INTRODUCTION
Recording clinical encounters between a patient and a physician is an idea that has received a lot of attention recently. Arguments in favor focus on the benefits that patients report,1 yet there is no consensus on how such recordings should be managed, with most healthcare institutions having no policy on it.2 A cross-sectional survey in the USA showed that 50% of physicians and 66% of the public were interested in recording, while 28% of physicians and 19% of the public were already recording clinical encounters.2 The main patient motivation for recording was reported as a means to enhance recall and understanding of information imparted during visits.2, 3 Unfortunately, while anecdotal reactions of healthcare professionals are typically one of hesitation, little is empirically known about the attitudes of physicians towards recordings. To address this topic, we conducted a survey among physicians working at Staten Island University Hospital in New York City.
METHOD
A 20-item questionnaire was piloted with 30 internal medicine residents in Staten Island University Hospital (SIUH), who were subsequently excluded from participation. The finalized questionnaire was distributed by email to 470 physicians at SIUH and affiliated practices via REDCap, an online survey platform. Three email reminders were sent between March and June 2018. Descriptive statistical analyses were performed on fully completed surveys using SAS software. The Northwell Institutional Review Board considered the study to be exempt.
RESULTS
A total of 134 of 470 potential respondents opened the survey, and 116 (25%) completed it. Most of the 116 respondents were male (57%), educated in the USA (57%), and had graduated between 2011 and 18 (48%). General medicine was the most commonly practiced specialty (see Table 1).
Table 1.
Respondent Characteristics (N= 116)
| n (%) | |
|---|---|
| Gender |
Male, 66 (57) Female, 50 (43) |
| Age |
25–29, 26 (22) 30–34, 32 (28) 35–39, 12 (10) |
| Medical education |
USA, 66 (57) Middle East, 18 (16) Caribbean, 6 (5) |
| Year of graduation |
2007–2010, 10 (9) 2011–2014, 41 (35) 2015–2018, 15 (13) |
| Specialty |
Medicine (general), 19 (16) Medicine (oncology), 12 (10) Medicine (sub-specialty), 13 (11) Surgery (general), 6 (5) Surgery (sub-specialty), 10 (9) Psychiatry, 8 (7) |
Of the 116 respondents, 58 (50%) did not wish to allow recordings and 26 (22%) were neutral, (see Fig. 1). The most common concerns were fear that patients might have undeclared motives, such as a wish to use the recording for litigation, and concerns that recordings could be used inappropriately, for example, placed online. Of the 84 respondents who initially did not wish to allow recording or were neutral, 25% said they might agree to record only a part of the visit, provided they could control the process. Overall, 30 (26%) of the 116 respondents were not willing to allow recordings under any circumstances.
Figure 1.
Number of physicians that agreed or disagreed to record the clinical encounter (N= 116).
Thirty-three (28%) physicians reported that patients had at some point asked them for permission to record, and around half (58%) of them had agreed to the recording. Moreover, 34 (29%) physicians were fairly certain while 14 (12%) suspected that a patient had secretly recorded a visit without their permission. One hundred three (89%) of 116 physicians admitted to having no knowledge of the laws governing patient-initiated recordings in their state.
Of the 32 (28%) respondents who agreed to allow patients to record, most considered it to be of benefit to the patient or their family. Twenty-three (20%) respondents thought that having a patient recording might even be an advantage to them in the event of a legal challenge to their practice.
DISCUSSION
In this survey of 116 physicians, half were opposed to the idea of recording clinical encounters. Although some physicians acknowledge that patients will likely benefit by listening to recordings, the overall reaction is one of hesitancy, borne out of defensiveness and concerns that the recordings would be disseminated inappropriately.
Nevertheless, despite these hesitant attitudes, clinicians, and their organizations, will likely face increasing requests from patients to record in the future.4 Healthcare organizations might wish to develop training programs or policies that reflect the increasing demands for transparency in clinical interactions, acknowledging that the laws of many US states allow patients to record their interactions should they wish to do so.5
This single-center survey of physicians is not without its limitations. The physician population surveyed is not representative of the national physician workforce. That 75% of the potential sample did not respond to the survey may have skewed the results. It is therefore possible the data might indicate more willingness to recording than is the actual case.
Compliance with Ethical Standards
Conflict of Interest
Dr. Glyn Elwyn has disclosures outside the work submitted (see separate form). Other authors have no conflict of interest to disclose.
Footnotes
Prior Presentations
None
Publisher’s Note
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References
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