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nolegion

Audio-recording your consultations with NHS doctors

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There's a really interesting point there MyTurn in relation to patient accountability too.

 

I wonder if there might ever come a point when recording is common place that a clinician can say: "Well, I told you to cut down on the fags/exercise more/eat less/use protection/brush your teeth etc etc." and turn it around onto the patient as the reason for the worsening of the condition using the recordin to say 'remember when I said this and you agreed?, listen...'

 

I recently sat and listened to a patient who was upset that one of our clinicians had told her that her weight was negatively affecting her health. She said that the clinician had been insensitive and that she felt judged. She was advised that losing weight would negate the need for more aggressive treatment and eventual surgery. Of course, I was polite and apologised that she was left feeling like that but I couldn't let the message be diluted. She could avoid the need for surgery simply by managing her weight, we all can.

 

Interestingly there's a scheme in North Wales where the orthopaedic team won't accept a routine surgical referral (knee replacements etc) if the patient has a BMI of over 30, instead the patient is sent to an exercise, diet and physiotherapy team who work with the patient to improve their mobility, lessen the strain on the sore bits and help them reduce their weight to make the surgery a safer prospect. The thinking behind it is actually quite astute, it improves the patient's health in more ways than one, actually prevents surgery in some cases where the combined effects of the scheme have strengthened the muscles around the affected site, reduced the strain on it and improved the person's ability to deal with it - so much safer than effectively cutting someone's leg in half to put in a new joint. Even better is that in those that do require surgery they're better equipped to have a full recovery, the body is more able to heal and the new joints last longer as they're not put under excess strain. But, explaining that to a patient who wants a new knee and feels they can't / won't reduce their weight is, I understand, interesting. I think recording would be quite useful in that circumstance as a tool to encourage mutual accountability.


My views are my own and are not representative of any organisation. if you've found my post helpful please click on the star below.

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Covert recording cannot prevent (it might improve things long term) poor care or failure (or dodgy building work) but it can act as evidence when pursuing justice. I believe that an individual is more likely to get a timely conclusion to any complaint, perhaps even without resorting to the dreaded legal route, with this proof. I have heard of cases where patients have spent years trying to get the NHS to apologise for their mistakes (let alone getting them to put in place measures to prevent recurrence). The stress and strain this causes the patient/family is deeply damaging and wholly unnecessary.

 

I know you were too ill to pursue your case at the time My Turn, but the odds of having your complaint treated seriously and of reaching a conclusion that you found acceptable were, in my opinion, raised by that recording.

 

Patients' recordings have only balanced the power. The absence of a recording will always fall in the favour of the medic.

 

The patient who felt judged by the GP's observation cannot have been blind to the fact that she/he needed to lose weight. Even if there were a recording of a GP providing this advice, if the patient ignores it, they will not be refused insulin if they go on to develop diabetes. I have wondered whether our 'free at the point of use' health service encourages people to not take responsibility for their own health...but then I look at the US where obesity is an even greater issue.

 

I'm all for bluntness. A relative of mine who had smoked for years (since they were a young teenager and constantly nagged by his family to quit) ended up in hospital where, I understand, a doctor warned him that unless he gave up the ciggies he could lose a limb. He never smoked from that day.

 

I have heard of the scheme you mention Think About It, where overweight patients over a certain BMI are provided with diet and exercise classes. Yes, I can see the benefits to the patient over surgery and how it might save the NHS money in the long-term, but like financial incentives to quit smoking, it peeves me a little that the state has to mollycoddle individuals, because every penny that is spent on them is perhaps preventing treatment for another patient (I would say whose illness is not self-inflicted, but I know that this is a complex area).

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Although I have followed recent posts here with interest I haven't felt like contributing much for a while. In a nutshell, the dear sister who developed a horrible disease called fronto-temporal dementia on which I commented over 5 years ago, died last month – within the timeframe the doctors predicted at the outset, and peacefully.

 

The expression 'merciful release', most certainly applies, in the light of the total incapacity, both mental and physical, she arrived at all too long ago; but she is sorely missed.

 

Now it's time to try to shake off the glums, and seek safety in battle.

…………………………………………………………………………………….

 

I have just challenged the RCPI ( Royal College of Physicians of Ireland) to explain itself, via an Irish e-magazine called' The Medical Independent.'

 

The article which caught my eye was published on 19 11 2015 and entitled:-

 

"RCPI sought detailed legal advice over patients recording consultations"

 

Which you can read here:-

 

http://www.medicalindependent.ie/75719/rcpi_sought_detailed_legal_advice_over_patients_recording_consultations

 

I note the comment I appended earlier today is poorly typed even by my woeful standards, but I expect the interested will still get the drift. I am suspicious of any construction of law which identifies that the taking of a recording is legal but that its production in court wouldn't be. Perhaps I'll get to learn some Irish law.

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Sorry to hear that.

 

 

RIP For your Sister.

 

 

May we all RIP now, too.

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nolegion, I'm so sorry about your sister. Big hugs from me. I wish you courage in the months or years to come. I know you did your best.

 

My mum who also had dementia died on Friday, I feel your pain. Your sister was younger than my mother, life can be so unfair.

 

HB x


Illegitimi non carborundum

 

 

 

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Oh, Honeybee, Nolegion, I am so sorry to hear your sad news. I know grief unleashes a myriad of feelings. Take care of yourselves.

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Commiserations, HB. It seems doesn't matter how much you expect the end to come, it's still tough to bear when it arrives. Thank for your kind words, and to Clear33, and to Sali. Truly appreciated.

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I know exactly what you mean, NL. I thought I saw it coming, but I still wasn't ready when it did. No, it's not easy.

 

HB :grouphug:


Illegitimi non carborundum

 

 

 

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Don't think we have had the pleasure of a link to The Wall Street Journal in this thread yet.

 

Well, here you go, from 30 11 15:-

 

What Patients Need to Remember After Leaving the Hospital

 

"…before patients leave the hospital they are shown how to access the system. They get a phone call at home to check if they have watched the videos or need help doing so. Currently, about 90% of patients are tuning in to their electronic-discharge instructions…"

 

http://www.wsj.com/articles/what-patients-need-to-remember-after-leaving-the-hospital-1448908354

 

Money talks, and, in this particular instance, I am glad of it.

 

Funny, though, how ensuring patients have recordings of important clinical matters is considered clever (and groundbreaking) when instigated by physicians, but, all too often still, an outrage to professional dignity when instigated by patients (as, now, for many years).

 

Many patients have been charging and discharging electrons for a long time.

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Today I revisited the Irish webpage linked a post or two ago

 

http://www.medicalindependent.ie/75719/rcpi_sought_detailed_legal_advice_over_patients_recording_consultations

 

where I am very glad to note that another (UK) contributor has now raised a pointed question from much the same angle as mine.

 

I also looked again at the comment, reported in the article, of one Ms Sheila O’Connor, National Coordinator of 'Patient Focus'. She:

 

"… told MI its view is that patients should tell the doctor “before they embark on a recording like this." (Emphasis mine)

 

Right. So that's an Irish 'Patient Focus' organisation telling the Irish reporting magazine (The Medical Independent) that, in Patient Focus' view, patients should blad-de-blah.

 

The first thing that strikes me is the silly language. 'Embark'. It's like Laurence ('Chuckles') Buckman – former chair of the BMA's GP Committee - fatuously arguing in the BMA against patients recording for reasons which included:

 

'…the process of setting up recording equipment, inevitable if the patient is making the recording, would take precious time away from the consultation, even when it works well. '

 

(See post 5th Jan 2015 ,this thread)

 

Or (as some protesting medical journalism has referred to) microphones or recording devices being 'thrust' somewhere by patients.

 

Oh, for goodness sake. I am not very techno-competent but even I can noiselessly press a recording button in my pocket when entering a consulting room – without a microphone in sight. Works fine and instantaneously.

 

So I had an elementary look at Ms O'Connor and 'Patient Focus' online, whence, under the banner:

 

"Illuminating the dark corners of medicine"

 

their website commences:-

 

"Too many people are harmed physically, emotionally and psychologically by healthcare in Ireland. Patient Focus aims to address the causes of this harm, support patients and to resolve difficulties as early as possible after they arise. We do this by acting as a point of contact for patients and/or their families, supporting and empowering them in addressing their issues and ensuring that lessons are learned by the system as a result. We will assist people make complaints, accompany people to meetings, inquests and court cases as necessary."

 

http://patientfocus.ie/site/index.php/patientfocus/

 

Mmmmm. To my way of thinking, there is no small 'disconnect' going on here.

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Below is text published today at the PHSO's website. I would normally excerpt and link rather than reproduce this much. But, as I post, access to the full report itself (published today) and direct links to the text below are not working. Something to do with the volume of traffic, I suspect. You can check what's going on via the PHSO main site, though (http://www.ombudsman.org.uk/)

 

...................................................................................................................................................

 

Devastated families left without answers as avoidable death and harm incidents aren’t being investigated properly by hospitals across England

 

08 December 2015

 

Nearly three quarters of hospital investigations into complaints about avoidable harm and death claimed there were no failings in the care given, despite the Parliamentary and Health Service Ombudsman's investigations of the same incidents uncovering serious failings.

 

The wide-ranging review of the quality of NHS investigations into complaints about avoidable harm or death by the Parliamentary and Health Service Ombudsman, found that inadequate hospital investigations are leaving distraught patients and families without answers and delaying much-needed service improvements.

 

The report published today reveals that hospitals are not investigating serious incidents properly because they often do not gather enough evidence, use inconsistent methods and do not look at the evidence closely enough to find out what went wrong and why.

 

The Parliamentary and Health Service Ombudsman, which investigates complaints which have failed to be resolved by the NHS locally, launched the review because it found a wide variation in the quality of investigations carried out by the NHS into complaints about avoidable death and harm.

 

The review reveals that some investigations carried out by the NHS into complaints about avoidable harm and death are not being carried out by someone sufficiently removed from the incidents complained about.

 

More than half (52%) of the investigations about avoidable harm and death carried out by the NHS where a clinician reviewed what had happened, used a clinician who was not independent of the events complained about, the review uncovered.

 

The review was based on interviews with hospital staff, a survey of NHS complaint managers and a review of the unresolved NHS complaints brought to the Parliamentary and Health Service Ombudsman.

 

It found that:

 

• Nearly three quarters (73%) of cases where the Parliamentary and Health Service Ombudsman found clear failings, hospitals claimed in their earlier investigations of the same incident that they hadn't found any failings.

 

• Hospitals failed to class more than two thirds (20 of 28) of avoidable harm cases as serious incidents, meaning that they were not properly investigated.

 

• A fifth (19%) of NHS investigations were missing crucial evidence such as medical records, statements, and interviews.

 

• More than a third (36%) of the NHS investigations which recorded failings did not find out why they had happened, despite more than 90% (91%) of NHS complaint managers claiming that they are confident they could find out answers.

 

As a result, people often have no choice but to bring their complaints to the Parliamentary and Health Service Ombudsman to try to get answers about what happened to them or a loved one and so that hospitals acknowledge the distress caused and demonstrate that they have learnt lessons and improved the service.

 

Parliamentary and Health Service Ombudsman Julie Mellor said:

 

'Parents and families are being met with a wall of silence from the NHS when they seek answers as to why their loved one died or was harmed.

 

'Our review found that NHS investigations into complaints about avoidable death and harm are simply not good enough. They are not consistent, reliable or transparent, which means that too many people are being forced to bring their complaint to us to get it resolved.

 

'We want the NHS to introduce an accredited training programme for staff carrying out these investigations as well as guidance on how they should be done, so the public can be confident that when someone is needlessly harmed it has been thoroughly investigated and answers provided, so that action can be taken to prevent the same mistakes from happening again.'

 

Cases highlighted in the report include:

 

• The parents of a baby girl, who was left with permanent brain damage due to errors with a blood transfusion, had to wait three years to find out what happened to their child. The Parliamentary and Health Service Ombudsman found that the NHS's investigation was carried out by a close colleague of the paediatrician in charge the day the mistake happened.

 

• In another case a young mother had her life cut short because of serious failings by a hospital trust to carry out tests to diagnose breast cancer and begin treatment. The Parliamentary and Health Service Ombudsman's investigation found that the trust failed to fully investigate the case and did not acknowledge the extent of the failings or the impact on the patient.

 

• The death of a 36-old-man, who was not diagnosed with a heart condition when he went to A&E with sudden, severe, chest pains, could have been avoided. The Parliamentary and Health Service Ombudsman's investigation found that the hospital trust repeatedly failed to give his parents answers before claiming to his parents that they were unable to provide answers.

 

The review found that even when a hospital trust finds failings in the care provided as a result of a complaint, it does not always take action to prevent the same mistakes happening again.

 

The hospital visits and survey of NHS managers found that frontline staff do not understand the important of learning from investigations because discussions about what improvements should be made are trapped at meetings with senior managers, who then fail to discuss them with those who provide the care.

 

When ombudsman staff spoke to hospital staff, they did not find any consistency about the level of training of NHS investigators. Some hospitals had a list of trained investigators while others did not use trained investigators but said that incidents were investigated by 'the appropriate person'.

 

Complaints about potential avoidable death make up around 20% of the NHS complaints the Parliamentary and Health Service Ombudsman investigates. Since 1 January 2015 to 1 December 2015 it investigated 536 cases about potentially avoidable deaths and upheld around half of these, a total of 264. Overall for health cases it upholds around 40% of complaints.

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The PHSO's website finally got its act together and enabled access to the full report:-

 

http://www.ombudsman.org.uk/reports-and-consultations/reports/health/a-review-into-the-quality-of-nhs-complaints-investigations-where-serious-or-avoidable-harm-has-been-alleged

 

In my view, it is a load of empty words and hot air. It may be that in certain of the individual cases which the PHSO examined for the purpose of compiling the report some belated redress may have been achieved, for which, if so, one must be glad.

 

It achieves nothing else except statements of the nauseatingly obvious, coupled with absolutely no meaningful plan of action.

 

I sure people will be 'shocked' to learn (from Annex D):-

 

................

 

" Some trusts said that clinicians were unwilling to review their colleagues' work, which made getting an independent clinical review difficult "

...........

 

" Trusts' complaints staff reported difficulties in challenging clinical opinions "

 

............

 

My Goodness. Who ever would have thought it!

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Yes, the Dame (not the pantomime variety but could be) from the PHSO was on the Today programme this morning waxing lyrical on how they help patients and their families get redress when they are met by a 'wall of silence' from the NHS. Not a good start to my day; my steering wheel has dents in now where I was gripping it so hard. The thing is where do the damaged and grieving turn after they receive a third-rate service from the ombudsman?

 

I think electronic discharge at Lennox Hill Hospital is a fine idea, but only in combination with normal 'face to face' procedure. How long before the hospital excuses itself of liability because the patient failed to watch the video?

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Two years ago, MP Anne Clywd (with Prof Tricia Hart) published a big report into NHS complaints handling after she had lost her husband in hospital in unfortunate circumstances. She didn't get much joy as this news story shows. http://www.bbc.co.uk/news/uk-wales-27119059

 

If an MP who has closely examined the workings of the NHS complaints system can't get any redress then less well-connected people may not have much chance.

 

Other countries health systems seem to do better at this than the NHS.

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I once made a complaint to a hospital and was invited to a large meeting. Needless to say, I wanted to record the meeting and this time I asked in advance. There were all sorts of comments about my request but clearly they could hardly refuse to hold the meeting on account of it being recorded. So they asked if they could have a copy of my recording which I happily provided.

 

I felt that giving them a copy was to my advantage because if I raised a serious matter in the meeting then they could hardly say they didn't know about it.

 

Unfortunately, I subsequently encountered such deviousness in handling the complaint that it got nowhere, even though I was being helped by a reasonably experienced advocate.

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Interesting, My Turn. Still, even if one cannot prevail in the end, I'm sure you would agree it's better to have a recording than not.

 

Going on from that, here's a story about a recorded meeting which appears to exemplify everything we know about medical incompetence and cover-ups.

 

Many thanks to the viewer who sent me this ITV link. It may be old hat to some, but I don't read the Sunday Mail and seldom watch television. It was 'directly-on-point' news to me, today:-

 

http://www.itv.com/news/2015-12-09/parents-discover-nhs-cover-up-over-death-of-their-son/

 

Commiserations to Mr and Mrs Condon and all good wishes for the future: holding this Trust and its staff to account potentially benefits all patients.

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" Bereaved families of systemic failure-related deaths have far too often become second victims, due to the NHS’s misguided secrecy and focus on reputation management," writes Shaun Lintern

 

http://www.hsj.co.uk/comment/the-nhs-must-stop-victimising-bereaved-families/7000919.fullarticle#comments

 

Good article.

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It's frightening how easily people (and not just in healthcare) put aside their morals and principles to protect their jobs, their reputations and their pay cheques. You half hope the tables turn so that one day they get to understand the pain they inflict by their unfairness and dishonesty.

 

So, Nolegion, how do you feel about the threat to the FOI? Those who resent any modifications are being encouraged to write to their MP to protest before they vote on any amendment. Although, to date, I have not used this Act, I am convinced that without it (and it should not be watered down in any way) institutions would be even more wayward and untrustworthy.

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Agreed on both scores, Sali.

 

I only really got to grips with making Freedom of Information Act requests after joining CAG, and looking for information to contribute to another CAG forum.

 

I think what I have learned is that the current Act is better than nothing. It is capable, on occasion, of producing startling results (mostly for the very persistent) e.g. the MPs' expenses scandal, and otherwise, sometimes, produces modestly useful information.

 

In the effort I became involved with (making sure that benefits claimants could get audio-recordings of their medical assessments), one enquirer (not me) even got the text of an internal document which showed the DWP knew it had been acting illegally.

 

These are not things to be discarded lightly in any event, but I think the point is that the Act is already replete with exceptions and exemptions, which, as a matter of routine, officialdom, frankly often dishonestly, tries, and usually succeeds in, hiding behind every day. If, now, on top of this, by introducing fees, they make it a plaything of the rich, and by introducing wide, inscrutable, powers of 'veto' into ministerial departments they make it ultimately toothless, I fear this legislation will become of little relevance to most of us. And that would be a cynical and very seriously retrograde step in this information age of democracy.

 

One can also readily see – as the government cannot have failed to – that by adding the further layer of bureaucracy (let alone the expense) represented by fees, the excellent approach of the potent 'WhatDoThey Know' site (easy to request, semi-anonymous, automatically shared result) would likely become untenable.

 

There is a curious alignment of thought about this between the ICO, The Telegraph, The Times (and The Sun) and the Daily Mail. Beware who you dine with, but I wish their campaign against meddling with the FoI Act every success, nonetheless.

 

My MP is a dyed-in-the-wool Tory of the first water. I will write to him all the same.

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Politicians and institutions are generally in favour of scrutiny when they are not the ones being scrutinised. Certainly there has been much unsavoury business uncovered using this legislation. I think it has made the public generally more cynical of those in charge. Still, I wouldn't have it any other way and, from what you say, the law needs reforming to prevent them wriggling out of valid requests for disclosure.

 

I will be writing with my views on the subject to my MP. I doubt it will make the least bit of difference though to how they vote, but, hey, what's to lose?

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That's the spirit, Sali, if I may say so.

……………………..

 

Satire doesn't come naturally to Dr Samir Dawlatly's keyboard, it appears, but he got a 'piece' published in 'Pulse' (GP e-magazine) today, all the same, entitled:-

 

'My 2016 prediction: It will be come mandatory for doctors to record consultations'

 

See:-

http://www.pulsetoday.co.uk/views/blogs/my-2016-prediction-it-will-become-mandatory-for-doctors-to-record-consultations/20030692.blog

 

Even though it is not exactly an insightful or witty composition, it serves to emphasise just how much the topic is, at last, taking root in the consciousness of some doctors:

 

"If patients can record the consultations, then why can't we? ",

 

Dr Dawlatly writes.

 

The important point, to my way of thinking, is the acknowledgment that patients are indeed entitled to audio-record their consultations behind closed doors. It's been said so often in medical press of various stripes now, that the notion is actually beginning to sink in – past the knee-jerk petulance, and legal ignorance with which all too many doctors have greeted the concept.

 

As regards the 'why can't we?', the answer is you already can, and do, with the patient's permission, which must given in the context of full knowledge of what purposes any such recording would be used for. But, many of us would be wary of giving any 'wide' permission (or perhaps any at all), precisely because of justifiable concerns about the insecurity of such 'personal data' in the NHS' hands.

 

"Who really believes that any of the data about them is secure anyway?" asks Dawlatly, tongue-in-cheek.

 

Well, exactly. See e.g. 'care.data' for further details.

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Apologies if this has been mentioned already. In mid-December Pulse Magazine wrote this:

 

Five ethical dilemmas from 2015

 

(1) Can I stop a patient recording our consultation?

 

A notoriously difficult patient starts an appointment by asking to record the consultation. Can you refuse their request? And what can you do if the patient records it covertly?

 

http://www.pulsetoday.co.uk/your-practice/dilemmas/five-ethical-dilemmas-from-2015-what-would-you-do/20030780.article

 

I didn't see the answers because I'm not a member of the web site.

 

It may be a fine point but I found it interesting that the author calls it "our consultation" because I tend to think of it as the patient's consultation.

 

--

 

My Turn

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I'm not registered on this site either, but we know what the answer should be legally.

 

I saw the one comment from a GP who said he had been recording all consultations for over a year - presumably this was with the patient's consent EACH time. He made this decision after being criticised by the NCAS and he believes this would benefit him in the case of any litigation because the 'courts will take patient accounts over yours.' Umm, my thinking is that the courts are more likely to believe the doctor, but at least a recording can provide proof either way. However, he doesn't make clear whether the audio notes are typed up and added to the patient's computer file later and, if not, whether this would impact continuity of care. Although, some patients may think doctors do not refer to patient notes prior or during their consultation anyway.

 

He doesn't say how he would feel if a patient requested to record him but refused to accept him doing the same. Nervous, I suspect.

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