The effect I would have to warn them about is that I would likely be far more conservative in my statements, use more hedge words and phrases, and spend more time issuing caveats. It is impossible to be ‘watched’ by all future potential listeners of the tape and not both consciously and unconsciously alter one’s communication. Ordinary contact with a patient is a closed session, during which my attempts to elicit history, express concerns, and describe plans for them is done with an audience of one in mind. As I speak I read my patient’s expressions and non-verbal cues as part of the feedback for our conversation. If I am on tape, I will be aware that other audience members will not have the ability of understanding the conversation only from this patient’s perspective; it will be colored by their own interpretations. I would probably be more likely to reccomend tests and procedures so that the burden of rejecting by the patient them would be captured on tape. As does occur during depostion, I would find myself carefully speaking to an undefined audience, rather than the audience immediatly before me. Again, this would not be my conscious plan, but I am guessing at how such observances might alter my behavior and judgements.

There are some exceptions, though. If the patient was alleging someone had done them an injury and was fishing for statements from me to use at some future time as evidence, then I would object and possibly refer the patient elsewhere. There are appropriate forums for this kind of conveyance of information, especially when litigation is expected, and the encounter of an office visit is not the best choice. If the patient wants an affadavit or deposition, that ought to take place after the clinical encounter is concluded and once I have had the opportunity to consider all the information I have obtained. If the patient doesn’t like that approach, they can always go elsewhere.

I also think that taping is highly inappropriate in any environment where privacy of other patients can be compromised; that means ERs, OR waiting areas, office waiting rooms, ICU waiting areas and any open evaluation and treatment areas where other patients are being seen or can be overheard at the same time.