By hitting the 'record' button, patients may make their physicians squirm

My dad had a health scare recently, and at a doctor's appointment to receive some important test results, my mom wanted to record audio of the visit on her smartphone.

“If he had gotten some terrible diagnosis, I wanted to be able to share that discussion with you and your sister,” Mom told me later.

But when she asked if it was OK to record, the doctor replied, “No. I don't want you to do that.”

Mom was shocked, and she felt the relationship instantly change.

“The doctor kept looking at my phone the whole time, like she was worried,” she said. My parents felt concerned, too. “To me, it's a line in the sand — is this doctor willing to work with me or not?” Mom said. “Why should I put my trust in them if they're not going to trust me?” She wasn't recording to be litigious, but to understand and review what was said.

The question of when or whether patients should record physician visits has become a highly contentious issue in medicine.

“Doctors are very angry about this,” says Glyn Elwyn, a physician and scientist at the Dartmouth Center for Health Care Delivery Science who has written about the issue for the journal BMJ. “Their first reaction — and it's ill-considered — is to be defensive or worried that it could be used against them in some way.”

Ali Seifi, a neuro-critical care physician at the University of Texas Health Science Center in San Antonio, wrote about secret patient recordings in the Journal of the American Medical Association. After his piece appeared, Seifi heard from doctors who said that they become more risk-averse and less frank when they see that a patient is taping a conversation.

“Physicians take it as ‘This patient might file a lawsuit later,' so they try not to be open to any complaints,” Seifi says.

Recording raises issues of trust for doctors as well as patients, especially if it's done surreptitiously. Seifi's interest in this issue began when he noticed a patient secretly recording their conversation. The message was clear, he says: “The patient doesn't trust me.”

Perhaps that's true.

On the other hand, Elwyn says, his research has shown that doctors who agree to go on the record with advice can boost their patients' trust and strengthen their relationship. It takes confidence to grant permission, though. Even experienced, competent doctors may worry about subjecting their advice to extra scrutiny.

“Humans are fallible, and it's very difficult for doctors to stay on top of everything,” Elwyn says. A doctor who misses the latest evidence or neglects to disclose a particular risk or side effect may be called out later by a dissatisfied patient. When patients record, doctors may feel an added pressure to stay up-to-date and to give extra care and attention to what they're saying. “That's not argument for not doing it — it just means that doctors have to be on their game,” Elwyn says.

Despite doctors' hesitation, Elwyn says his experience has found that recording has important benefits for patients. Retaining all the information conveyed during a visit can be difficult — especially if the patient's medical condition is complex — and patients and their families value an audible record, Elwyn says, because it allows them to share and reflect on what has been said.

Given these benefits, it's not surprising that some patients are covertly recording, as Elwyn describes in a study published recently in the journal PLOS One.

My parents are sharp of mind, but sometimes they come away from a visit with different interpretations of what the doctor said, and reviewing the conversation would help them clarify what went on. Sometimes the patient relies on others for day-to-day help, and these caregivers may want to review a doctor visit, too.

Seifi generally grants his patients and their families permission to record, but he says that intent is important. “Are they doing it to help the family or to give them material for a lawsuit?”

Doctors worry about a recording that gets shared with a wider audience or goes viral on the Internet. “It's a legitimate concern: What happens to the recording after the visit?” Elwyn says. “This is virgin territory.”

The Health Insurance Portability and Accountability Act grants privacy protection to patient records, but Seifi says that once a recording is made, it may be hard to ensure that it remains private. Many of his patients are hospitalized with serious brain injuries. If the sibling of a patient in a coma posts a recording of the doctor's discussion with the family on social media, the patient's privacy may be violated or the doctor's comments might be misrepresented.

“What's lacking here is a policy that says we encourage you to record, but please take good care of this record — we don't want it to appear on the Internet or social media,” Elwyn says. Such policies may be coming, but for now there are few rules in place.

For my parents, the issue remains a matter of trust. Although they're planning to return to the do-not-record doctor for another set of test results, they have decided to take their business elsewhere over the long term.