Audio-recording your consultations with NHS doctors

[honeybee13]

Hello nolegion.

 

Welcome back from me too. I hope you're soon back to normal.

 

HB

[Clear33]

Good to hear Nolegion

 

I have had a few instances over my lifetime when I wish I had privately recorded my Vet consultations. I presume this is also legal?

 

Clear33

[nolegion]

Good to hear from you, HB, and thank you. Clear33, forgive my ignorance, I'm not sure what a Vet consultation is - but if recording is good enough for Mitchell, I guess it's good enough for us!

 

Here's an article from yesterday and bang on the this thread's topic:-

 

" Patients can record GP visits without consent, solicitors warn "

 

By Marina Soteriou,06 November 2013

 

http://www.gponline.com/News/article/1219685/Patients-record-GP-visits-without-consent-solicitors-warn/

 

I should perhaps acknowledge that I am, so far, a fan of "GP Online" (formerly " heathcare republic"). Their reporting\editorial staff had the acuity and confidence to write squarely on the issue of patients who wish to record over 3 years ago, when the subject was a rarity on the net, and to a target readership unlikely to be appreciative of the line they took.

 

( see eg. post #30 here:- :http://www.consumeractiongroup.co.uk/forum/showthread.php?256545-Audio-recording-your-consultations-with-NHS-doctors/page2)

 

I hasten to add that there is, in my view, plenty to be disagreed with in the ideas the recent article reports and the muddled comments there appended to date. In particular, I strongly disagree with the notion that clinicians should be prompted to ask a patient for any reason why apatient should wish to record. Emphatically, No – if we want to tell you, we will; if we don't, listenup, this is my appointment. (And"Manas Skidar's" first comment is utterly misconceived, begging thequestion of the law in issue.)

 

But the reporter offers an informed view which doesn't misrepresent the law, and the magazine a forum for civilized debate.Good. Amen.

[Clear33]

Veterinary Medicine for my furry family

[Sali]

"The LMC said legal advice was that GPs should not refuse to go ahead with a consultation on the grounds that they object to a patient's wish to record it, in case the patient came to harm as a result."

 

'Should not' (refuse to go ahead...) needs to read 'cannot?'

[nolegion]

I agree we want to see certainty in the language used –precisely to guard against piratical "guidelines"- type interpretations. I do not believe this is an area where doctors can be trusted with any degree of discretion: the wrong sort will just use any such as option to try to bully patients into not recording at all. Still, I think the discussion is going in the right direction when a local medical authority confirms legal advice received making the legality of patients taking audio recordings, overtly or covertly, perfectly clear.

 

Thinking about Clear33's point re visits to the vets, and the decades of taking treasured furry family friends to see them, I reckon that in terms of:-

 

1. Access to timely care, at agreed and convenient times

 

2. Emergency and out-of hours cover (inc. home visits)

 

3. Behaviour of reception staff

 

4. Patient-side manner

 

5. Time-spent courteously listening to reports of patient condition

 

6. Thoroughness and speed of examination, testing and diagnosing

 

7. Efficacy of treatment\ candour\clarity of care plan

 

8 Empathy, and

 

9. End-of-life care,

 

I would far rather be a cat than an NHS patient.

 

(Having said which, no-one's going to take my temperature the way vets do if I can possibly help it.)

[nolegion]

Chennai (or Madras as some still know it) is currently hosting the world chess championship (Carlsen v Anand - first match today, drawn), and is the source of this report last month:-

 

" CHENNAI: Most patients waiting outside doctors' cabins use their phones to text, surf the internet, and post messages. Now, some of them have started using their phones to record conversations with doctors to be doubly sure of the advice, but the practice, often done without the doctor's consent, has ruffled physicians…"

 

http://articles.timesofindia.indiatimes.com/2013-10-25/chennai/43393842_1_outside-doctors-patients-second-opinion

 

Early days in India, then.

[Sali]

It seems it is illegal in India to covertly record conversations, which is not the case here. If I heard a medic come out with a statement like 'when I am being recorded I measure my words' or 'the basic trust is lost,' I would conclude that they are not very capable and make an appointment elsewhere. This stance is even more unacceptable when you consider that the patients are paying an upfront fee.

 

Vets normally do not offer a free at the point of use service - it's either payment with an arm or a leg or a hefty insurance policy with multiple wriggle-out caveats. Maybe that's why the care is better - but only if you can afford to pay.

[nolegion]

Aye. It seems that few discussions on this subject last very long before a doctor says that they would behave differently if they were being recorded.

 

My reaction is, "good" – now get some practice in by behaving differently when you don't think you are being recorded.

 

Here's an example where some very muddled 'thinking' (item 8) has recently been appended to an article I linked earlier:-

 

http://www.speaksooner.org/why-every-patient-should-be-recording-appointments/

 

But, with a prize prat like that, I'm not sure I can be bothered to comment further, there.

[Sali]

I confess I've never heard the term humanist medicine before, but looking at the definition, 'relationships between physicians and their patients that are respectful and compassionate,' I thought that was always desirable, to be strived for and judged on. Of course, I want the medic to know his or her onions too.

 

Reading the final comment (item 8) of this article reminds me that asking permission to record is too much of a lottery.

 

On another topic, I think that the more technically advanced we become, the stupider we are growing to be. We are ever reliant on computers and machines to diagnose - a human, a car - that we are losing our basic skills, failing to observe, scrutinise facts, apply logic. There are consequences.

[mr_mastiff]

I confess I've never heard the term humanist medicine before, but looking at the definition, 'relationships between physicians and their patients that are respectful and compassionate,' I thought that was always desirable, to be strived for and judged on. Of course, I want the medic to know his or her onions too.

 

Reading the final comment (item 8) of this article reminds me that asking permission to record is too much of a lottery.

 

On another topic, I think that the more technically advanced we become, the stupider we are growing to be. We are ever reliant on computers and machines to diagnose - a human, a car - that we are losing our basic skills, failing to observe, scrutinise facts, apply logic. There are consequences.

 

Hi Sali, I have played with a diagnostic computer programme! feed in the symptoms, blood results etc and get totally the wrong result. You still cannot beat the human senses and logic when it come comes to medicine. The worrying part is that if you ring 999 the questions that the operator will ask you are based on a computer programme which will not accept that you are seriously ill unless you happen to answer yes to certain questions and no to others. It is another area where the computer rules common sense.

[Sali]

That's a worry. Somebody who had less experience than you would have accepted the wrong result - with what consequences?!

 

I was listening to the radio last week and a lady whose husband had had some blood vessel accidently cut during (I think) hip surgery, died because the medical staff failed to notice his stomach filling up with blood - they were wating for a scan.

 

As skill levels slide because they cannot diagnose without a machine, I can only feel that this kind of scenario will become ever more common. Frightening.

[Clear33]

http://healthypets.mercola.com/sites/healthypets/archive/2013/09/30/neutering-health-risks.aspx

 

I agree with you Nolegion. You get a good Vet and these things do occur.

 

Without straying from the thread too much I find I HAVE to make some brief points. Because they are bulletpoints, be aware that I am just touching upon topics for those interested to do their own research and come to their own conclusions.

 

* End of Life care - to kill. Whilst with the introduction of pet Insurance, this has changed and treatments and surgeries are being given instead now - (unless you can't pay- in which case its back to death)

 

the flip side is Unecessary and intrusive procedures are taking place and if I see a new Vet - I state I have No Insurance !!!

 

*Dr.Becker in the link I provided, I have recently discovered . I respect her journey and resonate with it a lot. She gives examples of doing more harm than good...(the reversal of a medics oath to first do no harm). This takes real thought to fully appreciate.

 

* The Nutrition recommended by Vets is often bad - Reps.

 

* *over* vaccination for a fee - is a serious problem since there is NO scientific evidence for it at all. In fact, there is mounting scientific evidence of the damage this causes.

 

*Accommodation (stainless steel boxes) is dire and outdated. No natural light or views.

 

* self reported stats make it impossible to know if the surgeon is any good. I have only ever heard Vets state - the animal died under anaesthetic due to an underlying health condition. - who has ever heard a Vet say - 'due to my cock up' ?

 

And yet in my very limited time in an operating theatre, I witnessed exactly that.

 

* Animals cant tell you of the mistreatement they endure. Because a Vet is a Charismatic people person - dont assume they like or respect animals necessarily. There have been reported cases due to whistleblowers.

 

*Identical Drug issues as with NHS. Failure to note or observe side effects/deaths and report them. through the proper channels.

 

The cornerstones of Health are Nutrition, clean environment, good exercise and happy relationships with as little medical intervention as possible.

 

 

This isn't being taught in Vet School where the pharmaceutical companies have a strong foothold.

 

Still prefer to be an animal?

 

 

 

Clear33

 

 

 

I agree we want to see certainty in the language used –precisely to guard against piratical "guidelines"- type interpretations. I do not believe this is an area where doctors can be trusted with any degree of discretion: the wrong sort will just use any such as option to try to bully patients into not recording at all. Still, I think the discussion is going in the right direction when a local medical authority confirms legal advice received making the legality of patients taking audio recordings, overtly or covertly, perfectly clear.

 

Thinking about Clear33's point re visits to the vets, and the decades of taking treasured furry family friends to see them, I reckon that in terms of:-

 

1. Access to timely care, at agreed and convenient times

 

2. Emergency and out-of hours cover (inc. home visits)

 

3. Behaviour of reception staff

 

4. Patient-side manner

 

5. Time-spent courteously listening to reports of patient condition

 

6. Thoroughness and speed of examination, testing and diagnosing

 

7. Efficacy of treatment\ candour\clarity of care plan

 

8 Empathy, and

 

9. End-of-life care,

 

I would far rather be a cat than an NHS patient.

 

(Having said which, no-one's going to take my temperature the way vets do if I can possibly help it.)

[Clear33]

http://healthypets.mercola.com/sites/healthypets/archive/2013/09/30/neutering-health-risks.aspx

 

Link not working in my post - trying again!

[nolegion]

Interesting posts, Clear33, and I take your point.

 

I cling to the notion that it really ought to be possiblefor genuine 'professionalism' to be offered to 'clients' (inc. patients and furry-friends owners etc) whether the transaction is directly funded by those seeking information and advice, or indirectly through taxation.

 

You clearly know your ground, and, alas, it seems the notion of not allowing one's own interests to conflict those of clients - leading to the withholding or altering of information and the advice given, to the client's detriment - escapes too many vets as well as doctors.

Edited November 24, 2013 by nolegion

[My Turn]

Dr Ubani is now suing the family of the patient he killed by his negligence.

 

I suspect the Dr Urbani case is just the tip of the iceberg and that some doctors are saying under their breath "There but for the grace of God go I".

[nolegion]

Ah, Dr Urbani. I remember him - he was the one German courts decided we could call a quack but not a duck. Good to hear from you again, My Turn.

[nolegion]

Below I reproduce the full text of an article recently made available at the MDU's website. It is, in my view, clear and legally correct.

 

The MDU says it is the UK's leading medical insurer, and to have them talking unequivocal sense on the issue to the many practitioners they cover, and publicly, really is a major step forward.

 

Doctors may routinely pay lip-service to N.I.C.E and ignore what the BMA's ethics committee prints (while the GMC looks the other way) - but they always pay attention to their legal defence bodies.

 

The picking out (and eradication) of the fatuous argument that a recording patient's relationship with the doctor must somehow have 'irretrievably broken down' (thereby entitling the doctor not to treat the patient) is not a stray or whimiscal point. It is exactly what some doctors have tried to argue in the past. No more, now, I think.

 

(For those with stamina, I gave an example of the 'broken-down relationship' argument way back at post #19 of this thread. From memory, the facts concerned took place in 2006, and note that, at that time, it was being put forward by a deeply unpleasant little slime-ball of a GP with the aid of medical insurers.Times change.)

………………………………………………………..

 

 

What should you do if a patient wants to record a consultation?

 

28 November 2013

 

Dr Phil Zack, MDU medico-legal adviser

 

With the proliferation of smartphones, many patients now have the ability to record a consultation at their fingertips. Recording a consultation has some advantages for doctors and patients. It can help the patient to retain information for example, but when a patient covertly records a consultation, it can cause the doctor to question why.

 

One study suggested that patients immediately forget between 40 and 80% of the medical information provided by their doctor and almost half the information they do recall is incorrect.

 

To help ensure that they don't miss anything important, some patients are taking advantage of technology to record aconsultation and watch it back later. Earlier this year, one consultanturologist told a national newspaper why he had no objection when a patient asked to record a consultation on his smartphone. "A lot of patients come in armed with a notepad, but if they are scribbling away they'll be so consumed with writing down what they hear that they might not understand what they're being told. In the case of the chap who filmed me, I was discussing the ramifications of various surgical options. There were facts, figures and side-effects to digest. By filming me, it meant he could do this in the comfort of his own home and weigh up the options at his own pace."

 

Patients who understand the risks and benefits ofthe different treatment options are usually able to make an informed decision about the treatment they want which makes life easier for them and their doctors.

 

Covert recordings

 

The GMCexpects doctors to obtain patients' consent to make a visual or audio recording and to only make covert recordings with appropriate legal authorisation "where there is no other way of obtaining information which is necessary to investigate or prosecute a serious crime, or to protect someone from serious harm".

 

But what if the patient starts recording you without seeking permission or even decides to record a consultation covertly, as has happened to a number of MDU members recently? Can you refuse and are their actions a sign that your professional relationship with them hasi rretrievably broken down?

 

Patients do not need their doctors' permission to tape a consultation as the information they are recording is personal to themand therefore exempt from data protection principles. Section 36 of the Data ProtectionAct 1998 states: "Personal data processed by an individual only for the purposes of that individual’s personal, family or household affairs (including recreational purposes) are exempt from the data protection principles and the provisions of Parts II and III".

 

If you suspect that a patient is covertly recording you, you may be upset by the intrusion but if you act in a professional manner at all times then it should not really pose a problem.

 

Your duty of care also means you would not bej ustified in refusing to continue to treat the patient. If you did, it could easily rebound on you and further damage your relationship with the patient. And remember that your refusal to continue with the consultation could be recorded.

 

A more pragmatic (and disarming) response would be invite the patient to record the consultation openly and ask them whether you can have a copy of the recording which can then become part of the patient's own medical records. In seeking their consent to this you should reassure them that the recording will be stored securely by the practice and only used for this purpose.

 

It's understandable to assume the worst when a patient tries to record your consultation but it would be a mistake to think they are trying to catch you out or that a complaint or claim will inevitably follow. If you are concerned that the patient's actions are a sign that they do not trust you, you may want to discuss this with them but recording a consultation is not itself sufficient reason to end your professional relationship with them.

 

Finally, bear in mind that while recordings (even those made covertly) can be admitted as evidence of wrongdoing by the GMC and in court, they can also prove the opposite. In other words, if you have acted ethically and professionally you should have no reason to be worried.

 

Members with specific concerns about recording consultations should contact our advice line on 0800 716646.

 

http://www.themdu.com/guidance-and-advice/latest-updates-and-advice/what-should-you-do-if-a-patient-wants-to-record-a-consultation

Edited December 4, 2013 by nolegion

[nolegion]

I've gone through Dr Phil Zack's article (above) for the MDU several times, and basically, the more I read it, the more I like it – with the exception of one particular point: suggesting that doctors ask patients for a copy of any recording taken. This has come up before.

 

It was, for instance, a suggestion made by a director of the Medical Protection Society - which claims to be the world's largest medical insurer - in one of the first widely-available articles on the subject to appear on line, back May 2010. Earlier posts in this thread refer.

 

I think this is perhaps best regarded as a bit of 'window dressing'. To mix metaphors, maybe it is intended to make the pill easier for doctors to swallow, preserving 'face', and providing an illusion of 'control' of the situation.

 

I think the short answer to a request to provide a copy of any recording, should probably be simply 'no'. You have absolutely no legal obligation to agree. The'subject-access' provisions of the Data Protection Act do not apply to your recording. And you don't have to give any reason why you won't comply with the request either.

 

That may seem a bit abrupt, but the trouble is, in the wrong hands, the transaction could generate a bureaucratic mess the burden of which would lie at least partly on the patient, and thus be used as a deterrent, putting pressure on the patient not to record in the first place. You can just imagine the form-filling and quasi-legal terminology a self-important practice\business manager\ hospital administrator could come up with.

 

And that's quite apart from the time and expense of taking the copy and getting it to back to the doctor concerned, when you may well have other things on your mind, such as your or your family's health, and your day job.

 

Doctors have legal and professional obligations to keep adequate written records of consultations – as they are supposed to have been doing for decades. The chances of any doctor actually listening to a recording before, say, your next visit to a surgery or hospital, are very slim indeed in the ordinary course of events, so there is really nothing in it for the patient; except, as one commentator put it, the chance of the doctor leaving the recording on a train.

 

Ah, someone might say, what about the possibility of the record, resting in only one party's hands, being falsified in some fashion?

 

I would say, first of all, get real. There are many different and sometimes overlapping reasons why some patients would like to retain audio-recordings of their consultations and attempting to commit e.g.fraud or perjury isn't one of them. There are plenty of existing criminal and civil sanctions for that type of activity.

 

Secondly, I have genuinely, totally, lost count of the number of times doctors have been found to have created false medical records. The detection rate seems to be rising and this, I would suggest, is at least partly because of the 'digital age'. It is very hard to eradicate the audit trail in 99% of the computer-based records systems medical practitioners rely on.They still try it on though.

 

Sound recordings can also be subjected to minute digital, forensic analysis, and I don't think we are going find patients have any interest in trying to falsify them.

 

The boot is on the other foot.

Edited December 7, 2013 by nolegion

[My Turn]

Below I reproduce the full text of an article recently made available at the MDU's website. It is, in my view, clear and legally correct.

 

 

 

What should you do if a patient wants to record a consultation?

28 November 2013

Dr Phil Zack, MDU medico-legal adviser

 

With the proliferation of smartphones, many patients now have the ability to record a consultation at their fingertips. Recording a consultation has some advantages for doctors and patients. It can help the patient to retain information for example, but when a patient covertly records a consultation, it can cause the doctor to question why.

 

 

 

Hello Nolegion. That's a very useful article from the MDU. Now all we need is a glossy printed version of the article so that if we are a recording a consultation and the doc notices it then we could show him the official MDU stance.

 

Of course, at the same time we could politely decline to provide a copy of the recording!

[nolegion]

I like that line of reasoning, My Turn. Assuredly, one of the most important points in Dr Zack's article is to identify that patients who choose to record covertly should not be at risk of losing access to healthcare.

 

I am trying to cement in what's left of my wits "MDU (Zack) 28 11 13", so I have the reference completely ready should anyone ever again challenge my recording disposition.

Edited December 8, 2013 by nolegion

[Sali]

Well, my first thought is that it seems fair and reasonable for the doctor to request a copy of a patient's recording. However, I would not ever promise to do this and if, by some slip, I agreed it would be in my own time-frame - probably sometime-never. I do take your point that 'the management' could make the business of authorised recording a process of form-filling and hoop-jumping with the goal of dissuading patients.

 

Yes recordings can be analysed to see whether they have been tampered with, but I think the concern may be that only excerpts could be released (as one doctor has stated in these posts), painting a quite different picture. Mud sticks, as they say.

 

Surely the best way would be for the doctor to take an independent recording. Would they legally have to ask the patient's permission? Would you agree?

 

Having said all that, I would always opt for covert recording. The 'system' has already failed me once. I will not give it second chance.

[Zonker]

Sali

 

 

http://www.connectingforhealth.nhs.uk/systemsandservices/infogov/codes/lglobligat.pdf

 

 

apologies for not quoting exact bits, but essentially they need your consent

[Sali]

Thanks Zonker. I thought so.

[My Turn]

Having said all that, I would always opt for covert recording. The 'system' has already failed me once. I will not give it second chance.

 

Hello Sali. The way I have done it is to have an openly visible recorder and ask if it is okay to use it. If the doctor gets unhappy and asks for it to be switched off then I turn off the recorder and leave it out on display .... while my second covert recorder continues to record.

 

The last time I did this the covert recording caught the doctor berating me in a most unprofessional way and make extremely pointed suggestions that they would be arranging for me to be removed from their patient list. It's a good job I used a second recorder.

 

In fact I would always recommend using a second recorder because it's all too easy for rustling sounds or other noises to mask what is said.

 

The way I see it is that the consultation is private to me and that I can record it whether or not the doc gives his permission.