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Audio-recording your consultations with NHS doctors

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However, he doesn't make clear whether the audio notes are typed up and added to the patient's computer file later

good point. if a gp records, then it shld be available on the patients' record? and available eg re a dsar if needs be.

what about the other way around. when a patient records, can/shld it then be put on the gp records.


IMO

:-):rant:

 

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My belief is that any data request should include all data (relevant to you), whether written (hard-copy or computerised), audio or visual. Of course, you have to know that it exists to miss it. My guess would be that there is currently no mechanism to allow for a patient's request to add their own audio recordings (at this time) and many doctors would groan at the prospect - just another chore that takes up their time. Still, it would be interesting to know their response.

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I am grateful to 'The Transparency Project' (a new-ish charitable organisation trying to promote greater transparency in Family Courts), for writing about the case they summarise as below. It's not very likely I would have spotted it unless they had written about it online first:-

 

"In Medway Council v A & Ors (Learning Disability; Foster Placement) [2015] EWFC B66 a mother made covert recordings of the abusive and racially insensitive foster carer who she was living with along with her baby, and until the recordings were played she had been disbelieved. The court relied on the recordings and made findings against the foster carer who was clearly heard verbally abusing the mother"

 

You can see the whole of the Project's concise, clear and useful 'guidance' document about recording, here:-

 

http://www.transparencyproject.org.uk/press/wp-content/uploads/2016/01/parentsrecordingsocialworkersv2jan16.pdf

 

And if you are up for reading a careful and detailed judgment of over 100 numbered paragraphs, it's accessible here:-

 

http://www.bailii.org/ew/cases/EWFC/OJ/2015/B66.html

 

A couple of button-presses on a mobile phone really do seem to have made a huge difference to the course of this case.

  • Haha 1

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Here's a very recent article from the USA about medical records. I think it candid and excellent. Clearly, while there are different jurisdictions, there are similar problems for patients e.g:-

 

"What if my bank said they didn’t want to give me an itemized statement of my transactions, explaining that it includes technical financial terms, is hard to understand, and is likely to have errors? They don’t want me to be confused, upset, or angry, so if I submit a written request and pay a reasonable copying charge, they will send me my balance and a summary limited to total deposits, withdrawals and interest within 30 days? I’d lose confidence in my bank and find another. And I would tell all my friends to do business elsewhere."

 

Peter Elias, MD. 27 01 2016. From this blog:

 

http://www.kevinmd.com/blog/2016/01/shouldnt-hard-patients-correct-medical-record.html

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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.' ...

 

Surely that doctor who records recording all his patients almost certainly without their permission, is breaching GMC guidelines and also breaching the Data Protection Act.

 

Did he provide his or her name? I suspect not.

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I hadn't appreciated that viewers may not be able to see the comments appended to articles in "Pulse" unless they are registered with the site. As far as I can remember I registered (for free) over 5 years ago, and must have ticked a box saying 'recognise me on this computer' or some such.

 

The article My Turn spotted was in fact published earlier in 2015, and attracted over 50 comments in the magazine. I had a few things to say about those back in October (posts 21 10 2015).

 

Pulse featured the article again in December as part of a round-up of the most discussed 'ethical' issues during the previous 12 months. That attracted one further long comment, and I sincerely trust the wrath of whatsit won't descend on me for extracting it so everyone can see what Sali and My Turn have been discussing. It's certainly, er, 'interesting':-

 

| GP Partner 31 Dec 2015 5:56pm [i've removed the Dr's name only for fairness, because he isn't here to defend himself, as he would be if we were posting commentary in Pulse]

 

" I have been recording all consultations for more than a year. Nearly all patients think it is a good idea.

 

What prompted it was an NCAS inspection where, based on the written records, I was accused of failing in all aspects. It is simply not possible to type up all that happens in the 10 minute consultation, even if you could physically recall all the details.

 

I prioritise consulting over documenting irrelevant details. I prioritise looking at the patient over looking at the screen. I prioritise the patient agenda over trying to cover my back.

 

Like Haslam, I try not to restrict the patients in bringing their concerns, but with all the additional distractions (QOF, alcohol screening nonsense, 10,000 emails, NHS directives, work dumping by secondary and OOH, CQRS, annual reports, management initiatives wasting time on just about everything spring to mind) the price for attending to the patient is running late in surgeries and cutting back on documenting irrelevant minutiae, the reading of which will only waste other's time like the reading of irrelevant minutiae of OOH and MIU attendances for minor self limiting conditions is wasting my time.

 

My eyes were opened by the criticism dished out in the NCAS report, the same could happen if a solicitor would pursue you for some mishap, if it is not there it has not happened. Courts will take patient accounts over yours.

 

I have nothing to hide in my consultations. If I thought my work was not up to scratch I would resign as patients deserve a competent doctor.

 

I think GP's stand to gain more from recording the consultations than they could ever lose.

 

After 6 months of recording all consultations I started to get a feeling of unease over me when audacity crashed and no audio record was being made."

 

I certainly like the confidence which claims that doctors have more to gain than lose from recordings, but there are some puzzling aspects as well. What, for instance, is happening 'on the ground' when this doctor says that, 'nearly all patients think it a good idea'? My Turn correctly identifies that patients have the right to say no. Is this always being respected in practice? The comment doesn't say it isn't but it doesn't say that it is, either. Kind of important to get that right.

 

Further, it seems to me that there is some apparent confusion between the role of written medical records and a complete audio recording of a consultation. They tend to serve very different purposes. It is essential that there remains a concise but sufficient, readable, summary of clinical presentations, advice, medication and outcomes for each patient. Think of another doctor seeing the patient and relying on those notes – which they can usually scan within a few seconds. A subsequent doctor is NOT going to listen to recordings of, say, a patient's last 3 appointments, thereby perhaps taking up half an hour of his or her morning surgery, before the patient enters for a 4th appointment.

 

I don't know what insufficiencies the National Clinical Assessment Service's 'report' identified, but if they included insufficiencies in written patient records (which does seem to be indicated by the comment) those insufficiencies would remain no matter how many audio-recordings the doctor obtained and preserved.

 

However, the potential for evidential back-up (effectively cogent arbitration of matters of fact) for either side if something goes wrong, leading to a complaint or potential litigation from the patient, is indeed very real and valuable, as the comment claims - although it should be recognised that in the event of such a dispute, recordings in a doctor's hands could suffer the same tendency to 'vanish overnight' as other essential medical records so often do do, when push comes to shove.

 

Bit of a curate's egg of a comment from the doctor concerned, in my view.

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" Routine audio-recording of healthcare professionals in the workplace is new."

 

From:-

 

Weiner, Saul; Schwartz, Alan. Listening for What Matters: Avoiding Contextual Errors in Health Care Oxford University Press. Kindle Edition. (Published late 2015 in USA, but not yet published in paper form in UK. I downloaded a free Kindle for PC 'App', and the electronic book hard on its heels.)

 

I have just finished reading the book cited above. It's by two Chicago-based American research doctors and I found it hugely interesting, indeed compelling, from start to finish. My interest was assisted in no small measure by the expertly clear, accessible but not patronising, language in which it is written, which enabled me to understand the principal lineaments of a long and sometimes complex piece of medical research at the same time as making me feel I was reading an exciting short novel rather than an academic treatise.

 

I now note that part of the blurb at the publisher's website itself says the book possesses a:-

 

"[n]arrative style that reads more like an adventure than a clinical text". Spot on, for once.

 

It is also helpful that the two authors are clearly deeply committed to their subject and to improving the way doctors treat patients. As a patient at least, you can't help but like them.

 

Not all doctors are necessarily going to feel that way about this book and its authors, however, I fear. To be frank, the account reveals a 'swathe' of really rather shocking deficiencies in professional care (and attitude) - as well as some examples of excellent care, course – and the 'revelations' stem from covert recordings of medical consultations, by both 'dummy' (actor) patients and 'real' ones.

 

Nevertheless, while the researchers got a peer-reviewed paper on their findings published in medical journals last year, my bet is that this book will be the approach which really catches the attention of the medical profession – together with that of laypeople like me.

 

I am not going to attempt a full 'book review' at this stage, or perhaps at all. I have only just finished, as I say, and I need to live with it for bit – and certainly re-read parts of it to make sure I really have got it all straight. I would hate accidentally to misrepresent any part of what these authors have achieved.

 

Further, I note from the good Prof Glyn Elwyn's twitter-feed that he intends to produce a review in due course himself, alongside which I expect I will find that any extended efforts on my part would be otiose.

 

In bare summary therefore, the research included analysis of about a 1000 covertly (or semi-covertly) recorded medical consultations conducted over a period of 10 years. By 'semi-covertly' I refer to the fact that the doctors concerned had 'agreed' to the proposal that they might be recorded for research purposes at some stage in the future, but didn't know by which patients, or pretend-patients, or when, or even generally how frequently.

 

The research had two classes of 'patients' – one set of which (the 'actors') was 'scripted' to present essentially the same facts to different doctors. This provided a 'standardised' backdrop against which to assess the varying performance of different doctors round a central idea. The idea was, in my words not theirs I should emphasise, to see what extent doctors succeeded in producing care-plans genuinely tailored to each patient's individual needs, rather than producing some 'template' or 'stock' medical reactions which might not actually help the patient much, or even at all.

 

The second 'class' comprised volunteer (or, rather,' recruited') 'real' patients provided with audio-recorders but necessarily randomly-varied in the conditions they were presenting. The 'central idea', though, remained the same as above. The research had to develop and adapt 'on the hoof' to find consistent, statistically significant, ways of evaluating what actually occurred behind closed doors in both cases.

 

There are some twists and turns in the story, some most memorable vignettes of certain doctors' behaviour, and some sincere and emphatic conclusions.

 

If I have managed to whet your appetite at all, here is a proper online book review by The Electric Review which concludes with an enthusiasm I cheerfully endorse:-

 

'..[a] truly a unique and important book with a broad-brush reach: Consumers should read it to learn how to better communicate with their healthcare providers, while doctors should immediately review the Weiner-Schwartz “4C” guide-posts to learn how to hear what their patients just said.'

 

See: http://electricrev.net/2016/01/26/listening-for-what-matters/

 

and there is an entertaining and informative recorded interview with one of the authors available from their new website, here:-

 

http://www.contextualizingcare.org/2016/01/alan-on-catskill-review-of-books-and-a-letter-to-nyt/

In conclusion, the authors do not pull their punches, and I'll wrap up with one quotation from near the end of the book:-

 

' In health care, lack of respect [i.e. by clinicians, for their patients] can be subtle and hard to detect as we are loathe to recognize it for what it is. Physicians are variously described as detached, aloof, paternalistic, judgmental, and biomedically focused. When we examine the behaviors that inspire these less than desirable adjectives, they have a lack of respect at their core.

 

The problem of not seeing their shared humanity with patients is evident early in doctors’ careers. Recall the medical student in Chapter 1 who, while learning to conduct a medical interview, awkwardly attempted to ignore signs that his patient was distressed (because, it turned out, he urgently needed to make a phone call). Upon observing his attending physician intercede and engage— through exploring, processing, and responding— he exclaimed, “You mean you talk to patients like you talk to people?” What could be more revealing of a lack of respect than not seeing someone as a person? '

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I have just noticed that in this Twitter message, Glyn Elwyn posts a link to a free copy of his Patientgate article which appeared in the BMJ.

 

https://mobile.twitter.com/glynelwyn/status/443760069071892480

 

His BMJ link is this below. Many people will not have seen the article because it's usually behind a paywall.

 

http://www.bmj.com/content/348/bmj.g2078?ijkey=YIzyRP7LaYLZS6W&keytype=ref

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The right to record, openly or covertly, seems well established according to clear advice given by the medical insurance companies. The question is: what do you do if you get asked if you are recording covertly?

 

Saying "no" would be easiest but if you had to play the recordings later to a third party then could it be claimed the recording was obtained under false pretenses and therefore can't be accepted?

 

Saying "yes" runs the risk of inappropriate knee-jerk reactions from the doctor and this is not exactly conducive to getting good medical care.

 

Declining to answer might seem the best way but the situation will inevitably be seen as you are recording. Unwanted knee-jerk responses may also occur based on this assumption.

 

I have been asked this question by a doctor and have answered "no" even though it wasn't true. What should I say next time?

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Good point. Your previous abysmal experience of asking permission to record and then being abused after switching off the 'first' device should surely be in your favour - but then the law is such a fickle thing. I have never asked permission and am unlikely to for fear of the consequences on that day and in the future. I am willing to take the risk of denying covert recording (although if I actually would when put on the spot I don't know!) and argue my case when necessary. For me the benefits of a covert recording outweigh the risks of asking permission or being 'caught' doing something perfectly legal.

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Hello,

 

 

I posted here about a year ago. My Trust never got round to sending me a policy document on recording, covert or otherwise, so I have just proceeded to abide by the law. Thank you to people who responded to me.

 

 

I am wondering if anyone knows whether the DPA exemption applies to other areas of the UK or if private recording is only permissible in England?

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Sali - I have been put on the spot. I replied that there is no obligation to inform professionals if I am recording and that I would advise all professionals to assume they are being recorded.

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Sali - I have been put on the spot. I replied that there is no obligation to inform professionals if I am recording and that I would advise all professionals to assume they are being recorded.

 

Hello Tillandsia. If you can carry off such a reply with total lack of concern then the doc may be none the wiser.

 

However if you start blinking, dilating your pupils, blushing or stutter your words then the conclusion which will be drawn is that you are in fact recording. I foresee a knee-jerk reaction which may be made all the worse on account of your semblance of guilt.

 

My own approach is to deny it. After all, if you're asked the question by a doc then it shows they are concerned and if you confirm their fears is not going to make him feel better, especially as it was being done covertly.

 

Whatever you do respond you need to think it through in advance. There isn't enough time in the split second you get to reply to work out the pros and cons.

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Here's a brief article I saw online. If you're interested, Google shows several other reports about this advice.

 

Health minister Edith Schippers is recommending people record conversations with their doctors to make sure they don’t forget what they have been told.

 

The conversation should be recorded on a smart phone or similar device and used for personal information only, Schippers said.

 

‘Good care requires that doctors and patients agree about the treatment,’ Schippers said in a briefing to parliament. ‘And it is important that patients ask questions and doctors take the time to answer them.’

 

Doctors who don’t want to be recorded should then be required to provide the patient with written information, the minister said.

 

http://www.dutchnews.nl/news/archives/2016/03/86558-2/?utm_source=newsletter

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that seems fair, partic re some patients.

eg a relatives doc is now doing that (writing things down/printing off) given their circs.


IMO

:-):rant:

 

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Remember the American chap who, according to his account, accidentally recorded his colonoscopy on his mobile phone and was awarded $500k in damages? He stayed anonymous.

 

Not so 'Ethel Easter' who, intentionally, covertly recorded her hernia operation on a recording USB stick, which is what I now use to record consultations.

 

She hid it in her hair. Full story was written up by the Washington Post yesterday:-

 

https://www.washingtonpost.com/news/morning-mix/wp/2016/04/07/patient-hid-recorder-in-her-hair-as-surgeons-operated-on-her-their-words-left-her-deeply-distressed/

 

Interesting comparison in terms of reader responses. A short version of this story was also published yesterday in the online version of the Daily Mirror. As I post today, it has so far attracted only one comment from a reader.

 

As you may note, there are already over two thousand such comments appended to the Washington Post’s article.

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This was private medical care?! Personally, if I had received an initial reception from a consultant that this lady did, I would be booking in elsewhere for my operation. Perhaps she had no choice. These so-called professionals were dangerous in their disregard for her penicillin allergy, as well as deeply sinister in their sexual innuendo. How many medics were present I wonder? Not one seems to have had the integrity to speak out during the operation. Like in the UK, it seems the management are all too willing to dissemble, obfuscate or ignore patients' concerns. In my opinion these medics are not fit to be employed anywhere. I hope she takes legal action - sadly it seems this may be the only was to stamp out such bad practise and improve services the world over. Lucky lawyers, eh?

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This was private medical care?! Personally, if I had received an initial reception from a consultant that this lady did, I would be booking in elsewhere for my operation. Perhaps she had no choice.

 

The Washington Post article suggests that she effectively had no choice. "From the start, Easter was troubled that she didn’t trust her own surgeon, but she was in too much pain to cancel the operation." I have been in a similar situation where I have had a bad experience with some doctors but they are the only ones in town in that specialty and I find it hard to travel.

 

I searched Aamzon for USB style voice recorders similar to the one that patient put in her hair and was interested to see saw they cost less than £15. Some cost only half that.

 

They're small enough to put on your key ring. However several of them have the sort of glitches which could drive me to despair. For example, only starts recording after 15 seconds, needs the date entering each time, takes 8 hours to charge up, loses the audio file if battery runs out while recording, and so on. In circumstances when I am recording medical matters, I need reliability.

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I came across these audio clips which compare the audio recorded in different environments by some dictation machines as well as an iPhone. I wonder which of the settings is most representative of a medical consultation? It's tempting to assume a consultation is always in a quiet room but there are times when this is not so.

 

boardroom, classroom, cafe, lecture room

soundcloud.com/wirecutter/sets/audio-recorder-test-round-one

 

food court, office, park

soundcloud.com/wirecutter/sets/audio-recorder-test-round-two

 

The audio clips above were made for this rather interesting review of voice recorders:

http://thewirecutter.com/reviews/the-best-voice-recorder/

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I share Sali’s perspective (post 09 04 16 above) concerning 'sexual innuendo' and the 'deeply sinister' involved in the Ethel Easter story. It staggers me that so of much of the (now abundant) commentary on the internet – from both medics and patients, it would appear – tries to make excuses for the behaviour of the clinicians concerned. The link below is a more or less random pick to one of the many places where the issues have been discussed over the past couple of weeks:-

 

http://marginalrevolution.com/marginalrevolution/2016/04/what-happened-when-easter-taped-her-surgeons.html

 

And I agree, make an example of ‘em, E.E., if you have the time and strength for it.

 

Useful stuff on recording devices MyTurn. If you have now actually acquired a new one, any chance you could give us an indication of your own ‘road test’ analysis (– taking care not to infringe site advertising rules, of course!)?

 

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

 

Useful comment, from a medical professor, in the Wall Street Journal recently (12 04 16):-

 

'I don’t love being recorded, because every conversation I have is imperfect, but I do love this principle: “Integrity is doing the right thing, even when no one is watching.” Acting as if my every word is chronicled nudges me to constantly improve my skills in educating patients, explaining options, and answering their questions — for the 99% of visits that aren’t recorded. The best practice for physicians is to always assume you’re being recorded. That doesn’t make me paranoid. But it might make me a better doctor. '

 

http://blogs.wsj.com/experts/2016/04/12/should-patients-record-their-doctors-visits/

 

(NB. In the above quotation the words 'improve my skills etc.' were 'blue' and comprised a link which I have failed to incorporate in this post. So, it was to an article by Professor Glyn Elwyn's with which regular viewers here will be familiar:

 

http://thehealthcareblog.com/blog/2014/03/13/patientgate-digital-recordings-change-everything/ )

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This post is about recording doctors but with a difference. It also touches on the quality of recordings.

 

A friend of mine has bulimia and some years ago she was being treated by a psychiatrist as it was interfering with her life. At the time she was a mature student studying for a law degree at a good university.

 

By co-incidence her new psychiatrist was himself taking a course in medical law in order to later undertake medico-legal work. As English wasn't his first language, he asked my friend in one consultation if she could proof read a law essay he had written. She read it and made amendments which he was very pleased about. She later told me the essay had needed considerable adjustment.

 

The psychiatrist later asked her to write one of his law essays and reluctantly she did. This didn't end there and he started to ask for more and more help with further essays but she became extremely uncomfortable about it. She found herself in a difficult situation because she needed the psychiatrist to treat her bulimia and couldn't just walk away from the planned treatment as she may not get offered an alternative psychiatrist but, at the same time, she didn't want to write his essays for him. Out of desperation she skipped several appointments.

 

The psychiatrist then started to phone her at home asking for help with his essays and he would ring 6 or 7 times a day. It got to a stage where she wouldn't answer any telephone calls at all including those from me. The psychiatrist would leave messages on her answering machine asking her to contact him to help and then he would ring again if he hadn't heard from her. She, like many bulimics, is of a very anxious disposition and, as she lived alone, she found all this extremely intimidating.

 

After weeks of this crazy situation, one day she grabbed her answering machine and took it with her to meet the medical director of the hospital. She told him what had happened and played him several messages from her machine. After hearing a few the medical director turned to her and asked, "Are you sure that's Dr ABC? I don't think it is. It doesn't sound anything like him."

 

And that is the point I'm trying to make. If you have some noisy muffled recording then it may be hard to prove who the doctor is if ever you need to at a later date. Your noisy muffled recording may be good enough to jog your memory about what happened in the consultation, which itself if very useful, but that may be all. I suppose a forensic voice analysis may help identify the speakers but that's not the sort of thing which many people, including my friend, can afford. So it could be long hard slog to get a medical director, who has just developed mysterious problems with his hearing, to accept the identity of who is on the recording.

 

This is one reason I think it can sometimes be important to have a good quality recording in case the identities of those present is questioned. The review of dictation machines I posted recently on 10th April 2016 compared an iPhone and found the iPhone to be poorer then the dictation machines. I was intrigued enough by the review to buy their recommended model which I am now testing. By contrast those very cheap audio recorders for £10 that I see on eBay and Aamzon may be a great bargain but they may be a false economy in certain circumstances.

 

Well, to come back to my friend's experience, it was by a total stroke of luck that just as the medical director asked his question about who it was, my friend and the medical director could hear the next recorded message starting up with "Hello, this is Dr ABC".

 

How sweet. I agree that may not have been 100% proof but it quickly helped the medical director to put aside his mystery deafness.

 

Unfortunately, the hospital trust went on to manipulate the complaints process shamelessly in order to bury my friend’s complaint despite such strong evidence but that's another story.

 

If anyone has any comments on this then it would be interesting to hear them.

 

 

My Turn

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My quick thought would be make sure your recording device(s) are tested to ensure good sound quality beforehand (even when background noise is present) and start your consultation by confirming the name of the medics present in a friendly introduction. Your recording is digitally date/time-stamped and the formal notes from the appointment (kept by the doctor/hospital) should back up these facts. Is it for you to prove or them to disprove?

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Reading the comments on this post was a little frightening. You are not speaking in private if the patient is out cold on the operating table and there seemed to be little disquiet about the 'touching' comments, which I found particularly worrying. The arrogance of some of the contributors is quite outstanding.

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Interesting story, My Turn. The part about the attempt to deny the facts (i.e. the fact the it was the doctor concerned whose voice had been recorded) is particularly sinister. All too obviously, such a denial - in the circumstances described - carries with it the express or implicit accusation that the complainant must be fabricating both the account and the evidence. Very nasty.

 

On the score of achieving better recording quality, I take your point. I use two of the inexpensive USB sticks you refer to, and they suffice for my current purposes. However, that’s partly because I already know how the particular conversation went, when I listen again later at home, I suspect. In, say, court, I am sure I would be glad of a clearer, single, recording. Perhaps, I should persuade myself to part with a bit more cash to get a better device and use a ‘stick’ as back up to that. I will ponder… ( parting with cash doesn’t come easily to me… )

 

Outrageous commentary (from some quarters) on the latest U.S recording-patient story continues to pile onto the net, Sali. The competition for ‘my pet hate to date’ is fierce but the current front-runner in my book is the blog here:-

 

http://www.bioethics.net/2016/04/stinging-doctors-recording-your-own-surgery/

 

in which the author concludes:

 

“There was some fault in both sides in this case, but the greater offense was that of the patient.”

 

Ye gods.

 

Just how ignorant, arrogant, biased and fatuous can a person be?

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The competition for ‘my pet hate to date’ is fierce but the current front-runner in my book is the blog here:-

 

http://www.bioethics.net/2016/04/stinging-doctors-recording-your-own-surgery/

 

in which the author concludes:

 

“There was some fault in both sides in this case, but the greater offense was that of the patient.”

 

I rather suspect the American courts will disabuse the author, Craig Klugman, of that notion when they determine the exact amount of substantial damages to be paid to the patient.

 

Of course the patient was not, as he suggests, "playing gotcha". I am perfectly sure the patient would have been more than happy if the medics had not insulted and abused her. Recording their abusive behaviour is not "playing gotcha". That outdated school of thinking based on the right of the privileged to routinely abuse the vulnerable and the perpetrators feel offended when they are caught out.

 

My Turn

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