Doctor visit or Deposition?

[Rich_by_the_Bay]

Need some feedback.

I saw an older lady in my office today about to undergo major cancer surgery, lots of medical complications, etc. She was accompanied by her 30-something daughter, by appearance and demeanor quite the take-charge type. After introductions, the daughter asked if I minded if she recorded the entire visit, pulling out her Sony digital recorder.

I offered that sometimes that can make things feel a little more formal or inhibited than otherwise, but if that is what Mom wanted, I would agree. Mom consented. I would add that I always try very hard to have good communication, encourage questions both during the visit and later by phone; indeed I pride myself in that. Tears are not uncommon, and unstated fears often get stated for the first time in this setting (I work in a major cancer referral hospital).

Frankly, I didn't like it. Normally my visits are warm and at ease, free interplay, lots of nonverbal communication. With the Sony, I found myself choosing my words carefully, avoiding humor, and generally feeling stiff and inhibited. Superficially, I am sure her main justification was that she not miss something important, but written notes have always solved that problem nicely.

About half way through, she ran out of tape. Within two minutes, Mom was teasing me about my tie, and the rest of the visit went very well. I am quite aware that there is a sense of activism and take-charge with doctors nowadays, but... I kind of felt like the intimacy and 'sanctity' of the visit were compromised when the recorder was running.

I wonder how you all feel about this. If it catches on, I might have to FIRE early . I'm questioning my reaction.

 

[REWahoo]

Doc,

Some situations are not meant to be recorded verbatim, no matter how good the intentions. From this point forward you will have this as example to use as to why you must say "no" if someone else wants to record one of these sessions. Taping the conversation inhibits the open exchange of information and should not be allowed.

 

[razztazz]

YOUR reaction is probably exactly how I'd handle it. If it's one for The Ages you have to speak more carefully. However, yes, we are all, at least externally, encouraged, admonished, challenged  to take control of our health care   be well-infomed, and questions and ..... well, I cannot go to medical school to cover for the doctor. Thats what I'm paying him for. So I 'm gonna ask questions especially if its complicated like cancer stuff. And once's state of mind can influence what notes they take too. I've noticed it with myself and others.  Capturing the event en toto  might be a better option.

Also, with one exception I've found Drs dont like informed patients and they don't like to answer any questions they havent answerd 1000 times already with the stock answer

I not only want the answer,  I want record that I asked the question.

 

[mikew]

We have observations of our classes. During these everything is formal and stiff. People teach by the numbers. Student interaction and learning suffers. Students don't ask questions. Thank god it is only once a year.

OTOH I have some students who record my lectures because  they (mistakenly) respect what I say and want to make sure they didn't miss anything. At first it freaked me out, I got used to it after a while.

Can't say anything about the legal dimension but it seems the mother is going to get the legally correct treatment nothing more nothing less.

 

[cute fuzzy bunny]

"I dont allow anything to be recorded unless I have my own recording of the same conversation, and I dont have a recording device with me right now, so we can either reschedule the appointment so I can set something up or have the meeting right now without it being recorded."

Last thing you ever need is a piece of a conversation pulled out of context in a boardroom or a courtroom, unless you have access to and can play the entire thing.

I've had a few requests to do recordings. When faced with leaving and coming back later and having dual recordings, the recording goes out the window. Every time.

Are you sure she 'ran out of tape'?

 

[Dawg52]

If I had been in your shoes, I probably wouldn't have liked it. But there were times my Mother would take my Dad to the doc and she could no more tell me what he said than a man in the moon. So from that perspective, I can understand it. Not always easy for people to absorb what someone in the medical profession has to say.

 

[samclem]

Wow, this is a tough one.

Daughter's perspective: " I've been to 10 different doctors with Mom-- each time we feel like we are rushed, each time I get home and wonder if I remember everything he/she said. The info we're hearing could spell life/death for Mom--I need to understand it, look up stuff I don't understand on the Internet, etc. I also need to make sure brother and sister understand what is going on--they always ask me, ad I can't always remember the technical terms. I'm not taking any chances--the doc won't mind if I tape this."

But, altogether, I think you were right to be uneasy. I'm sure I would have been less direct and used far more qualifiers if the tape were rolling--and that would have reduced the effectiveness, and the needed warmth, in communicating with Mom and daughter.

Does your hospital/facility have a policy on this? If they did, it might make your life easier. I would think they'd at least want to have a legal rep in the room--how cozy would that be?!

 

[Scrooge]

At first it freaked me out, I got used to it after a while.

Naturally, having something like that pop out of nowhere in the middle of a patient visit can throw you off. In the long run... well, thinking back to LBJ's and Nixon's tapes, sometimes they remembered that the recorder was on and Spoke For The Ages and sometimes they didn't.

From the legal perspective, definitely check with the admins, the ethics board and anybody else at the hospital that can help. I am sure you have heard all the horror stories.

 

[Brat]

I agree with Cute & Fuzzy, as well as the others who say that a patient's family member is often put in a tight spot by other family members.  It is a tough call, but re-scheduling with dual recorders makes sense whatever the reason.

 

[Cal]

I think samclem nailed it. Whenever I have conversations with my parents about their health, they never remember details about what was discussed - but then still ask me to look into it for them.  :

If I had been the daughter and had been there, I don't think I would have recorded the conversation. But I could envision asking one of my parents to record something if they went alone so I could answer questions for them later. They get very intimidated at the doctor and worry about "questioning" the doctor and offending her.

I also see it from your perspective - there are way too many "oops! I spilled coffee in my lap - give me a million dollars" kind of people out there nowadays. I don't think I'd be comfortable being recorded. You just never know the context in which the recording will be used.

 

[sgeeeee]

When I was a professor I was considered by most students and professors to be a really good teacher. My classes had lots of classroom participation. I knew what points I was getting across effectively and which points were missed because the students let me know in real time. We collaborated in the classroom to make it effective. I won lots of awards and recognition for that, but more importantly, my students did better in follow on courses than other students.

My courses were popular enough that enrollments were high, so the university decided that the best way to reach more students was to televise my classes. I had a live classroom, but there was a camera on me at all times and most of my students were miles away. I was awful and I knew it. My classes became dull and students turned silent.

But my options were either to get better at teaching in front of a camera or be a bad teacher. I was not allowed to reject the closed circuit classes. I talked to a lot of the television professionals and started learning different ways of playing to the camera. I also started spending some time in each class coaxing student participation and making them feel more comfortable in front of the camera. My televised classes got a lot better.

I know your situation is different. There is a lot more riding on your relationship with your cancer patient than there is on my relationship with a graduate student in electrical engineering. But maybe there are things you can do that maintain the excellent interaction you are used to between you and your patient, while still satisfying the needs of the patient and family to capture everything they need to know.

One thought: You might insist that the initial part of your examination remain recording free, but agree to summarize and answer questions on camera at the end.

 

[Martha]

The good thing is that if anyone ever asks in the future you can describe how it went the one time the meeting was recorded.

You handled it well. Damn lucky the tape ran out.

 

[Martha]

Rich, I wonder about something. When I am at work I sit behind a desk for most of the day. I have a computer, I check my email and check this site from time to time.

I also have been hanging around a hospital a lot in the past year. The doctors are often on the go, moving from room to room. Sometimes you might see them at a computer terminal, which seem to be everywhere. Are you walking around a hospital right now, stopping at a computer from time to time to make notes, and checking this forum? Just curious.

 

[Rich_by_the_Bay]

One thought: You might insist that the initial part of your examination remain recording free, but agree to summarize and answer questions on camera at the end.

That's an interesting suggestion. "Why don't we get through the first part of our visit without a tape recorder so we all feel relaxed about our private discussion. Then we can turn it on so you can ask questions you think you might forget if you don't record it."

CFB's advice about medicolegal protection by double-recording is good, too, though it might not fly in this context (a bit too challenging, some patients come from distant realms and can't easily reschedule, etc.).

 

[Rich_by_the_Bay]

Rich, I wonder about something. When I am at work I sit behind a desk for most of the day. I have a computer, I check my email and check this site from time to time.

I also have been hanging around a hospital a lot in the past year. The doctors are often on the go, moving from room to room. Sometimes you might see them at a computer terminal, which seem to be everywhere. Are you walking around a hospital right now, stopping at a computer from time to time to make notes, and checking this forum? Just curious.

I spend about half of each working day doing administration, sitting at my desk mostly. The other half is often teaching or seeing patients. I enjoy checking in here often but briefly when I am at my desk. One of the luxuries of my senior status. Then there will be 2 week stretches where I am on the inpatient rotation and don't get home til late, and check in from home only.

I don't browse from the hospital/patient care terminals. Wouldn't be prudent.

 

[Martha]

CFB's advice about medicolegal protection by double-recording is good, too, though it might not fly in this context (a bit too challenging, some patients come from distant realms and can't easily reschedule, etc.).

Too adversarial. I would never say that to a client who wanted to record our conversation. It would be better to simply say that when people aren't used to being recorded it inhibits conversation.

I don't browse from the hospital/patient care terminals. Wouldn't be prudent.

Thanks for satisfying my curiousity. I have seen nurses on the Internet a couple of times.

 

[cute fuzzy bunny]

I never made it an adversarial situation, and re-scheduling never became a problem.

What happened was the folks who wanted to record the conversation really didnt want ME to have a recording of THEM, and once faced with that, decided they didnt need it.

To simplify, instead of saying you would rather reschedule if the recording is to take place, just pull out your own recorder. I think you'll get the same effect.

 

[macdaddy]

Rich: FIL is a spine surgeon and if a patient asks to record the conversation, he'll tell them it's not within the office policies and offer to refer them to another doctor. This is due solely to malpractice concerns and the litigous nature of that sub specialty. I think he does make his hospital email address available to family members in case they have questions, and there is always a nurse who they can call for information as well. My initial reaction would be, let them record it, for the reasons stated on this thread. But is it worth the risk that a lawyer finds a way to attack you in court with your own words? That would be a nightmare.

I imagine if this became a popular practice, the insurance companies might put language in their policies to prevent it. Could you see a patient coming and saying to a primary care provider, "it hurts in my back, neck, and chest... and i have headaches and head pain..." (on tape). Then the doc has to say, okay, let me run these 80 tests on you for $100,000 and put you through a lot of unnecessary pain and expense to cover my ass...

 

[poboy]

Could you see a patient coming and saying to a primary care provider, "it hurts in my back, neck, and chest... and i have headaches and head pain..." (on tape).

My old golfing doc friend says there is nothing more enjoyable than asking a patient what brings you in today and have the reply, " I don't feel good"

 

[LovesLife]

Perhaps if the problem is that other family members are unable to attend the doctor appointment and miss out what was said then maybe a phone consultation between the doctor and family member could be arranged. If patient confidentialty is an issue then permission to discuss matters before hand could be handled prior to phone appointment.

 

[Rich_by_the_Bay]

Perhaps if the problem is that other family members are unable to attend the doctor appointment and miss out what was said then maybe a phone consultation between the doctor and family member could be arranged. If patient confidentialty is an issue then permission to discuss matters before hand could be handled prior to phone appointment.

As you can imagine, we do this quite regularly. Most of the time it is not a problem but there are more than a few families where you have to recycle the whole, long thing 3, 4 or more times. That can take a lot of time which takes away from other patients or self. Normally we request that such families appoint a spokesperson who can help in that regard, but that's not always feasible.

I enjoy relating to families most of the time.

 

[Meadbh]

Rich, this is a difficult situation. While probably well motivated, there is a significant possibility that the recording is being done "just in case" something goes wrong, to have as evidence. There are also privacy issues for you and the way I see it, they need your consent. If there is no existing policy, I suggest you check with your friendly hospital lawyer on how to handle this situation in the future. It might be wise to begin the recording by having a short discussion about its purpose and getting an agreement not to use the tape in any litigation. Better still, get the patient to sign a waiver of liability that you can keep on file. Then relax.

I once led a family meeting that included 30 relatives and a lawyer. Their relative was critical following care at St. Elsewhere's, and they were not happy. It was most uncomfortable and changed the focus from the patient to "can we sue?" Our family meetings are often held to discuss life or death issues and our practice is to have a team member take notes and document the dialogue and decision making in the chart. Now we always ask who's coming.

 

[Rich_by_the_Bay]

Thanks, all, for the insightful feedback.

I'll check to see if any policies are in existence.

I think in the future I'll decline to have the entire visit recorded in the interest of open communication and everyone's comfort including mine. But I'll offer a recordable few minutes at the end where specific questions can be asked and recorded to help them remember the information. During that phase I'll be cautious in my remarks, and open with a statement that we have all agreed to this recorded session solely to help the patient recall the advice we agreed on today, and I'll summarize what was recorded in my note.

Any other suggestions are always welcome.

 

[samclem]

Rich,
- Not to drag this out, but I think the suggestion to make your own recording is a good one as well. Let everyone know, and you could even state at the outset words to the effect that you are making your own recording in order to have a reference of the discussion in case the family does have questions. Ultimate reason--to have something to prep the legal folks in case it is ever needed .

 

[macdaddy]

Thanks, all, for the insightful feedback.

I'll check to see if any policies are in existence.

I think in the future I'll decline to have the entire visit recorded in the interest of open communication and everyone's comfort including mine. But I'll offer a recordable few minutes at the end where specific questions can be asked and recorded to help them remember the information. During that phase I'll be cautious in my remarks, and open with a statement that we have all agreed to this recorded session solely to help the patient recall the advice we agreed on today, and I'll summarize what was recorded in my note.

Any other suggestions are always welcome.

Rich I hate to say it, but I think even your well reasoned approach may be putting yourself into legal jeopardy. I would check with the hospital's counsel, as another poster mentioned. Imagine that one time you forget to re-cover some ground on the recorded tape. In court, it turns into you never having covered the information at all. And the recording makes filing of a suit more likely, and makes it more likely to be found non-frivilous.

Is the kind of recording you propose in the best interest of the patients? Absolutely. Is there a way to do it under the current rules, without putting the physician in serious legal jeopardy? Unfortunately, I don't think so.