How you respond in this type of situation is dependent upon patient needs, your existing relationship, your comfort level with being recorded, and any other relevant circumstances. Once you have examined the factors in a given scenario, the next step is to plan your approach. Each scenario and circumstance requires careful consideration and perhaps a different approach.
Patient Needs
It is important to take into consideration the patient’s level of independence, healthcare literacy, culture, English proficiency, as well as any disabilities the patient may have. Audio recording may be the optimal mode of communication for some patients by helping to improve patient adherence to treatment plans and self-management and serving as a future reference to instructions or education, thereby improving a patient’s health outcomes. Providers may also benefit since recording provides a memorialization of what was actually said, thereby preventing miscommunication.
Consider the example of an elderly patient who lives alone, with whom you have a long standing and trusting relationship and asks if she may audiotape her visit so that she can better remember your care instructions and adequately relay her clinical condition to her son and daughter. Presuming that you are comfortable with being audio recorded, this type of situation is an opportunity for you to engage your patient and her family in a partnership of care that may improve self-management of her health condition and foster greater patient satisfaction with very little extra time spent on your part.
However, despite this potential benefit of recordings, there are also risks, the degree of which is impacted by some of the following factors.
Existing Relationship and Other Relevant Circumstances
Is the existing relationship between you and your patient one of mutual respect, as in the example above, or one of distrust, as might exist following an unanticipated outcome – either with or without medical error?
Certain circumstances, such as the disclosure of medical errors - whether yours or that of another practitioner - require careful, thoughtful deliberation. These sensitive situations require honesty and diplomacy on your part; however, recordings should not be permitted without the express consent of an attorney acting on your behalf.*
Your Comfort Level
It is important to examine your own comfort level with being tape-recorded. Not everyone is comfortable with public speaking or with being tape-recorded. Do you experience dry mouth, quivering voice, sweating, or increased heart rate? Do you forget what you had planned to say? If you are uncomfortable, it is not recommended that you agree to recording since your discomfort may have a negative impact on what is actually said and how the recording sounds to the listener.
Your Approach
After examining all of the factors, you may want to consider the following approaches:
1. If the factors are not ideal and you have the opportunity (e.g. no emergent patient need, an inflammatory scenario, a mistrusting relationship, or an unanticipated outcome), contact the Princeton Insurance Risk Resource Line at 1-866-Rx-4-Risk (866-794-7475) prior to agreeing to any recording. It is a good idea to have a plan of action in place in the event you are suddenly confronted with this type of situation and do not have time to contact Princeton Insurance. If you are not comfortable with the request, by all means, share your thoughts with the patient, such as:
Ø “I appreciate my relationship with my patients and I want to be comfortable with our interactions with a degree of candor,” or
Ø “In general, I am not comfortable speaking into a recorder of any type in any situation. I do not want my anxiety to hinder effective communication with you.”
2. If all of the factors are ideal (e.g. based on patient need, your relationship, “benign” circumstances, and you are comfortable), consider methods to coordinate and facilitate the situation so that you have control of what is recorded, and when.
For example, in the aforementioned example, you might consider first focusing on the history and physical, a discussion of the findings and agreed upon plan, and then a summary of the visit. An advantage to this approach is that you have control over what is recorded as opposed to a free flow dialogue which may be damaging to your defense should a claim ever arise in the future.
3. Offer to provide a written summary of relevant points as opposed to a tape recording.
4. Implement a standard format for instructional and educational material.
5. Utilize a standard patient summary form that provides an overview of the interaction, including a review of discussion, diagnosis, implications, required follow-up, self-management, instructions and/or education, and medications. An electronic medical record system may be helpful here, or if paper-based, an example of one such form is the “Office Visit Follow-up Instructions” form found in our Physician Office Practice Toolkit.
6. If you decide to allow the recording, it is advisable that you retain an original copy the tape. Be prepared for these scenarios by having your own tape recorder available. Properly label the tape with the patient’s name, ID, and date of recording, and store tapes in a fire-safe container. To avoid the temptation of recording over used tapes, be sure to have an adequate supply of blank tapes on-hand.
Advance Planning
Anticipation and preparation are important to your ability in maintaining control should this situation arise in your practice. Identify, in advance, the ideal and not so ideal factors and plan what your approach might be. Remember to consider when preparing for such situations the particular patient needs, your existing relationship, other relevant circumstances, and your own comfort level. For example, think about the type of patients you have seen in your practice that made you uncomfortable and the most effective method of managing interactions with these patients in the future.
Different scenarios and circumstances require careful consideration and different approaches. It is important to remember that some scenarios and circumstances, such as unanticipated outcomes with or without error, may require collaboration with Princeton Insurance representatives and/or legal counsel. In any setting other than your own office, such as the hospital, patient or family requests such as this should be first discussed with the facility’s risk manager. It is recommended that you become familiar with the policies and procedures of the facility so you are prepared for future situations.
Recognizing the importance of quality provider-patient communications (deficits in communication patterns with patients are allegations appearing with regularity in malpractice claims); Princeton now provides training in provider-patient communication. For more information about the courses, contact the Risk Resource Line at 1-866-Rx-4-Risk (866-794-7475), or see article on Communication Courses in this issue.
* For guidance with disclosing unanticipated events, call the Princeton Insurance Risk Resource Line at 866-RX 4 Risk (866-794-7475) to speak with a Risk Services Consultant.