Audio-recording your consultations with NHS doctors

[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.

[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.

[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......

[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!

[estellyn]

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.

 

If I were to design the bodycam system for care homes, I would have them always on and controllable/reviewable by an outside firm (as in the article) so that there can be no interference by the home themselves. It should be easier and cheaper to review the cams of the 12 staff on duty than the (for example) 36 bedrooms plus 4 lounges and assorted bathrooms. The main effect would be preventative - an always on bodycam which you have no access to is going to be a serious discouragement to any abuse in the first place, rather than only reviewing when abuse is suspected. It also targets the perpetrators rather than the victims, and ensures resident privacy is preserved as much as possible.

[estellyn]

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.

 

[estellyn]

Umm, constantly switched on body-cams. The footage I've seen from body-cams is often so jerky it would be hard (for me, anyway) to watch for more than 5 minutes without feeling nauseous. Also, there may be aspects of their care that a patient/resident (or their relatives) may not wish to be filmed and how would that be solved and what would happen if it were not respected? Some residents may not wish to be filmed at all.

 

The article was talking about permanently on cameras in all bedrooms - my suggestion of body cams is because with cameras in rooms, resident privacy is completely removed. Many residents in care homes are not completely dependent, particularly where there are mental health issues, but will not have decision making power over their care, and may be overridden - their personal lives then either get filmed or they have to alter their behaviour. I've worked in a few homes, and there is plenty going on in the resident's lives that they would prefer not to be filmed. Body cams at least ensures that the only time filming occurs is during staff interaction with the resident - which is the bit that needs to be monitored.

[estellyn]

I have no issues with cameras in public spaces just in bedrooms.

 

No, I wasn't a care home manager, I was the nurse night manager responsible for staff and care on night shift. I like the idea of 'not for profit', but as many homes are private, it would decrease the incentive to own or build homes and I can't see the current government picking up the slack.

 

To improve care a combination of better staffing levels, better training, better shift management and care policies and better wages. No sadly compassion can't be trained, but I think having care staff involved in decision making, understanding why things are done are certain way and learning the history of their clients, meeting family members etc. all does help.

[estellyn]

Sali, I hasten to add this is well over 15 years ago, however you're right to assume that I never did get any feedback. Being told "I'm not allowed to call an ambulance, they have to be seen by a dr..." by someone in charge of someone else's care scared me, as I said, it still does.

 

However, I'm happy to say that in the many dealings that I've had with them since I've never had such a cause for concern. My role doesn't carry any more influence, it's just a job, albeit a very rewarding one 99.9999% of the time even though it's getting more and more challenging.

 

I never had any instructions from my nursing home manager not to call an ambulance if needed, and I worked in a couple of places - but then again, I wouldn't have paid any attention anyway. Pretty worrying if the residential side had those types of instructions.