Would you allow patients to record their visits if they ask you?

[slappy]

A recent discussion at a different forum got me thinking.

Would you allow patients to record your interaction with them?

I have segmented the poll answers to allow for various considerations.

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[FlowRate]

Trying to imagine myself experienced enough to make this decision on my own and not appeal to supervisors and institutional policy: Depends on my relationship with the patient and, if a psychotherapy patient, I'd explore why they wanted to record first. So most likely yes for psychopharm, maybe yes for psychotherapy.

It'll be interesting to see what I think when I'm actually experienced enough to know what I'd do independently and what experienced folks on this forum think.

 

[wolfvgang22]

It depends in the purpose of the recording. For training, or to help a patient remember key points, sure. It is polite if they ask.
I catch patients surreptitiously recording appointments on their smart phone from time to time. Sometimes I call it out immediately, sometimes I wait and observe before I decide what to do.

 

[splik]

As a resident I absolutely allowed my patients to record sessions (this was particularly the case for psychotherapy). It is great for patients to be able to listen to the sessions as homework, and for my patient population nice for them to have the sessions to remember what we talked about. I am highly selective about who I will see as a patient so you already have to go through multiple screenings in order to get to see me anyway (so basically I dont have any patients right now lol).

Of note, I've only practiced in states where people cannot record you without consent, but the majority of states and federal laws allow physicians to be recorded by patients without their knowledge/consent.

One caveat, if my patients are recording the sessions, then I'm gonna make my own recording (stored in a HIPAA compliant way of course) too.

You should assume you're being secretly recorded anyway (hell, the government is secretly recording us), but if a patient surreptitiously records without informing me of their intent then that is a different thing altogether (and is in fact a criminal act to do so where I am). If there is no trust, then there can be no therapist-patient relationship. You should also familiarize yourself with your state laws, institutional policies, and come up with your own personal policies about this. You might be more concerned about the recordings will be used in states with one party consent laws (i.e. that people are allowed to record conversations they are privy to without the consent of all parties), whereas if you're in a two-party consent law like me, unauthorized recordings can't be used in lawsuits etc

 

[birchswing]

I asked once when I had a psychiatrist with a really heavy accent and I was feeling like my memory was failing me. He wouldn't allow it because he said in his words that listening back to it I might hear it out of context and not understand what he was conveying. Didn't really make sense because me leaving not understanding him was the reason I wanted to record to begin with. I can see it scaring people since you don't have much control over it once it's been recorded. If both parties record, then it seems like there's little room for worry, though.

 

[Crayola227]

I think it's really meaningful to watch the episode of the BBC tv show "Black Mirror," that deals with the idea of people having an implant that allows them to record everything they see or hear for later playback, and explores what the benefits as well as fallout might be.

I think the episodes might be of particular interest to psychiatrists, and in our current society and tech is quite timely.

Human memory is imperfect - and going by some other animals, it could have evolved to be better than it is. But it didn't.

Cue song lyric, "memories fade, cuz they're designed that way."

The interaction between patient and physician is a moment in time - and I would worry that some uses of technology might interfere with that interaction and that moment in a way that would do more to degrade the value, change the meaning, rather than to preserve it.

I think there's value to remembering things imperfectly.

I would prefer to keep things organic - the medical record as typed or dictated by me, notes I might type or handwrite for the patient, a notebook the patient has, a voicemail I leave for them.

I would probably explain to a patient about recording, that "you can't point a camera at someone and then say, "Act natural!" and expect that to happen. We both need to be able to act naturally and uninhibited here."

My 2 cents anyway.

 

[WisNeuro]

Only if it's part of the protocol (e.g., PE) for me. And that's usually just the exposure part, not the post-processing.

 

[Salpingo]

A recent discussion at a different forum got me thinking.

Would you allow patients to record your interaction with them?

I have segmented the poll answers to allow for various considerations.

I don't think its useful to have hard-and-fast rules, but its definitely a great opportunity to understand the patient. Personally, this has only come up when performing consults and that patients were paranoid about medical professionals. In those cases, there are typically issues with the power dynamic, and a way for the patient to wrest back control over consults that were "forced" on them. The power struggle typically resolves when they realize I'm not there to push any meds or "lock them up." Of course, thats mostly characterologic paranoia. I may have been recorded unknowingly by some psychotic patients.

This hasn't happened to me in the outpatient setting, yet, although I've had patients bring in notes to write stuff down. If its early in dynamic therapy, I'd probably allow it, but try to explore the patient's need to carry therapy with them between sessions. If its later in therapy, I'd be a little more apprehensive, wondering if patient was concerned about termination or "holding onto" me. At that point, our relationship should be normalized to some extent, and it would be odd to record therapy in the same way it would be odd to record a date or job interview or meeting. In cognitive therapy, I'll often write out mantras for the patient to have on hand, but I'm not sure if thats the equivalent of being recorded. If it came up in medication visits, I would probably offer to write out information for patient to hold onto.

My guess is that the biggest concern for providers is that they would lose control. I'm sure I'd be terrified of having my likeness or voice on YouTube, or passed around to people I haven't met and don't have a therapeutic relationship with.

 

[wolfvgang22]

Good point. I'm this particular patients doctor, not all of YouTube or Facebook's doctor. I'm not here for public critique by people who weren't even there and don't have all the information and who have never met me.

 

[NickNaylor]

The prospect makes me uncomfortable, but I can’t really point to a specific reason why. Ultimately, if someone wanted to record the appointment I’d be curious to know why, but unless I thought something potentially problematic was going on I probably wouldn’t throw a fit.

 

[HarryMTieboutMD]

I would definitely NOT want patients recording their appointments with me, but as Splik said in most states it is legal even without the physician's permission.

The government at all levels is strongly anti-doctor most legislative bodies are filled with/paid for by trial lawyers and the doctors who do get elected are typically republican surgeons (or in the case of Bill Cassidy a GI doctor- but close enough) who don't give a $hit about this kind of thing

 

[Liquid8]

I wouldn't be comfortable with it. When one starts therapy, you really need to establish the frame: i.e. the ground rules about the environment and relationship that enables a patient to be frank and open with the therapist.

For me, allowing a recording blurs the boundaries. For a start, it would make me anxious, because I would feel that they might have an agenda, ulterior motive or lack of trust which would impact the therapeutic relationship. I’d also be concerned about the impact on the patient themselves. Often subjects raised in therapy can be highly distressing for the patient, and while this is appropriate in the room as there is someone there to contain things it’s not necessarily the case outside the clinic. Then there's obvious privacy issues - if someone else listens to the recordings there could be all sorts of unintended consequences.

 

[NickNaylor]

I wouldn't be comfortable with it. When one starts therapy, you really need to establish the frame: i.e. the ground rules about the environment and relationship that enables a patient to be frank and open with the therapist.

For me, allowing a recording blurs the boundaries. For a start, it would make me anxious, because I would feel that they might have an agenda, ulterior motive or lack of trust which would impact the therapeutic relationship. I’d also be concerned about the impact on the patient themselves. Often subjects raised in therapy can be highly distressing for the patient, and while this is appropriate in the room as there is someone there to contain things it’s not necessarily the case outside the clinic. Then there's obvious privacy issues - if someone else listens to the recordings there could be all sorts of unintended consequences.

I completely agree with respect to the psychotherapeutic setting - that would be a no-go in my mind. For standard medication management visits, though, I see recording as less problematic (but still bizarre in my mind).

 

[TexasPhysician]

Not acceptable in this medicolegal age. Doing so without me knowing would also be grounds for discharge from my clinic.

 

[Bartelby]

Some good thoughts. In the absence of an individualized good reason not to, I would let the patient record. In my mind, it is their session to do with what they wish. If I felt someone's competence to weigh the risks and benefits of protecting the information was impaired (for instance, they are manic and want to post it to a YouTube channel to prove to others that they are Jesus) then that would be a different story.

There are some real pros/cons, though.

Cons:
-They could post it to YouTube, or anywhere else. They could post clips out of context, or even doctor the clips in an unfavorable way.
-In case of an adverse event, those recordings would be admissible in court and might be used selectively to make you look bad.
-There could be psychotherapeutic issues as mentioned above (for instance, the patient "taking you with them" in a somewhat regressive way).
-It could make you anxious or self-conscious, and could thereby impair rapport.
-The patient could accidentally leak it, and even though it's not your fault that might be harmful to them.

Pros:
-It could serve as an aid to memory, because the patient could review content that might have flown over their head the first time. This could be especially important for patients with impairments in memory, attention, verbal abilities, etc.
-It could improve rapport; you are granting them a potentially uncomfortable request.
-Recording might make them feel more comfortable, and more at ease that you have nothing to hide (for instance with a paranoid patient).
-It respects patient autonomy, emphasizing that it is their session and respecting their process (presuming that the patient believes they can get more out of the interaction by reviewing it later)
-In cases of any alleged misconduct, such as sexual misconduct, I would personally prefer if a recording existed that a third party could review. In other words, in some cases a recording could be protective.

You have to know your local laws, and weigh out what feels right for the patient in front of you. I agree with the above posters that surreptitious recording is not okay. The treatment relationship is based on mutual trust, and that would be a real violation of that trust.

 

[Ceke2002]

My guess is that the biggest concern for providers is that they would lose control. I'm sure I'd be terrified of having my likeness or voice on YouTube, or passed around to people I haven't met and don't have a therapeutic relationship with.

As I've seen happen on a patient orientated forum.

 

[Dr. Curious]

I'm curious to learn about the results of this poll. Are you willing to share?