“Smile (or not). You’re on candid camera!” Patients’ covertly recording care

“What might happen if patients were to use digital devices such as smartphones to covertly record clinical encounters? Increasing reports of the practice of patient’s covertly recording clinical encounters suggest that these are no longer hypothetical questions.”(Tsulukidze et al, 2015).iphone camera2

Researchers in 2015 search Google & Google blog search engines to find written texts (excluding audio & video recordings) that were about patient covert recording of clinical encounters. They analyzed 62 texts from patients, clinicians, advocates, dentists, insurers, and lawyers. Four(4) themes emerged that represented the groups’ reactions.

  1. Such recording is a new behavior eliciting strong positive and negative reactions.  Comment –
    • e.g., “accept the prospect of covert recording as a product of the digital age and ensure that it does not work against you [clinicians]” (Contributor 3, editor, T40)
  2. Covert recording shows a lack of patient trust in providers or the system 
    • e.g.,…ALWAYS record EVERYTHING. These people [physicians] can lie, cheat and steal and act immorallyand do so regularly. (Contributor 13, T36)
  3. Through recording patients were asserting new control over and ownership of the clinical encounters.
    • e.g., When a patient seeks a consultation […], the information being processed is almost exclusively relating to the patient. Under the Data Protection Act, that data is therefore personal to the patient. By recording it, that patient is merely viewed as processing their own data. (Contributor 15, dental adviser, T42)
  4. Responses were confused & conflicting, with patients & providers seeking legal and ethical counsel about the recordings.
    • e.g., Would any of the practicing physicians here remove a patient from their care if you found out your patient was secretly recording you? (Contributor 22, physician, T30)   (Tsulukidze et al)

lightbuld among rocksCOMMENTARY: As with all qualitative studies, the value is on getting new, in-depth information on something that we know very little about, and their sample represented diverse perspectives.  A weakness is that the researchers used existing documents so that researchers couldn’t explore further and were limited to what these particular individuals chose to put out on a public site. Because RNs were not included, a parallel study of covert recording of RNs would be valuable.  RN-patient encounters are necessarily different from physician-patient encounters, and RNs have been rated by the public as the most trusted profession year after year in Gallup polls. I am unaware if anyone  knows the who, what, when, where, why, and how of covert recording of RNs.  Nonetheless, RNs should examine whether they would be comfortable with being recorded because we know that privacy standards, patient empowerment, and the proliferation of recording devices have changed.

CRITICAL THINKINGImagine that your most recent patient encounter had been recorded.  Clinically would you have done anything differently?  Ethically do you consider this right and good or wrong and bad?  Why?  Legally does your facility have and enforce policies/standards related to patients’ recording?   Whom in your facility would you go to for advice if you learned this was happening?  What are related patient privacy issues?  Should we fight against patients’ recording or assume that it will happen and find ways to make it work in provider/facility interests?  How would we do that?question

FOR MORE INFO: The FREE  full text is available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416897/   Tsulukidze, et al., (2015,  May 1).Patients Covertly Recording Clinical Encounters: Threat or Opportunity? A Qualitative Analysis of Online Texts. PLoS One. 2015; 10(5): e0125824.

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