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Recording consultations with your doctor should be welcomed

22 May 2014

On the forum of the British Medical Journal website, there is a discussion about the right a patient has or does not have to make recordings of their consultations. It is interesting to read the responses. Interesting and disappointing because too many contributors have a defensive attitude and wonder why a patient would want to record. They suggest patients might use the recordings against them later or want to record them just to catch them out. Surely they can simply take notes as a record of the conversations.  It does not seem to occur to these posters that even note-taking means patients only write down what they THINK they have heard and understood. Just because they write it down does not mean they write down the right thing.
Patients are not adversaries. They are partners in their own treatment. Why the hostility? Do doctors forget that patients might need to listen to their words a couple of times, perhaps with a dictionary at hand, to fully understand what they have been told? (This study demonstrated that patients forget between 40-80% of what they are told and that even the things they do remember is often inaccurate!!)

I do not see why doctors would have an issue with this. It happens so often that, especially in Bad News Conversations, patients only hear half of what is said and forget the rest. This can lead to a lot more problems later when patients might claim they were never told something or where they have misinterpreted what the doctor said. As a nursing student who has extensive experience as a Health Care Assistant in End of Life care, it happens far too often that nurses are asked by patients to repeat and explain what the consultant has just told them.

Doctor says: "This treatment is palliative but we should be able to stop the tumour from growing further."

Patient hears and writes down: Treatment will stop tumour.

For most lay-people, this will read as: this treatment will stop the tumour from growing which means it will kill the tumour which means this treatment might actually rid me of this tumour.

Doctors might think that is a silly thing to conclude and that they were surely VERY clear in not saying the treatment was curative. But how much do we expect patients to know about treatments? Curative? Palliative? Health Care Professionals (HCP) should ALWAYS assume (in a non-patronising way!!) that the patient has not understood what they have said and ask them to repeat in their own words what you have told them. I also think that every consultation should start with a recap from the last one by asking the patient to explain in their own words what they remember form the previous consultation. So that when you build on what you THINK was understood, you don't simply go further down a path of total misunderstanding.
If we care about our patients, surely the worst thing we could do is send them in to a treatment they think will cure them when in fact, they might endure terrible side effects for something that won't?

I simply do not see the problem in people making audio recordings of the conversations. For the life of me, I cannot imagine what it is that you could be saying as a HCP to a patient that you do not wish them to be able to hear again? It is not like medical notes where the communication is aimed at other HCPs. There indeed might be things you would prefer a patient not to see (although you should always be mindful that patients might request to see their notes!).

If your first response is: Why should a patient want to record me talking? Then your focus is not on the patient but on yourself. If a patient wants to record your conversation, it might be because last time you spoke, they did not understand. Or last time you spoke, they had so many questions. Or last time you spoke, there was too much information for them to write down. Or last time you spoke, the news was so bad, they were unable to take it in. In all these cases, it is up to the HCP to improve our communication skills and ensure the patient leaves with a full understanding of what has been discussed.

Remember that in a HCP - Patient relationship, the HCP ALWAYS has the advantage of knowing more. Patients feel this. They know they will only ever know what you tell them. You decide what they get to know so the least you can do is to allow the patient to actually understand the things you let them know. It is up to you to make sure they fully understand. And if it helps a patient to understand you better if they can record the conversation and go over it again at their own leisure, then so be it. Better informed patients leads to better health outcomes.

From personal experience, my wife had a brain tumour and the Neuro Oncologist was going to explain all the treatment options and prognosis and so on. I asked politely if I could record the conversation (just sound) so we could listen again at home afterwards to make sure we were able to take it all in (my wife was no longer of the mental capacity to take things in so it was all down to me to listen and remember). He refused in a less than polite way. The news was terrible and after the words "palliative radiotherapy" we heard nothing else that was said. I tried to take notes but my brain was numb. Over the next few months, the consultant kept saying that things had been discussed in this particular meeting but I had no recollection of it. We thought there might still be chance of a cure. When it was over, the MRI scans revealed there had never really been that chance. I must have misunderstood him when he spoke to us. But I have no way of checking that. I was devastated. This could have been avoided had I recorded the conversation. Then I would have understood and remembered.

I am not saying he was lying. All I am saying is that consultants should be aware of how patients interpret what they say and how a recording can help clarify things. The arrogant refusal of consultants to let patients record conversations shows a lack of patient-centred care. The first thought should not be: they might use it against me. It should be: It might help the patient to understand me better so we can come to a more collaborative treatment.

Why not record the conversation and let both parties have a copy for their records? This safeguards against patient editing the recordings and making false claims.

I hate to say this but could this be an example of the difference between the focus of medical education and nursing education? Between the Medical Model and the Holistic Model? Just throwing it out there....

P.S. Legally, patients are allowed to record their consultations. However, if you can not be open about it to your doctor and need to do it on the sly, you may want to reconsider your relationship with your doctor...

2 comments:

Julie said...

A couple of good sporting results this weekend. Rejoice!

Julie said...

*grin*

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