When patients secretly record their doctor visits

“Doctor, can I record this conversation?”

It’s happened to me a couple of times already. But the question above was never asked. Rather I was informed later on that my conversation with a patient or family was recorded without my knowledge. Smartphones have made it all too easy for patients to secretly record conversations with their health care providers. Simply hit a button,  lay it innocently down by your side in the office or hospital, and patients get an instant video or audio capture of a conversation with their physician.  When my medical team and fellow physicians found out about the unauthorized recording of our conversation, the news was met with a combination and anger and disgust.

That reaction, it seems,  is typical of what most physicians would feel in the same situation. Why would a physician be upset about a patient secretly recording a conversation with them?

Well, simple, really. Most physicians are in chronic fear that the next person to hear or view that recording will be a malpractice lawyer, dissecting it,  consonant by consonant,  probing for potentially actionable material. The recording, in the physicians mind, changes the nature of the physician-patient relationship. It makes the patient a potential adversary, it makes the doctor feel as if they are in front of a jury and can not speak frankly, it makes them feel as if they are unworthy of trust. In other words, physicians do not like being recorded because they assume that the person recording them has negative motivations.

But let’s pause for a moment and look at this a different way: What if they don’t have negative motivations?

What if it’s the 74-year-old husband, who I counselled extensively about how to help keep his COPD at bay? And the next time when he came in with his wife she tells me, “He said you didn’t tell him anything!”

What if it’s the woman, whom at every visit, can’t seem to remember which medication I told her to stop and which one to start? And how about the concerned adult children who couldn’t make it to their parent’s appointment and want to talk to me about how their parent is doing?  Might those people benefit from the ability to record a discussion with the physician?

That that end, Cullman Regional Medical Center instituted a plan that created audio recordings of the instructions that patients received at the time of discharge from the hospital. The audio was a verbatim recording of what the patient was told as part of their discharge, which was administered by a nurse or case manager.  The recordings were uploaded to a cloud, where they could be accessed by calling in, or via the Web. The hope was that the recording could help clarify any confusion that the patient or their families may have about the numerous questions that often arise after leaving a medical facility. They called the program, appropriately enough, “Good To Go.”  The program turned out to be a great success, not only did it improve patient satisfaction scores but surprisingly reduced 30-day readmissions by 15%.

So to my patients who feel the need to secretly make recordings of our conversation, please feel free the ask the question, “May I record this conversation?” You’ll find the answer is often “Yes, please do!”

Deep Ramachandran is a pulmonary and critical care physician, and social media co-editor for the journal CHEST. He blogs at CaduceusBlog and ACCP Thought Leaders, and can be reached on Twitter @Caduceusblogger

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  • DoubtfulGuest

    I believe it’s wrong for anyone to record a conversation without permission.

    But this: “It makes the patient a potential adversary…”

    ROFL…Since when do you all not see us that way already? How is that new? :/

  • Lisa

    I can see why patients would want to record a doctor visits, although I do believe it shouldn’t be done without permission. Recording is easier than taking notes. I’ve taken notes during critical appointments, then later wondered what piece of information I left out.

    Perhaps doctors could turn recordings of visits into a service and record the visit for a fee.

  • FEDUP MD

    I don’t have a problem being recorded. In fact, not long ago, a family recorded a brain death exam I did. Most times I give the option to leave if they want but some really want to stay and these people did, and wanted to prove to relatives in another country that the patient was indeed unresponsive and that the family had done the right thing by agreeing to organ donation. Perfectly reasonable. But if they had done this without my knowledge I would have felt this was a grave breach in the trust in our relationship.

  • SteveCaley

    I think it’s a bit “not-cricket” on the patient’s part, but effectually harmless. If the patient’s baiting you into a trap during the conversation, that’s worth watching for; but if you generally endorse ‘memory aids’ for a patient, and encourage them to be used openly, I’d imagine that would be a big benefit on the physician’s side if there was surreptitious recording. The patient would have to explain why the recording was done surreptitiously, for it to have much presence, I’d expect.
    Any patient who wants to catch me sounding like a fool, better talk to my wife. The novelty wears off after a while. If I don’t remember what an inspissated incunabulus is, I’ll have to deal with it.

  • FEDUP MD

    I am presuming that you can see the other person, and hence know they are there, and can ask them to leave. The equivalent to getting recorded without consent would be, say, them watching you with your doctor behind a two way mirror without your knowledge. You always have the right to boot someone from the exam room. Always.

  • medicontheedge

    As long as BOTH parties agree. Clandestine recording is sneaky and aggressive, and actually ILLEGAL in some states.

  • T H

    Why fear recordings if you are already giving the patient and family your best effort?

    That being said, California law is a “two-consent” state. You and anyone else in the conversation must give explicit permission to record…. but you CAN record things – they just can’t be used in court

    Press? Medical Boards? Parents? Wife?

    As ever, best effort with honesty and openness = best policy.

  • FEDUP MD

    I am not sure where you are getting the “assistant” from- no doctor I ever trained with, or visiting myself, ever used anything but the name for whatever the person was- if they were a student, a student, for example. As far as chaperoning, I only have ever run into this at the GYN, and it usually is the nurse who checked me in who chaperones. This is generally written in the fine print at most practices to protect both patients and staff during very intimate visits. In some cases, assistance may very well be required- I can tell you from experience that pap smears I can do much faster if I can hand someone the equipment, which reduces the time I am in there, which I can tell you from personal experience is preferable. I have not run into the scribe situation yet.

    • DoubtfulGuest

      FEDUP MD, I generally agree with you and I welcome medical trainees at all levels in my care. How do chaperones protect the patient, though? I’m not the first person to raise that concern on this blog. Yes, doctors have the right to protect themselves, but some people just feel weird with an audience. I wish doctors would at least acknowledge there’s often a tradeoff between their feeling of safety and the patient’s.

      I’ve had good chaperones, who greeted me like a human being, showed concern for how I was feeling, and generally created the appearance of being there in case either me or the doctor needed anything. I’ve also had more than one instance, in which the chaperone (yes, usually a nurse) marched stiffly into the room with the doctor, with no greeting, then stood stiffly against the wall like a sentry the whole time. Probably they were just uncomfortable on a personal level, but it really felt like a shameful thing, as though I was being accused of doing something to the doctor that I hadn’t done. To circle back to the post topic, I agree with you on recordings, but I share Ed’s feeling that patients can be observed in a non-helpful, non-consensual way as well.

      • FEDUP MD

        Chaperones protect the patient by the assurance that someone is watching the exam and ensuring they are not being assaulted. It is rare but it does happen, sadly.

        • DoubtfulGuest

          I agree with Ed on this one…if the person watching is an employee of the doctor, I’m not sure how it provides that assurance for the patient. For some patients, depending on their past experiences, having two or more people present could be frightening. I’ve never felt that a doctor was even attempting to be inappropriate. I’d prefer to be able to trust the doctor and I feel weird that it’s implied I shouldn’t.

          What would be wrong with acknowledging that chaperones are mainly to protect the doctor, because of a few deeply disturbed patients out there? If people knew the bad stuff that some folks do to doctors, they might be more understanding. Not just accusations but also what amounts to workplace harassment or even assault of the doctor. That would make more sense than the “protecting patients” argument.

  • FEDUP MD

    To continue, it seems like a straw man argument because I have never seen it, nor have I encountered it as a patient, not have I ever done it. But there certainly are situations where assistance is required to properly do a job, particularly a procedure, or to protect patients and staff.

  • rbthe4th2

    I for one praised a doctor I had who looked something up in front of me. I said it means that looking for an answer to make sure they were doing right by the patient meant a lot. I want them to be human. Its the ones I’ve had that weren’t human that really made things a mess.

  • Robert177

    I have a brain injury which has destroyed much of my short-term memory. Because of this, I cannot remember most of what any doctor tells me during an office visit. Many times I have asked the doctor if I could record the visit, for later reference, and in every case they have said OK.

  • Lisa

    I was being snakry when I said that perhaps doctors could turn recordings of visits into a service and charge a fee.

    I do think you should ask permission or tell someone you are going to make a recording. It may be legal to secretly record a conversation in Arizona, but just because something is legal does not mean I feel comfortable with it.

  • medicontheedge

    It is ILLEGAL in many places… and explain how SECRETLY recording someone is going to help in anyone’s medical care. These tactics are used as “gotcha’s”, nothing more. By aggrieved people to further their own NON medical issues.