Recording consultations: a win–win situation for physicians and patients

Encouraging patients to record consultation summaries may improve health outcomes

Technology plays a significant role in medicine, and technological advances are constantly changing how medicine is practiced. Technology is also widely used by patients, who are now able to apply it in a medical setting. For example, the rapid adoption of smart phones, tablets and other personal electronic devices has made audio or visual recording of consultations relatively straightforward.

The recording of consultations is not a new concept. A 1990 study investigated the effect of video recording consultations on physician behaviour.1 The benefits of recordings for oncology patients have been well established.2-4 The technology available for recording has expanded dramatically over the past 25 years; however, it is unknown if doctors are aware of the potential clinical usefulness of recording consultations.

Physicians can enhance patient care by using personal electronic devices in their practice. A recent study showed that 69% of respondents wanted to record consultations, motivated by the desire to improve their care experience and share the information with others.5

Benefits of recording consultations

There are several benefits of encouraging patients to record consultations, and particularly to record a management summary at the end of a consultation.

Patient recollection

Compliance with management plans and subsequent health outcomes depend on a patient’s ability to recall the management plan in the first place. To promote patient recollection of a consultation, physicians can encourage patients to record the discussion of the management plan at the end of the consultation. This would allow patients to review the crucial information provided later in a familiar environment and without time constraints. The benefit of recording a consultation has been demonstrated in an oncology setting, where the use of audiotapes has been reported to improve patient recall and satisfaction.2 One patient from a non-English-speaking background commented that an audiotape allowed for slower review of the information, which may not have been fully understood when first discussed. A review examining the effect of providing recordings to people with cancer and their families recommended that physicians consider offering recordings as most patients find them useful,3 or even prefer4 recordings. Using recording devices with the aim of improving patients’ understanding and compliance with management may result in better health outcomes.

Patient empowerment

Patient autonomy should always be considered and prioritised in medicine. Patients have the right to share decision making with their physicians. One study identified patient empowerment as the prime benefit of recording consultations.5 Additionally, patients have used recordings to share information with family and friends.4 By offering patients the opportunity to record the management plan at the end of a consultation, physicians may provide patients with a sense of control.

Ease of use

Both audio and video devices can be used to record consultations. Audio devices are readily available as independent voice recorders and on mobile phones, and allow patients to easily review medical information. Video recordings might be particularly useful when practical techniques, such as the use of an inhaled medication, are being demonstrated.

Creative integrity of the physician

Providing patients with an opportunity to record the management plan at the end of a consultation maintains a physician’s ability to carry out the majority of the consultation without feeling pressured or scrutinised. Although one study showed no evidence that video recording altered a physician’s consultation behaviour, there were several factors that were not considered, and the authors noted that decision making could be degraded or enhanced.1

Avoiding surreptitious recording

Concerns about secret recording of consultations have recently been raised.6,7 In Australia, it is illegal to make voice or video recordings of private conversations without the other party’s permission except in Queensland, Northern Territory and Victoria. Furthermore, it is illegal to communicate or publish the recording to any third party without the other party’s permission in every state and territory.7 Despite this legislation, medical practitioners are still at risk of being involved in legal action as a result of surreptitious recording.8 Physicians may derail secret recording that is already occurring, or reduce the likelihood of secret recording, by offering patients the chance to record a consultation summary. The additional benefit is that the responsibility to initiate this opportunity is removed from patients, who may feel uncomfortable about asking to record consultations, or be concerned that their motives will be questioned.5

Risks of recording consultations

Although encouraging the recording of consultations may be beneficial, there are also risks to be considered.

How the recording is used

Perhaps the most important consideration is how the recording will be used, and by whom. Despite most states requiring permission from both parties to record interactions and all states requiring permission from both parties to share recorded information with a third party, there are situations in which the agreement of privacy may need to be broken. In the Surveillance Devices Act 2007 (NSW), for example, the prohibition to communicate information obtained by a listening device does not apply in the case of an offence against the Act, or if there is imminent risk of serious harm to persons or of substantial property damage (the Act, Section 11).

Documentation

In the case of a recorded consultation summary, a physician may consider keeping a copy of the recording for the medical record, which raises a number of potential difficulties. Physicians may ask patients to forward the recordings to be added to their medical records or may have to also record consultations. There is then the matter of how the recording might be stored. If an electronic records system is available, it may be possible to upload recordings to patients’ medical records. If not, other methods of secure storage of recordings would have to be found.

Time management

One critic argues that recording may lead to consultations taking longer.9 While one study investigating the effect of video recording on a physician’s consultation behaviour did find a 1 minute increase in consultation time, the increase was not significant.1 However, in that study, the recording equipment was already set up, whereas in a standard consultation, it may take additional time for the patient, physician or both to prepare recording devices. Furthermore, to ensure the recording has been successful, the physician may request that it is replayed, which would take time.

Conclusions

The decision by physicians to encourage the recording of consultation management plans is an individual one. If a physician does decide to allow recordings, there are several factors to consider. For example, which patients should be offered recordings? It may be appropriate to start with long term patients, with whom the physician has established a trusting doctor–patient relationship, those with chronic disease and subsequent complex management plans, or patients who have received bad news. It may also be necessary to highlight the intended use for recordings. Importantly, it may benefit the patient to discuss confidentiality and when the recording may be required to be produced.

The use of recording devices for oncology patients improves recollection and satisfaction. However, it is not known if physicians outside the field of oncology have used recordings in their practice, and to what extent both physicians and patients are aware of the potential value of recordings. There are benefits and risks to be considered, and the decision to encourage the recording of consultations will be made on a physician-by-physician basis. Overall, given the benefits for patients, we recommend that physicians should encourage patients to record a management summary at the end of a consultation.