Audio-recording your consultations with NHS doctors

[nolegion]

Although I am very sorry for any patient who has to endure the sort of obstructive, would-be patronising attitude to obtaining information about their own health such as Clear33 encountered, it is good to have such a clear exposition of the experience here.

 

It is an attitude which should indeed be 'archaic', but, alas, is yet all too current.

 

The obtaining of written information by a patient still largely relies on the subject access provisions of the Data Protection Act 1998 (at least a 40-day wait and up to £50 in cost). It is NHS 'policy' to provide (eventually) copies of letters passing between doctors about oneself – but one needs to 'insist' and usually to 'remind' to achieve this end.

 

That was also, in my view, a spirited possible 'defence' by T.A.I, even if slightly wide of the mark on this occasion. It goes into my library of arguments, all the same. Not many days ago, I was told by a practice manager that audio-recording of consultations would become unnecessary because of increased patient-accessibility to their medical notes. I think she had in mind the supposed new online access by patients to parts of GP records – for such as can and care to risk it.

 

" #(L) tib fib, conf. w/ XR " (!) is a v. useful illustration of one of the many reasons such an argument fails completely.

 

***

 

I have been discussing a recent 'blog' article in "Pulse" (a, if indeed not 'the', principal GP e-magazine), and the 34 comments appended to it to date, with an old co-conspirator of mine.

 

Spot, or rather fail to spot, the references to the detailed, extensively-researched and published knowledge about how thoroughly useful for their health and healthcare patients find having an audio-recording to take home can be.

 

It is frankly dismaying still to find such concentrated professional ignorance and arrogance on this subject in current print:-

 

http://www.pulsetoday.co.uk/views/blogs/-no-im-not-ready-for-my-close-up/20010634.blog?sm=20010634

 

Archaic, indeed.

[nolegion]

After my last post about the 'archaic' commentary in PulseToday, I collaborated with my aforementioned co-conspirator to produce a further 'comment' to be appended to Dr Zoe Norris' article. It takes the shape of a fairly detailed rebuttal of the approach both of the article and some of the earlier 34 comments. This my co-conspirator duly posted as comment 35. Very shortly after this, Pulse placed the whole article, otherwise freely available since 29 07 15, and all comments, behind a paywall. (!)

 

Too late. Here's a further version of the original article published in a separate magazine:-

 

http://content.yudu.com/Library/A3t5q7/PulseAugust2015/resources/62.htm

 

And here's the text of the final draft of 'comment 35', straight from the PC of my co-conspirator:-

 

………………………..

 

Let's first at least get some legal issues straight.

 

1. It is not the case that (per article) patients' recordings (overt or covert) cannot legally be shared with "third parties". The relevant statutory provision is s 36 of the Data Protection act 1998 which exempts personal data processing where individuals do it for their 'personal, family or domestic purposes'. This exemption certainly extends to sharing a recording with family and friends, and such recordings can be used in evidence e.g. in disciplinary proceedings.

 

2. Note that this exemption would not apply to e.g. covert recording by a doctor of a patient (ref. comments various) because that would be being done for the purposes of the doctor's business or profession. This doesn't make doctors (per article) "lesser beings than those they treat". It just means that doctors are subject to the same law as everyone else.

 

3. It is not the case that (per Anonymous | 30 July 2015 10:34am):

 

"Anything that transpires during a medical consultation is part of the medical record. We have every right to ask the patient for a copy of the recording to be included in the records"

 

A patient's recording belongs to the patient and a doctor has no more right to a copy than s/he has to copies of any written notes a patient might take during a consult.

 

4. Those who say they would try to deregister \de-list ('ban') patients who record need to think again, fast:-

 

"…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." (MDDUS – 31 03 15)

 

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

 

5. A patient is under no obligation to explain his or her reasons (ref. comments various) for wanting to take a recording of a consultation home. (And see, for instance, response no. 5 to Dr M McCartney's recent BMJ article:

 

Margaret McCartney: Trust the patient

BMJ2015; 350 doi: http://dx.doi.org/10.1136/bmj.h3181(Published 10 June 2015): BMJ 2015;350:h3181

http://www.bmj.com/content/350/bmj.h318 )

 

Second, I suggest it really does pay to stand back and think – avoiding 'knee- jerk reactions'.

 

The high value patients report as placing on audio-recordings of consultations to take home has been extensively researched and confirmed by physicians many times. A desk-top study published last year, 'Providing recording of clinical consultation to patients - a highly valued but underutilized intervention: a scoping review.' examined 33 relevant previously published research papers out of a candidate list of over 5000.

 

http://www.ncbi.nlm.nih.gov/pubmed/24630697

 

A few sane and thoughtful comments on Dr Z's article here touch on the known benefits: such as to recall detailed and often worrying information presented in a highly compressed time-frame, and to gain the analysis and support of family members\ other carers - but frankly they are pretty much drowned out by outrage, and hostility towards patients who want to record e.g:-.

 

Anonymous | 03 August 2015 6:41am

 

" my patient asked me to film the consultation and I just broke all their 32 teeth"

 

I urge practitioners to respond to this issue in a more considered and professional fashion. A further piece of research was published last year, "Patients Covertly Recording Clinical Encounters: Threat or Opportunity? A Qualitative Analysis of Online Texts" by a team of physicians which included some of those involved in the desk-top study I referred to earlier. It is easy to read and highly informative as regards patient attitudes to the subject of recording over several years. In particular, I would draw people's attention to a comment reported as made by a lawyer in a medical journal by back in 2008:-

 

"I have been consulted by several patients who wish to record all medical appointments—and now do—and would like to do so openly. However, [sic] I advise them to do so on an undeclared basis, precisely because medical practitioners\hospital administrators routinely try to bully such patients into not recording (by delaying their consultations\treatment while 'policy' is considered, or by threatening to remove them from GP practice lists, for instance). (Contributor 2, lawyer, T43)"

 

And to the 'Reader Comment' (1) there ,'Mature consideration of patients recording consultations':-

 

"This article bases its conclusions on researching the net. Patients do likewise, and while they may find many contributions pointing out the usefulness and legality of recordings, they will inevitably also find some hostile reactions from members of the medical profession. Patient conclusion = record covertly".

 

http://www.plosone.org/annotation/listThread.action?root=86282

 

…………………………………………………………..

[nolegion]

The extracts below are from a research paper published today in the BMJ, entitled:-

 

Patients recording clinical encounters: a path to empowerment? Assessment by mixed methods

 

Glyn Elwyn, Paul James Barr, Stuart W Grande

 

" Mobile technology has become pervasive; it is no surprise that it has found its way into medical encounters, with reports of patients recording clinical encounters using either smartphones, or other devices. Some ask permission to record, while others do it covertly. The behaviour is new, facilitated by devices that make it easy. It may also indicate the development of a new attitude towards what has been called the ‘ceremonial order of the clinic’, challenging the established etiquette of a deferential and subservient patient norm."

 

………………………..

 

" Of the 130 complete respondents, 128 answered the questions regarding their experience and views on covertly recording a visit with a health professional (table 2). In this sample, covert recording had been performed, or known about, by 33 (26%) respondents. A total of 19 (15%) respondents reported secretly recording a medical encounter, with a further 14 (11%) respondents reporting that they personally know of someone who has secretly recorded an encounter. When asked if they would consider recording a medical visit with a health professional, 45 (35%) respondents stated that they would, and a further 44 (34%) indicated a willingness to record only after asking the clinician for permission. Finally, 98 (77%) respondents indicated that they would like their clinic to allow recordings of medical encounters."

 

…………………………………

 

" They also described how they made use of such recordings, including the associated benefits and concerns. A recurring concern was that recording would violate the etiquette expected in clinical encounters, a deviation from the passive role of the patient. Consequently, many patients volunteered that the solution to this tension would be to ‘normalise’ the behaviour, to make it part of usual practice. "

 

……………………………………..

 

" Another factor leading to covert recording was experiencing 'jaw-droppingly awful treatment…' "

 

……………………………………

 

"The portability and multiple capabilities of smartphones, or similar digital devices, has conferred increasing agency on some patients, who have decided to seek a more tangible record of their healthcare encounters. This is supported by the finding that 19 (15%) of our survey respondents indicated that they have secretly recorded a medical encounter, while 89 (69%) respondents indicated their desire to record clinical encounters, split equally between wanting to do so covertly or with permission. The overarching motivations to record resided in the ability to re-listen to the medical encounter on their own or with others, to enhance recall and understanding of health information. Some patients were motivated by viewing recording as a potential means of obtaining verifiable evidence of poor care experienced."

 

…………………………………….

 

The data published in the article is (or are) 'ground-breaking'. There has been no precedent for this type of illuminating, professionally-published, information on this thread's topic. Typically, in my view, the assiduous authors have made sure it has been published in the 'Open' section of the BMJ – so every patient who has online access gets a chance to read and consider:-

 

http://bmjopen.bmj.com/content/5/8/e008566.full

 

I think of this as a further aspect of the enabling of 'patient empowerment' as referred to in the paper iteslf. Truly excellent. I do hope viewers will take the time to read the full text. It's definitely worth it.

[nolegion]

A lot has been published, mostly in America, on this thread's topic over the past couple of weeks.

 

I have just read a most detailed, and curiously 'multi-faced', piece of such writing which appeared very recently online here:

https://www.ecri.org/EmailResources/Risk_Management_eSource/RMRep0815.pdf

 

(If for any reason that link doesn't work, try going to:-

https://www.mlmic.com/blog/physicians/what-to-do-when-patients-record-conversations-with-their-physicians/

and press the Covert affairs: recording conversations etc. link there).

 

It is a bit odd though. It starts out all gloom and suspicion – and by using the term 'scenario' reminds me of some of the earliest (and worst) legal journalism on the subject first published in 2008 (mentioned in the v. early days of this thread). It opens with:

 

"It’s an awful scenario for anyone, not just healthcare providers: a conversation you thought was private was recorded. Your words, especially out of context, don’t represent you the way you would have wanted.

 

And if you’re a doctor, it’s not hard to imagine it getting much worse. That recording can end up on Facebook, or Twitter, or YouTube, and hurt your reputation and practice. It can end up in court.

 

What was once the domain of spies and G-men is an increasingly common phenomenon, a dark side to the proliferation of smartphones and other mobile devices that makes providers cringe."

 

…but goes on to provide some perfectly practical examples of the usefulness of recording, and includes this reported text:

 

" Just because patients are taking more control, however, providers need not feel as if their role is diminishing. Risk managers can work with providers to find the silver linings to these seemingly dark clouds, empowering patients to be involved in their care in ways that can benefit everyone."

 

Still, CAG gets an indirect mention via full reference in the footnotes to a pioneering article I linked some while ago in which text from contributors here was cited. (Tsulukidze M, Grande SW, Thompson R, et al. Patients covertly recording clinical encounters: threat or opportunity? A qualitative analysis of online texts.PLoS ONE 2015 May 1;10(5):e0125824). So that is pleasing, in any event.

[Sali]

Some hospitals have a written policy banning patients from using recording devices (although mostly we are unaware of this). I recall a past post mentioning a GP surgery which displayed notices outlawing the practice too.

 

If audio/visual recording consultations have expressly been forbidden (and you have been made aware verbally/by signage/in writing, [even if it goes against the laws of the land]), would the MPTS or a court be within their rights in refusing to accept the (covert) recording as evidence because it was obtained unethically? Does it just come down to showing that the recording is relevant to the case? (A feat in itself I would imagine).

 

What recourse is there if the evidence is rejected?

 

Bearing in mind that you had been made aware of the recording ban, what sanctions could legitimately be imposed on the patient by the GP/consultant/hospital without breaching the NHS constitution and how would you challenge them?

[nolegion]

1. In my view, most NHS 'policies' on our subject turn out to be at best 'void', and may go on actually to be 'illegal', since they incite staff to potentially criminal acts. The receipt of medical services is a statutory entitlement and not something to be trifled with by 'information governance managers' (= record clerks) in ignorance of the law.

 

It follows that notices stemming from these policies (e.g. 'no recording') should not affect a court's (or the MPTS's) decisions about the admissibility of evidence. The GMC had its backside kicked by the High Court last decade about refusing (initially) to hear covertly-recorded evidence, and has now listened to such in several cases.

 

Procedurally, there would be little a patient could directly if the (now) 'MPTS' should start misbehaving again, though, since a patient is not a party to the disciplinary action: that is GMC v Doctor.

 

In other forms of civil action where a patient was a claimant, say, if the evidence were excluded that would normally come up as an 'interlocutory' matter before the commencement of the main action. And if improper exclusion directions had been made, that could be appealed to a higher judge or court as preliminary issue.

 

Where, as mentioned, relevant to the matters in dispute, the weight of authority is soundly in favour of admissibility.

 

2. The immediate, practical and serious problem of what to do if a doctor or 'administrator' of some stamp should start to try make access to healthcare by a recording patient difficult – or even to deny it altogether - is a very real consideration.

 

I don't think there are any legitimate 'sanctions' that a NHS body could seek to impose, but there is at best only limited utility in being entirely right if one is also entirely dead.

 

On the plus side, since the start of this thread, there has now been so much published by the GMC, BMA, and medical indemnity providers, indicating that such treatment - or lack of it - would be unprofessional (here, closely equating to potentially 'negligent'), it would a brave, and\or very ignorant, doctor who went along with such illegal bullying.

 

I've been an 'overt recorder' for over 10 years now, and there were occasions in the early years where I was threatened with withdrawal of healthcare – which I had to 'tough out' and 'face down'. Not pleasant, but I can say that this hasn't happened to me for many years. There really are ample resources for medics to go check and learn the errors of their proposed ways.

 

I am also now bolstered by My Turn's Manoeuvre. If I really did feel too ill to stand my ground at any particular juncture, I could turn off the visible recorder and leave the other one catching each and every word, perfectly legally. And, assuming I recovered and could prove loss (such as extended, unnecessary pain), I would thereafter sue; and I would also notify the GMC and report their response in this thread.

[Sali]

Plenty of people who would benefit from a recording of their consultation will not challenge a notice prohibiting recording devices or, in the absence of signage, will accept a doctor's word that it is against policy if they request to do so.

 

I've often wondered whether the lawmakers are so stupid that they make laws which have more holes in than a string vest, and so blurry that no layperson quite knows where they stand, or whether there is a method in this madness which ensures that the legal profession is always booming, supporting Dickens quote that the one principle of the English law is, to make business for itself.

 

It would be helpful if organisations like the CQC did not sit on the fence on such matters. It should not be left to individuals or their loved ones, almost certainly at a time when they are most vulnerable and/or stressed, to challenge these policies.

[think about it]

 

I've often wondered whether the lawmakers are so stupid that they make laws which have more holes in than a string vest, and so blurry that no layperson quite knows where they stand, or whether there is a method in this madness which ensures that the legal profession is always booming, supporting Dickens quote that the one principle of the English law is, to make business for itself.

.

 

Sali, your quote made me smile as a friend once said to me that lawyers charging by the hour were perhaps the only people in the world who were rewarded for having the lowest possible productivity levels. The longer it takes, the higher the fee...

 

Purely hearsay, of course...

[nolegion]

It seems ages since I have been able to find time to contribute here. I am glad one or two others have and kept the pot boiling. I couldn't agree more about the inaccessibility, grotesque expense and bone-headed unfairness of far too much of our law.

 

Still, we can say that one very important principle remains intact. It is not now, and never has been, illegal in the UK for a patient to audio-record their medical consultations behind closed doors…

 

******************************

 

…which is not the case in a minority of American States, California being one State within that minority; and here's a recent (09 09 2015) blog\ article written in the context of Californian law:-

 

" When is it OK to record your doctor's orders?"

 

http://www.scpr.org/blogs/health/2015/09/09/18068/when-is-it-ok-to-record-your-doctor-s-orders/

 

It seems that where it is illegal to record without consent, clinicians don't give it, leaving patients to go without the benefit or break the law.

 

I find the comment appended yesterday (by one Sue Iri) of more importance than the article itself.

 

See what you think.

 

********************************

 

Tomorrow ( probably) I will finally get a chance to secure discussion of patients who record at my 'Patient Participation Group' . Co-conspirators of mine are laughing at me, saying I haven't got a prayer of getting docile middle-aged patients (who 'enjoy sitting on committees with doctors present') to think about the issue seriously at all. Perhaps they will be proved right. We shall see. Wish me luck.

[Clear33]

I did send you an abundance of luck - express. Hope it helped. And a big thankyou for all your help on this thread and elsewhere @Nolegion.

[nolegion]

Many thanks for your good wishes and kind words, Clear33. Appreciated.

 

I found my 'PPG' meeting yesterday somewhat hard going. Although the end result was even better than I had hoped for (I thought it would take more than one meeting to get there, if at all), I cannot claim that I 'won the day' with any ease or elegance.

 

As predicted, most members took up, early, varieties of "we-don't-want-to-upset-doctors" positions without listening to the evidence in any detail. I think what turned the tide was Mr Michael Valentine's story. Viewers here may remember him. He was the patient who, in my view, behaved in an exemplary fashion when confronted by appalling behaviour from a doctor while attending an outpatients appointment at Derriford Hospital, Plymouth, last May. I linked his story on 24 05 2015, and for ease of reference, here it is again:-

 

http://www.plymouthherald.co.uk/Plymouth-dad-left-terrified-doctor-imprisoned/story-26546536-detail/story.html

 

The point, or at least the one that I eventually succeeded in getting onto the table, is that this can be viewed as a story about ignorance. My quest, as I had carefully explained, was not to try to tell patients how they should prefer to consult, but to emphasise that lack of awareness about the legalities of how patients may choose to consult has potentially very serious consequences for both sides of a consulting room.

 

This appeared to strike a chord with our chairman - currently a GP who retired from the practice some years ago. He agreed that what happened to Mr Valentine was of course disgraceful, and volunteered the suggestion that what was needed was for the practice to have a 'policy' about recording; and he was confident that the currently-practising clinicians would respond to the issue seriously if he suggested this on behalf of the PPG.

 

He then, rather nattily (if not, quite, absolutely…er… ingenuously, in my personal opinion), silenced the majority 'nay-sayers' by averring that since the formulation of policy would be a matter for the partners of the practice, it would be proper for the 'formal' position of the PPG to be 'neutral' unless and until this had been arrived at.

 

Job done, for now, one way or another, and I look forward to learning about the practice's 'recording policy' in due course.

[nolegion]

Here's an article which I found interesting over the weekend, and, basically, well done Bramley Court care home, in Birmingham. An experiment about the use of cameras in a care home which seems to be proving a success:-

 

http://www.independent.co.uk/life-style/health-and-families/health-news/care-home-surveillance-technology-could-let-relatives-check-residents-on-their-smartphones-10491956.html

 

To my way of thinking, however, the conclusion of the Rachael Pell's report is not just weak but pathetic.

 

Those who debate this subject in public need to get to grips with the relevant, central law before they open their mouths. You cannot install a camera, covert or overt, in a resident's bedroom in a care home unless the resident consents, or if the mental capacity to consent is lacking, at the instigation and\or with the consent of those entrusted to make 'best interests' decision under the Mental Capacity Act, which category includes Court of Protection deputies and those holding powers of attorney (as well as other relatives and carers).

 

A motion-sensitive camera in a bedroom is thus, from the resident's point of view, an OPTION - not a decision to intrude which can be imposed e.g by a care home operator.

 

What on earth is the point of whining, Ms Pell:-

 

"Care homes should be safe, trusting places without the help for intrusive technology."

 

…eh?

 

Of course they should be. Fantastically, indeed grotesquely, obviously, that doesn't mean to say that they all are.

 

Airliners should be safe places. Let's remove all the security checks. What nonsense.

 

Just a view.

[estellyn]

I don't like the idea of cameras in bedrooms. If it's staff we're monitoring then maybe they should be wearing cameras to film interactions. I don't like the idea of intruding on the privacy of residents and would fear that relatives would agree to cameras despite the resident's wishes or without consultation. Relatives are often surprised to find out about the lives of their relatives in care - including the number of sexual relationships that spring up in care homes between residents - certainly not something we want to be intruding upon.

[nolegion]

Hi estellyn.

 

While I can see where such arguments come from, I am less clear where they lead to.

 

Take the case of Mrs Gladys Wright, at the 'dementia-specialist' home, in Wraxall, near Bristol – mentioned in this thread several times. Although it has been my privilege to talk briefly with Mrs Wright's son and daughter who installed the (covert) camera-in-a-clock in their mother's room at that home, I don't know what actually prompted their initial concerns in the first place. It is unlikely to have been very much coherent commentary from Mrs Wright herself (now deceased), and if they had tangible proof of abuse by any specific staff, no doubt they would have relied on that without having to go through the wearisome, sad - no doubt dismaying - exercise of following many hours of DVD footage.

 

What they did discover was, by anybody's standards, horrible.

 

What they achieved, however, was the suspension of the perpetrators of the abuse, their eventual criminal convictions, and their banning from 'care', for life.

 

Now, as the chap from another family with a relative at the home (indeed two such relatives) said more recently on television, if the Wright family hadn’t done what they did, those staff could be abusing his mother and sister, today. And it was disgraceful that the care home operators were trying to introduce "policy" effectively to "ban" covert recording - an argument which that family won because the adverse publicity forced the operators to withdraw their proposal. Just as well, because an application to the Court of Protection for a formal 'best interests' ruling under the Mental Capacity Act would have taken many months and tens of thousands of pounds.

 

I am completely on the side of the Wright family (and the 'subsequent' family), and can only hope that if I succumb to dementia my children will be as vigilant on my behalf.

 

Yes, it can be described as 'intrusive', but not a fraction as 'intrusive' as the violence dished out to Mrs Wright. And if for any weird, and frankly unlikely, reason a family took the trouble to install such surveillance in a care home bedroom other than in a relative's 'best interests' (and after consulting the wishes of the relative where possible), the law, however cumbersomely, can review the actions taken, and the motivations involved, in great detail and with potentially very serious consequences.

 

When it comes to cameras being installed by care home operators themselves - which is what the Independent article was about - I think the arguments are, indeed, far less clear cut. First, they should require the consent of the resident or competent relatives on their behalf if capacity to consent is lacking, and keep any 'permissions' on rolling review - because people are entitled to change their minds. It's certainly predictable, I readily concede, that some 'sloppy' operators could 'cut corners' in such processes and actually try to cut staff training and supervison costs by this means without genuine, considered consents being obtained

 

And one can argue: what do overt cameras actually achieve? When someone knows they are on camera they would have to be enormously stupid to launch into the type of behaviour which poor Mrs Wright collected. But they can't install cameras absolutely everywhere. So if you have callous, cruel and abusive staff, they will do the abusing where such cameras cannot record the abuse. The whole point of a covert camera is that it should stay covert - or you won't expose the criminals. Staff should be trained to expect that they could be being recorded at any time, anywhere in care home where residents are allowed - without their knowing about it.

 

That being said, I think the third-party monitoring system referred to in the following article from The Times (which gives rather greater detail about the actual operation of the system at Bramley Court than the Independent's coverage linked earlier) may well have its merits. The burden of monitoring is taken from family members, and possible suppression of evidence of criminality by a care home operator is circumvented.

 

http://www.thetimes.co.uk/tto/health/news/article4561583.ece?shareToken=c1f2ce6ef22ed59adb3b1c981d0da923

 

Perhaps some sporadic, variably-sited, and covert use of such a third party system (with all relevant prior consents carefully in place) could address many concerns at once. Meanwhile, Bramley Court is clearly pioneering an experiment and is confident of its standard of care. Let's see how they get on. I wish them well.

[estellyn]

I'm not against covert cameras where abuse is suspected. Having managed staff in a care home on night shifts, I've come across some poor treatment (the staff being fired as a result). and it's important to remember that abuse may not be overt, it may be neglect, poor care, psychological abuse etc. Some of it is in the training, and some of it is bad people in a position of power over the vulnerable.

 

I understand that horrible things have happened to people. While nursing I was at the coal face doing everything I could to ensure the best possible care for my patients. I would have had no problem with a wearable camera for myself. I feel that as it is staff that are being monitored, the patients/residents should not suffer further by loss of privacy. Have wearable cameras such as bailiffs wear, not accessible by the staff members themselves. All interactions with patients would be monitored, and staff would be unlikely to commit abuses as they are being monitored.

 

My problem is with cameras in bedrooms as a policy. It is easy to believe that all residents are vulnerable and unable to vocalise or understand what might be being done to them, and yes, there are residents like that.But there are also lots who are having a life and shouldn't have their privacy taken away - especially where there are other options like some sort of body camera for staff.

 

It's important to maintain privacy and dignity for our older people in care homes.

[nolegion]

I like the idea that (as regards carehome-operator initiated monitoring) cameras worn by staff would be less intrsuive because less continual. Downsides - bathrooms? - calls for help by residents not being answered but not being observed?

 

*******************************

 

Many know that the 'Parliamentary and Health Service Ombudsman's office' (PHSO) is the end-stop for complaints about the NHS. Those who reach this point often express grave dissatisfaction with the result.

 

Time and time again, the PHSO just bounces the complaint (already many months, or even years, old by the time it reaches the PHSO, having been blocked, belittled and fobbed off all the way to the PHSO's door) back into the system, saying that the complaint to the PHSO is 'premature' because there is more that those lower down the chain could do to resolve the matter. Staff move on. Doctors emigrate. Evidence gets 'lost', and even if you do finally re-negotiate the complaint back up to the PHSO - oh dear, there now really isn't sufficiently 'robust' evidence for those lower down the chain to reach any definite conclusions about the matter, and the PHSO drops the case as having no prospect of a 'worthwhile outcome'. It just adds deep insult to deep injury.

 

But what if your complaint includes inadequate supervision, monitoring, reporting, remedial action required of the health body in question by the Care Quality Commission? Well, there is a special, additional form of bureaucratic insult reserved just for you in these circumstances. Because that aspect of your complaint is classified as a complaint not about the health service but about 'Administration' the PHSO will only consider this angle if it is referred to them by a member of Parliament.

 

So, even though exactly the same underlying facts might be concerned with both 'aspects' of your complaint, the CQC's responsibilities won't be examined at all unless you can get your MP involved in the detail. ( And it's just too bad if you don't happen to have an MP at the time because Parliament has been dissolved pending an election, say.)

 

What does this mean in practice e.g. how many complaints against the CQC has the PHSO considered over the time the CQC has existed in its current form – which is since 2009?

 

Well, over the last 6 years the PHSO received 354 complaints about the CQC.

 

The PHSO has actually 'accepted for investigation' a whole: 17 such complaints

 

And the number upheld as valid complaints against the CQC, in whole or in part? Well, that would be a fat ZERO.

 

That should keep the officials in both the CQC and the PHSO well pensioned-up and on the honours list, now shouldn't it?

 

( Source: this response of 21 09 15 to a Freedom of Information request:-

http://twitdoc.com/view.asp?id=222982&sid=4S1Y&ext=PDF&lcl=PHSO-response-FOI-complaints-about-CQC-21-09-2015.pdf&usr=Minh_Alexander&doc=282276821&key=key-vbIQRAXVwqF9Rcng677d )

[nolegion]

And, talking about complaints against doctors, there was a colourful article and set of comments in every doctor's favourite paper, the Daily Mail, today. Good quote from a patient-charity director:-

 

"Joyce Robins, co-director of charity Patient Concern said: 'Some of patients' complaints against doctors will be mistaken, some will be mischievous - and many will be spot on but impossible to prove.

 

'Fourteen years ago the Bristol Royal Infirmary Enquiry recommended that doctors should tape record interviews with patients - but the medical profession opposed it, saying it would destroy trust.

 

'So we still have the position where patients hear one thing, doctors report another - and when there are only two people in a consulting room, the chances of having a complaint upheld are nil.' " [Emphasis mine]

 

http://www.dailymail.co.uk/health/article-3246376/Rude-doctors-62-medics-slapped-wrist-regulator-commiting-faux-pas-including-swearing-patients-calling-bonkers-o.html#ixzz3maVhyMHY

 

So the obvious conclusion is that patients should do what, every time…?

[estellyn]

And, talking about complaints against doctors, there was a colourful article and set of comments in every doctor's favourite paper, the Daily Mail, today. Good quote from a patient-charity director:-

 

"Joyce Robins, co-director of charity Patient Concern said: 'Some of patients' complaints against doctors will be mistaken, some will be mischievous - and many will be spot on but impossible to prove.

 

'Fourteen years ago the Bristol Royal Infirmary Enquiry recommended that doctors should tape record interviews with patients - but the medical profession opposed it, saying it would destroy trust.

 

'So we still have the position where patients hear one thing, doctors report another - and when there are only two people in a consulting room, the chances of having a complaint upheld are nil.' " [Emphasis mine]

 

http://www.dailymail.co.uk/health/article-3246376/Rude-doctors-62-medics-slapped-wrist-regulator-commiting-faux-pas-including-swearing-patients-calling-bonkers-o.html#ixzz3maVhyMHY

 

So the obvious conclusion is that patients should do what, every time…?

 

After yet another terrible experience with a consultant I bought a recording device which I'll now be using. I also write down my presenting condition, with details typed out for the GP and request it goes into my notes.

 

I'm yet to meet a good GP or consultant......I'm told they exist......

[nolegion]

Commiserations on the experiences, estellyn. It can be deeply discouraging to encounter really poor treatment from doctors. The resentment patients can feel about it is often bitter - and all too enduring.

 

On the plus side, though, welcome to the legion (for now we are a legion) of recording patients! I have found it truly encouraging to learn from other patients how taking recordings home has helped them get their healthcare back on track.

 

Please come and say how you get on with the concept, when the moment is right. It can take an appointment or two before the process becomes 'automatic' and 'normal'. And then people never look back

 

I've got a consultant's appointment tomorrow (2nd time with this particular one) after a year of, it seems, wall-to-wall tests, specialists and consultations for a particular condition. Tomorrow's medic is the only one who has caused me concern to date. And her behaviour indicates to me she hadn't read, last time, the day-one note which I asked a previous specialist to put in my clinical notes declaring that I audio record all clinical consultations behind closed doors. I'm guessing it will probably come as a shock to her when I draw her attention to this tomorrow. Could be a bumpy ride – but nobody will misreport me. I will have a complete record of all that is said and done.

[honeybee13]

No flies on you then, nolegion.

 

I hope it goes well tomorrow.

 

HB

[estellyn]

Commiserations on the experiences, estellyn. It can be deeply discouraging to encounter really poor treatment from doctors. The resentment patients can feel about it is often bitter - and all too enduring.

 

On the plus side, though, welcome to the legion (for now we are a legion) of recording patients! I have found it truly encouraging to learn from other patients how taking recordings home has helped them get their healthcare back on track.

 

Please come and say how you get on with the concept, when the moment is right. It can take an appointment or two before the process becomes 'automatic' and 'normal'. And then people never look back

 

I've got a consultant's appointment tomorrow (2nd time with this particular one) after a year of, it seems, wall-to-wall tests, specialists and consultations for a particular condition. Tomorrow's medic is the only one who has caused me concern to date. And her behaviour indicates to me she hadn't read, last time, the day-one note which I asked a previous specialist to put in my clinical notes declaring that I audio record all clinical consultations behind closed doors. I'm guessing it will probably come as a shock to her when I draw her attention to this tomorrow. Could be a bumpy ride – but nobody will misreport me. I will have a complete record of all that is said and done.

 

Thanks, I'm happy to be part of the legion, and I will report back, though I'm planning on covert recording.

 

Good luck with your appt!

[nolegion]

Thank you, HB and Estellyn, for your good wishes. They worked.

 

My appointment last week was a 'doddle'. I will spare everyone a blow-by-blow account, but without my having to re-draw attention to my recording, er, disposition, at all, it was like I was consulting a totally different medic. From salutation to valediction it proceeded courteously and helpfully, and I felt the queries I had hanging from the last appt were properly listened to and addressed.

 

There is, no doubt, a range of possible reasons for the marked change in the consultant's behaviour; and since, as I say, I never referred to recording, I will probably never know exactly why for sure.

 

One such, however, might be that she had worked out all on her own she had behaved like a cow as sulky as arrogant at our last encounter and decided to mend her ways. Another might be that this time (it seemed clear) she had actually read the full set of my hospital-based clinical notes (as she clearly hadn't earlier) and discovered my declaration about audio recording consultations – which I think a tad more likely an explanation.

 

However it went down, I now feel I have this strand of my healthcare back on track, and am a considerably more cheerful unit as a result.

 

***

 

Let's hear it for the Danes:-

 

http://intqhc.oxfordjournals.org/content/early/2015/09/23/intqhc.mzv069

 

I can't help thinking this English publication of some Danish research has lost clarity in translation, but at least the numbers are clear. A study involving 2784 outpatients provided with audio recordings of their consultations – with, surprise, surprise, very positive results.

[honeybee13]

I'm glad things went well, nolegion. And that you feel better about life.

 

HB

[Sali]

I am unaware of how a PPG operates, Nolegion. Do the GPs attend the meeting, or are the views of the members (who I assume must be their patients) presented to them later in writing? On the subject of recording consultations, why is it that you have to wait for them to come up with a policy, when it is perfectly legal in the UK for a patient to record their consultation overtly or covertly? Is this policy just about how they will make the patients aware of their rights?

 

And what will you do if you do not like the policy they come up with? What clout do you have to change it? Are timescales involved and enforced?

 

****

 

I don't think anyone would argue that a vulnerable person's privacy and dignity isn't important, but the risks have to be balanced. A person's consent (on camera installation) should always be sought where possible.

 

I cannot see body-cams in a hospital or care home setting working. The police body-cams are (currently, I believe) only switched on at certain times - when it is suspected by the officer such evidence may be useful, but that's not a foolproof system. Constant surveillance (on body-cams) in a care home or hospital setting would, I feel, be open to abuse and how would you go about seeking permission on each occasion?

 

When would the footage be reviewed? Only when a resident/patient/family member raises concerns? Constantly, like at Bramley Court? How long would the data be held? Who would have access to it?

 

A covert camera (installed in the room) would pick up most forms of abuse (including neglect, poor care and some psychological abuse) and will often be a last resort. It will be seen as a lack of trust in the care home's management to address issues and conerns, but I cannot think of an occasion when a relative would do this unless they absolutely believed it was in the best interests of their loved-one.

[Sali]

After yet another terrible experience with a consultant I bought a recording device which I'll now be using. I also write down my presenting condition, with details typed out for the GP and request it goes into my notes.

 

I'm yet to meet a good GP or consultant......I'm told they exist......

 

Yes, I am also sure that there are many excellent medics out there, but just like blue whales, I know they exist - I've seen pictures and there's a skeleton of one in the Natural History Museum....I've just never encountered one in its natural environment. Yet.