Patients recording consultations: anxiety still seems to rule

Ever since our Minister of Health, Welfare and Sport published a letter to the House of Representatives in which she encourages patients to record their consultations, there has been a lot of discussion on this topic.

Stefanie van den Bosch

Trainee Oral- & Maxillofacial Surgery and REshape Fellow

Ever since our Minister of Health, Welfare and Sport published a letter to the House of Representatives in which she encourages patients to record their consultations, there has been a lot of discussion on this topic.1

Healthcare professionals seem to be reluctant in this matter and express their worries. “Will patients share these recordings on social media and what happens next with this information?”, “I do not feel comfortable with recording everything that is said in my consultation room.”, Patients could sue me using these recordings.” Just some expressions of worry and anxiety that one could hear in discussing this matter. Unnecessary fear and mistrust in my opinion.

Giving patients online access to their medical record didn’t lead to sharing delicate information such as lab results on social media. There are however patients who share their radiographs online in blogs in which they share their experience in health(care). One can question whether this is a good thing to do, and whether our opinion on this issue is relevant if a patient feels the need to do so.   Of course we can advise patients not to share a recording online, since it concerns medical information and what is said may not be applicable to other patients with the same condition.2

The fear that as doctors we have to be careful with every word we say in a consultation, seems odd to me. Is it not part of being a professional that we choose our words carefully all the time? And why would a patient misuse these data? In my opinion the relationship that I have with my patients is based on mutual trust. Patients do not solely have to trust me to be able to treat them well, I have to trust them as well. Functioning as equal partners in their health(care) process demands mutual trust. One might find this naive, it is common sense to me.

“Functioning as equal partners in their health(care) process demands mutual trust.”

Furthermore, I see a similarity with the fear that arose when email and online patient communities were introduced. Patients could contact us 24/7, we would potentially be overloaded with questions and messages of patients and have a lot more work to do. This never happened. Long running online patient communities show that patients do use it, they do send us questions, the amount though is not overwhelming.3

Research in oncological care shows that recordings of initial oncology consultation can reduce anxiety during consultation, enhance recall of information, improve decision making and satisfaction with this decision and improve communication with family members.4 This, combined with the fact that patients are able to recall a maximum of 8 minutes of medical information and they remember only 25% of the information that is presented, shows the great potential benefit of recording consultations.5 Other forms of communication to provide and support information should not be forgotten. Although written information is often too difficult, there are studies that suggest that written information can improve patients compliance to post-operative instructions.6,7 Furthermore, visual communication aids can improve remembering medical information.8

Although recording consultations still isn’t common practice, supporting our spoken information with visual communication aids is. A lot of doctors already support their information by making drawings and showing pictures. In our hospital the use of 3D-imaging, 3D surgical planning and 3D printing to support consultation and decision making is daily practice.

Considering the literature, it almost seems malpractice not to record consultation. Naturally medicolegal aspects are important and there are organisational issues to overcome. Hack et al have identified 8 of these fundamental components for implementation of consultation recordings which may help us.4 Data management, involving key figures in care (such as site leaders and chief nurses) and identifying responsible persons are some of the essential organisational fundaments.

Either way, practising defensive medicine and letting fear rule is not what we should do. Improving health(care) every day, making it better than the day before is what we should do. When recording a consultation can help in this, we should just do it.

Sources

  1. Kamerbrief minister Schippers, Juridische status geluidsopname gesprek met arts, 10 maart 2016
  2. Van de Belt T. Opnamen in de behandelkamer: stand van zaken ICT&Health nr.3 Juli 2016
  3. Aarts JWM et al, Lessons learned from the implementation of an online infertility community into an IVF clinic’s daily practice. Human Fertility, 2015; 18(4): 238-247
  4. Hack TF et al. Promoting consultation recording practice in oncology: identification of critical implementation factors and determination of patient benefit. 2013 Jun;22(6):1273-82
  5. McGuire LC et al. Remembering what the doctor said: organization and older aldults’ memory for medical information. Exp Aging Res 1996;22:403-28
  6. Walsh TM et al. Readability assessment of Internet-based consumer health information. Respir Care 2008;53:1310–5.
  7. Blinder D et al. Patient compliance to instructions after oral surgical procedures. Int J Oral Maxillofac Surg. 2001 Jun;30(3):216-9.
  8. Kessels RPC et al. Patients’ memory for medical information. R Soc Med. 2003 May; 96(5): 219–222.