recording/

[My Turn]

How does a doctor know when a patient trusts them? How does a patient know when a doctor trusts them? And, as you say, My Turn, what does it matter? Does the doctor's expertise increase in the warm glow of a patient's trust? Perhaps trusting your doctor brings psychosomatic benefits.

 

Was it a first appointment with this particular doctor, My Turn? What made you think of taking two devices into the consultation, one of which was hidden? Were you anticipating the response you received?

 

It's a fair cert that if you had complained about the doctor without your recording as evidence, your concerns would have been dismissed and you would have been labelled a vexatious patient.

 

Does your reputation (as a digital recorder of consultations) follow you? Do you feel you are treated differently now? Better? Worse?

 

What happened to the doctor?

 

 

Hello Sali. The Patientgate incident happened back in 2007 and it was my GP whom I was consulting. I wrote about it in http://www.consumeractiongroup.co.uk/forum/showthread.php?256545-Audio-recording-your-consultations-with-NHS-doctors&p=3142208&viewfull=1#post3142208

 

I had started using two recorders in my consultations because any movement of my microphone would cause loud rustling noises on the recording. The idea was that if one recorder got rustled at a particular moment then the other would still have a clear recording.

 

I found recording consultations was particularly valuable because I was having a lot of extremely serious memory problems due to my medical conditions. I was living in London at the time and this wasn't really the sort of consultation I would have wanted to share with someone accompanying me. Even if I had wanted someone with me, there wasn't anyone in London I knew well enough to ask. So recordings became an essential memory aide for me.

 

On this occasion I got permission from my GP in advance at the previous consultation. So I was very surprised when she asked me turn off the recorder. I did so but before I could turn off the second recorder she launched into a tirade which completely shocked me and left me unable to clearly recall what had been said. In fact most of what happened next was a complete blur and I can not emphasize enough how useful it was for me to later take a clear headed and dispassionate view of what had been said by listening to the recording in the calm of my own home.

 

Unfortunately I continued to be too ill with my memory problems to see a complaint through and sadly the recording never got used in any formal way. As it happens, I also used the same technique in my consultations with a hospital doctor and you're absolutely right to guess that I got characterised as a "vexatious patient". Amazingly, my wish to complain was turned into an aspect of my medical condition and it got reported in clinic letter.

 

I don't mention to doctors my wish to record consultations any more, so I don't really have a reputation regarding this. I did give an interview about my experiences to Radio 4's Inside Health programme and I had thought some doctor of mine may recognize me from this but fortunately that didn't happen. The programme is still available at http://www.bbc.co.uk/programmes/b048l0sm. You may notice that sometimes Gyn Elwyn and I each tactfully change the gender of who was involved!

 

Regards,

My Turn

[Sali]

So the doctor reneged on the agreement to allow you to record the consultations. I'm not sure I would have been clear headed or dispassionate when I later listened to the GP's tirade. My blood would still be bubbling today.

 

The experience must have left you shaken to the core at a time when you were vulnerable and I can see why you would continue to record consultations. It's a shame that you were unable to make a formal complaint against the doctor - she/he deserved to be reprimanded and 're-trained' at the very least. We have to hope that justice will catch up with them one day.

 

My own experiences (not as a patient to date) with the healthcare system means that I am now a covert recorder (and actually not only in that environment - a recording can be useful in other situations). I only wish I had been born with hindsight.

[My Turn]

So the doctor reneged on the agreement to allow you to record the consultations. I'm not sure I would have been clear headed or dispassionate when I later listened to the GP's tirade. My blood would still be bubbling today.

 

The experience must have left you shaken to the core at a time when you were vulnerable and I can see why you would continue to record consultations. It's a shame that you were unable to make a formal complaint against the doctor - she/he deserved to be reprimanded and 're-trained' at the very least. We have to hope that justice will catch up with them one day.

 

My own experiences (not as a patient to date) with the healthcare system means that I am now a covert recorder (and actually not only in that environment - a recording can be useful in other situations). I only wish I had been born with hindsight.

 

Hello Sali. It's the same old story: it's very hard to bring medical profesionals to book. Although a recording helps prove what was said, it is still a huge task to get redress and it can take a very long time.

 

Without appropriate medical attention during that time my health declined and I became less and less able to assert my rights. Sadly, my recording sat gathering dust while I tried to work out alternative ways to get medical help but it never really arrived until several years later.

 

My Turn

[nolegion]

I wish Joanna Slater and her initiative in developing an 'app' for recording medical consultations, and capturing other medical information, as detailed below, every success:-

 

Article: "Using technology to negotiate medical minefields", 17 07 2015

 

http://www.heraldscotland.com/news/13439253.Using_technology_to_negotiate_medical_minefields/

 

(The same article appeared in the Belfast Telegraph)

 

There has been an American version of this idea for some while and I don't know how much the fully-developed version of 'MyNotes Medical' will differ from that. But I will be keeping an eye out for its launch in the UK and (depending on £ + 'terms and conditions') look forward to trying it out.

 

Strikes me, though, it will have to be incredibly user-friendly (and inexpensive to run) to find a market niche between a) those who already have the knowledge and equipment available to them effectively to organise their own private version of this, & b) those who are for one reason or another modern-technology\web unaware and\ or averse.

 

You will see that, v. usefully for our topic, the Patients Association essentially welcomes the idea. You will also see, however, the (newish) Chair of the Royal College of General Practitioners, Dr Maureen Baker, disgracefully criticises the idea in a display of thumping ignorance and arrogance. It is in fact a glaring version of what "Dutchcloggie" in another forum pointed out to a notional reluctant or protesting doctor:

 

"...your focus is not on the patient but on yourself. If a patient wants to record your conversation, it might be because last time you spoke, they did not understand. Or last time you spoke, they had so many questions. Or last time you spoke, there was too much information for them to write down. Or last time you spoke, the news was so bad, they were unable to take it in. "

 

(And see Sali's post of 15 07 2015)

 

The very high value patients place on having an audio-recording of consultations to take home for the benefit of their healthcare is well-known, having been repeatedly researched by doctors.

 

Either M. Baker is ignorant of such research and opened her mouth without pausing to check; or, she is aware of such, but, from her senior position, is prepared to ignore its findings entirely on account of her perception of doctors' personal 'fears' - to the complete detriment of the considerable potential benefits to patients, even when for instance, they can be 'an essential memory aide' as My Turn has just been describing (14 07 2015). As I said, it's either ignorance or arrgance, and in context I don't know which alternative I find the more contemptible.

 

Incidentally

 

As regards medical research papers concerning the recording of consultations, I was aware that some illustrations of these were noted at the foot of the Elwyn\Buckman BMJ article I wrote about in this thread on the 15th January of this year. While checking for these I discover that a version of the article concerned has now been posted online here:-

 

http://pdf.thepdfportal.net/?id=298573

 

It's confusing, I find, to get to a really readable version from this site, though. You need to use the "download" option rather than struggle with the unparagraphed text in the 'preview' window. It then, seems to me, doesn't actually download at all but makes my PC appear 'hang' before, eventually, going back to where you started. If you then close that revisited page, you find a potentially much clearer presentation behind it – but in far too small a font. So I increase the viewing size via my browser. Quite a palaver, but for anyone interested you will now be able to see for yourselves whether you think my extended 'review' of the arguments concerned, back in January, was fair or not.

[My Turn]

 

PRESS RELEASE

For immediate release: Thursday, 2 July 2015

Doctors are warned that the law offers little or no protection from patients covertly recording consultations.

 

>

 

 

Hello Nolegion. The Medical and Dental Defence Union press release you quoted is VERY GOOD!

 

It explains in very clear English that patients can record and can do so covertly. A doctor who tries to discharge a patient or refuse to see them again on the grounds of covert recording is not going to get any support from their medical insurance if a patients challenges it.

 

For a long time the GMC has sort of implied that patients can record their consultation but despite that some doctors may have felt he could use a patient's wish to record (especially if it is done covertly) as grounds for claiming the relationship between patient and doctor has been damaged by the patient's action and therefore he does not need to treat the patient any further. That line of argument is not going to work any more.

 

The press release is the sort of article I will print and take to consultations in case a doctor I see is reluctant to let me record.

 

I feel we have come such a long way since this thread was started and, to me, this press release is a milestone. Here's the link to the press release once again in case anyone reading this wants to see what I am referring to. http://www.mddus.com/media-centre/press-releases/2015/july/doctors-should-not-fear-covert-recording/

[nolegion]

 

For a long time the GMC has sort of implied that patients can record their consultation but despite that some doctors may have felt he could use a patient's wish to record (especially if it is done covertly) as grounds for claiming the relationship between patient and doctor has been damaged by the patient's action and therefore he does not need to treat the patient any further. That line of argument is not going to work any more.

 

The press release is the sort of article I will print and take to consultations in case a doctor I see is reluctant to let me record.

 

 

Let's ram that point home, My Turn.

 

Below is the full text of the earlier version (31 03 2015) of that advice from the Medical and Dental Defence Union of Scotland:-

 

" A RECENT call to the MDDUS advisory service highlighted some confusion over a patient’s right to covertly (or indeed overtly) record their medical or dental consultation.

 

The member in this instance was shocked to learn that he had been covertly recorded using a smartphone. He was seeking confirmation from MDDUS that he could warn the patient that this was not acceptable, that the patient could not record their consultations again without his explicit consent and that if continuing to do so they would be advised to register with another GP.

 

Discovering that you have been covertly recorded can be unsettling but the reality is that there is nothing to legally stop patients from doing so, nor is there any need to seek your consent. When a patient records a clinical consultation, the information being recorded is almost exclusively relating to that patient. Under section 36 of the Data Protection Act there is an almost total exemption for individuals who are using personal data for their own domestic and recreational purposes. The DPA views this data as personal to them and that the recording of such is simply the patient processing their own personal data. Ultimately, the data is viewed as confidential to the patient but not to the consulting clinician.

 

Patients may record consultations for a number of reasons. They may wish to aid their memory if there is likely to be a complex or lengthy discussion. They may wish to let their family members listen to help clarify matters or keep them informed. Or it may be that they are dissatisfied with the advice they are being given and want to seek another’s view. It is worth noting that covert recordings are admissible as evidence when judged as relevant to a legal case.

 

If a clinician becomes aware that that they are being recorded covertly then inviting the patient to continue recording openly may positively influence the situation. A gentle question around their perceived need to record the consultation may help clarify matters for you and indeed the patient. A request can be made that in the future they alert you to this activity but be aware that the patient does not have to comply with this – although demonstrating acceptance and lack of defensiveness may enable the patient to be more open and overt going forward.

 

On the final point raised by our member, deregistering a patient for this activity alone does not adhere to NHS contractual obligations or GMC guidance on removal of patients and the usual conditions and processes would apply in this respect.

 

ACTION: Be aware of a patient’s right to record consultations, covertly or overtly, and use this data as they wish. Avoid knee-jerk and negative reactions to these situations."

 

[Emphasis mine]

 

http://www.mddus.com/risk-management/risk-alerts/2015/march/covert-recording-of-consultations/

[Sali]

Well, the press release may be something to pull out if you somehow get caught covertly recording, but it wouldn't encourage me to ask permission beforehand.

 

Some people with complex or long-term conditions may build up a relationship of trust with a particular doctor. However, many of us will have brief and sporadic interactions with medics. It's nigh on impossible for many people even to see the same GP at each (perhaps infrequent) appointment.

 

Mr Buckman (in the BMJ article) questions the motives of a person who clandestinely records a consultation. As has been repeated time over in this thread, the reason why some recordings may not be done with mutual consent is that we are afraid of asking and being refused and truly damaging the doctor/patient relationship with repercussions for our own or a loved one's on-going care. Who would risk that?

 

Mr Buckman, in his argument against recording, suggests that consultation lengths would increase - he would 'speak slower with half an eye to posterity.' Well, that would be the same if a patient is forced to take notes and what's wrong with posterity influencing behaviour? Notes taken by a patient under pressure (who may be dyslexic, hard of hearing or have arthritic hands) in a consultation are more likely to be incomplete/inaccurate and thus less beneficial to them.

 

I love the way he refers to the time likely to be taken setting up the recording equipment like it was some kind of Victorian contraption.

 

Let's be honest, there are no negatives here for the patient. The medics are only concerned about their own reputations and careers and the prospect of unequivocal evidence that could threaten that scares the living daylights out of them. I for one would have more faith in a medic who welcomed me to record a consultation from the outset.

 

Neo-Luddites be damned.

[nolegion]

Ah well – to say the least things don't always go as planned. I had secured a 'slot' on my 'PPG's' (Patient participation group's) agenda at its meeting earlier this week, and had print-outs of recent posts by contributors here ready for discussion.

 

For good and understandable reasons, the meeting ran out of time to cover all the agenda and we never got there. September it will have to be, then.

 

Meanwhile here's a spicy little article from the States concluding with an address to medical practitioners (about recording by patients, of course):-

 

"Expect it, embrace it, don’t complain about it."

 

http://www.imedicalapps.com/2015/07/smartphone-physicians-privacy/

[Clear33]

That is getting better. 'Expect it. Embrace it. Don't complain about it'. I like it! I feel some trust arising.

 

 

I couldn't bear to comment on previous Doctors moanings because they are showing themselves and the medical profession up. Their excuses for not being recorded are simply beyond ridiculous and so obviously self serving.

 

 

I think in part it is due to this:

 

 

http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html

 

 

And recordings and sharing of recordings will highlight the dubious nature of medicine. In the past, medics have gotten away with keeping patients isolated from one another too, including keeping medical notes a secret between Doctors from patients, so they could basically make up anything they liked.

 

 

Last week I had to go to A&E for myself as advised by the walk-in centre. Of course I recorded everything as I am getting good at remembering that now. The Doctor in A&E was unecessarily patronising to me and tried to make me feel as though I should not be there. ( I was following orders from the walk in centre). I was told because I did not arrive by Ambulance then it could not be serious. Erm, Scientific evidence please?

 

 

Upon leaving, I requested a copy of my test results and notes.

 

 

I think there must be a special lesson on facial expressions to offer patients upon this request at medical school because instead of being a normal human, smiling and saying, 'yeah, sure' , there is a look of astonishment, bewilderment, screwing up of face and shock.

 

 

The Doctor had the cheek to speak as if he was talking to a naughty three year old and said in a slow, stern tone: 'Notes are for specialist to specialist only. Not for patients to read'. But all the more clearer for the recording, me thinks.

 

 

How archaic is that! I saw two Nurses at the walk-in centre and received the notes from each immediately and there were three factual errors in it.

I am beginning to feel that notes and simple facts can not be taken down accurately and patients notes instead become Chinese Whispers between medics, but at least if we can keep on top of the errors as we go along, there is less likelihood of medical error down the line.

 

 

(Was also told verbally that everything was normal when in fact upon reading the results, it was not and there are certain results out of range - this happens a lot to patients and is another breech of trust for those simply wanting facts and can seriously delay diagnoses with sometimes fatal consequences).

 

 

 

 

This same bad attitude occurred with my friend who is also in hospital as she tried to tell the Doctor that he was dosing her meds incorrectly. His first response was arrogance and to patronise her, until he realised that yes, the patient was actually right and he had been about to administer to her the incorrect dose.

[think about it]

Accident and Emergency is an interesting place, I've the express misfortune (long before my employment with the NHS) to spend many many late nights there as a child/adolescent due to my brothers being acutely unwell for most of their lives. One thing is true, the Emergency Dept is just that; everything happens at warp speed and as a result the clinical priority is preservation of life and limb. It's only now, in my late 30's that I realise what really was going on and some of how the department works.

 

A&E notes are handwritten, generally on the fly and concentrate solely on the above; preservation of life and limb. They're generally written in a series of acronyms and symbols designed to speed up the process and when they come into us here in general practice, normally need some translation by a GP into something which can be meaningfully entered on our clinical system by one of the admin staff. One we had last week contained the wonderful sentence:

#(L)tib fib, conf. w/ XR which in polite long hand ought to read: Patient has broken their left leg below the knee, I've confirmed that both the tibia and fibia are broken with an x-ray.

 

It's difficult to know why the clinician that treated you wasn't Mr/Mrs Congeniality. Possibly because they'd been on duty for 14 hours at the end of a 12 day stretch and desperately needed a pee / sleep / something to eat and had another 22 patients waiting with the trama phone ringing from an inbound ambulance crew with a crashing child on-board. Possibly because the last patient didn't make it an he/she'd left a grieving family in the cubicle. Possibly because the Health Secretary and his cronies are doing everything in their power to discredit the work done by him/her and their colleagues. Possibly they were just not a very nice person (it happens)...

 

What is true is that he/she should have given you a copy of your notes. It could be that whilst your blood results were outside 'normal' range, they were within safe limits or were congruent with the reason why you had to attend A&E, if you've an infection then of course your inflammation markers / white cells are going to be elevated as your body responds and fights, they're only going to return to normal once the infection has cleared, certainly not before you leave the department.

 

A&E staff are a little like attack dogs, they serve a very distinct purpose within the NHS. They don't plan treatment or ongoing testing, they stabilise and admit or patch up and refer / send home. If results are dangerous or serious then the lab will call the dept. and tell them, if they're within acceptable ranges then they won't.

 

I mentioned earlier how I'd seen a lot of A&E, I've seen the teams work tirelessly to try to save someone, I've been the grieving family when my brother didn't come home and I've been the patient with the sore leg that I thought was a #(L)tib fib, conf. w/ XR but turned out to be a sprain.

 

I agree, recording is good - if only for your own records to remember what was discussed or indeed to provide feedback later down the road if something goes awry but I'm always mindful of the fact that A&E is a bit of a zoo operating on the very limits and that sometimes a clinician there can get a little jaded as to what serious looks like at the end of a long shift of re-assembling car crash victims and jumping on the chests of elderly people reaching the end of their lives.

[Clear33]

I am afraid A&E simply was not like that at all. The Staff were refreshed and not over worked. It was a pretty light workload too. When I returned to ask for my notes, the staff including the Doctor were all hanging around the desk, chatting.

 

 

The waiting room was full of patients who had brought themselves there and looked reasonably ok. That made me feel better because it would normally be the last place I would go.

 

 

I believe the policy for Hospital notes, maybe to ask for them in writing? Can someone confirm this, so that they can make money from you?

 

 

"A&E is a bit of a zoo operating on the very limits and that sometimes a clinician there can get a little jaded as to what serious looks like at the end of a long shift of re-assembling car crash victims and jumping on the chests of elderly people reaching the end of their lives"

 

 

Yes, that is called being a bad Doctor and why those with mental helth issues die far earlier and why women are more likely to die from heart attacks as they are sent home with 'nothing wrong'.

 

 

Like Ms.Thompson in this article, I was suffering, and still am from female heart attack symptoms. I was only asked if I was getting chest pain. As you can see, female heart attack symptoms are different. And often there is no chest pain.

 

http://www.wsj.com/articles/SB10001424052702304432704577347723157872672

 

I was also berated for getting myself to A&E - the diagnoses was made 'therefore it can not be serious'. And yet you can see in this article 13% of those having a heart attack take themselves to A&E.

I am rather like this and do not like to bother them.

 

 

When I finally do go, I should not be made to feel like that. There should have been a 'well done you' for going.

It will take weeks to see my G.P.