OUR BLOG: A MEDICAL HUMANIST'S NOTES

Why Every Patient Should Be Recording Appointments

July 9, 2013 at 4:22 am · filed under Patient Advocacy, Patients

Like many proactive patients, you might already bring pen and paper to your doctors’ appointments so you can take notes.

But in this post I’m going to make a more radical suggestion: that you record your doctors’ appointments instead.

My reason for suggesting that patients record their appointments is based both on scientific principles and on my medical humanist practice, in which I documented countless patients’ understanding (and misunderstanding!) of their diagnosis and treatment options for the medical record as a means of facilitating communication with their care providers.

Brain scans reveal that people’s immediate reaction to upsetting or threatening news takes place within the primitive limbic lobe of the brain, which guides one’s deepest instincts and emotions. This means that the intense emotions experienced at the moment of hearing bad news tend to overwhelm our capacity to process things logically or intellectually. Maybe this is why patients have so often told me that they have trouble understanding information during appointments. “You hear what the doctor is saying but you don’t comprehend,” as one patient explained it. Another patient, who was working as a nurse at the time of her diagnosis, admitted with reluctance that despite being familiar with medical terms, following her diagnosis she needed “a translator” at her appointments.

Bringing a tape recorder—or simply using the “record” function on many smartphones–allows patients to replay the conversation later and write down their questions and concerns. I’ve witnessed how helpful it is for doctors when patients come prepared with a list of specific questions, which can help communicate exactly what they do and don’t understand, and what sort of information they are prepared to hear.

How have patients responded to my suggestion that they record their visit? “I hadn’t thought of that!” is frequently what I hear.

On the heels of their surprise often comes a fear of how their doctor might react to being recorded. In an email conversation, a patient with whom I had been consulting asked for my advice as to how best to bring this up with her doctor. I suggested she say something along the following lines:

“As I anticipated our visit I was prepared to come with pen and paper but then I could see myself overwhelmed by the information and unable to write down all that I would need to know to make the right decisions for myself. For that reason alone I would like to record our meeting with you so I will have the opportunity to re-visit our conversation—word for word—and identify what questions and concerns my husband and I may have. I think using a recorder will help us communicate more openly.”

Asking to record appointments is a way to signal that you are committed to being an active and informed participant in your own care.  It’s also a good reminder to your doctor that medical terms may represent a foreign language to you.

In my years of fieldwork as a medical humanist, I observed that most doctors welcomed the chance to work with patients who were taking steps to fully understand their diagnosis and treatment options–and recording appointments can be one such step. But I’ll admit, I’m curious about the experiences other doctors and patients have had with this, if any.

Doctors, have you had patients ask to record appointments? What are your feelings about being recorded? Patients, have you either recorded appointments or else had a doctor ask you not to?

I’d be interested to know more about who is doing this and how doctors have been reacting.

To comment on my latest blog post (May 2015) click here – To Record or Not to Record, That Is the Question

10 Comments »

  1. My colleague and collaborator Tom Cole (http://www.uth.tmc.edu/hhhs/faculty/cole.html) directed me to this intriguing post, and in turn, I want to direct you to another of my wonderful collaborators at the Medical Futures Lab (http://www.medicalfutureslab.org/), Bryan Vartabedian, who addresses this issue in a June blog post at 33 Charts: http://33charts.com/2013/06/doctors-on-the-record.html

    Hope this leads to further development of this idea!

    Comment by Kirsten Ostherr — July 11, 2013 @ 1:34 am

  2. Thanks for sharing. I think this is a wonderful idea. I also add that someone should also go along so they can be a third ear – patient, recorder and other.

    Comment by Joseph Moore — July 11, 2013 @ 12:23 pm

  3. recording makes so much sense it should be mandatory…. i bring a pen and paper but it still proves to be an overwhelming experience and most surgeons I’ve seen give off a ” no notes please” vibe..for the most part the whole patient / doctor interaction is depressing,it’s like you should feel lucky they gave you the time and I have seen ” top ” surgeons in NYC….
    but maybe things can change, after a 45 minute session with my therapist I said, ‘ that was a lot, I’ll never remember all that we said , I need notes!”. She then e-mailed a few bullet points that we had discussed!…. really was helpful…..

    Comment by gary b — July 11, 2013 @ 1:50 pm

  4. As a nurse practitioner with extensive experience in gyn and breast oncology, I’ve found this very helpful to patients. It’s true that the people who request it tend to be well-informed and highly engaged in their care, and that the request itself puts the provider on notice to be clear in communication.

    I feel it’s essential that recording only be done with the awareness of the physician/provider,not surreptitiously.

    I appreciate your work!

    Comment by Susan Shinn — July 11, 2013 @ 2:07 pm

  5. Recording appointments is a great idea! Maybe someday we can get it passed as law in certain cases.

    Comment by hal f — July 14, 2013 @ 6:09 pm

  6. This is a great idea, but have to admit my own reluctance at the thought of bringing it up at an office visit. In this age of medical liabilities, proposing to record an office visit gives me pause. Will it be perceived as an affront by medical practitioners, as if I am recording in preparation for some sort of malpractice suit? Maybe this is my own fear, but a concern nonetheless. What do practitioners think?

    Comment by Meg C. — July 28, 2013 @ 11:14 pm

  7. Excellent article, and informative subsequent comments. I take the liberty of comparing comments 4 (a clinician’s perspective) and 6 (a patient’s perspective).

    To be very sure, nobody likes the idea of being recorded surreptitiously in any circumstance: which might lead some clinicians to think of trying to ‘ban’ all recording of consultations. Reciprocally, and most certainly, many patients are wary of a clinician’s potential reaction to a request to take an audio-recording of a consultation: which might lead some to record surreptitiously.

    So, please, clinicians, ‘bridge the gap’ by telling patients that, at entirely their option, they are welcome to take an audio recording of their consultation home, without their needing to give any reason (or sign any ‘waivers’ etc.). It can be done by notice board in clear and friendly language. The result will be confidence on both sides of a recorded consultation, and an opportunity for far better recall of, and compliance with, advice given.

    The arrival of good quality and inexpensive recording facilities in the pockets of so many patients is a fine development on which the science and art of consultation can capitalize, for everybody’s benefit.

    Go on to consider offering a recording to those not so equipped?

    (We have come a long way from:-
    http://blogs.reuters.com/great-debate/2010/03/15/iphone-app-makes-doctors-irate/)

    Comment by no legion — July 29, 2013 @ 11:15 am

  8. It is a surprise to me that people devoted to such a noble goal as to bring more humanity into the doctor-patient relationship, would see the introduction of technology (recording) with all of its baggage, as a desirable step!

    Never mind the litiginous ghost who is present at every doctor-patient interaction, just think yourselves of how you answer a question from a friend or colleague and how you would answer a question from a news reporter on camera. The answer you would give the reporter is stilted, formalized, unnatural and motivated by an intense desire not to say anything that could come back and “bite” you.

    You can’t let compassion and feelings take over and you can’t use the verbiage that the patient would easily understand since a colleague or authority might find it only 98 or 99% accurate.

    If you want strictly accurate, formally stated information without a shred of empathy or attention to your own situation, then go to a downtown specialist or order a deposition. I couldn’t possibly enumerate the number of times that my patients have come to me stating that they didn’t understand anything that was said by the specialist. Occasionally they are so distraught they come in on the way home from the specialist visit. A tape recorder there would not have made anything clearer.

    Nothing works better than bringing an informed, intelligent family member who can listen from outside the patient’s emotional turmoil, take notes and ask questions, but leave the tape recorder at home!

    Comment by Gerald Corcoran, MD — September 2, 2013 @ 9:51 pm

  9. I have also wanted to take a recorder into my appointments. I get my care at the VA hospital in Temple,Tx. I am sad to say that when I asked if I could bring a recorder into my appointment was told by the PCP staff that I would be escorted out of the facility and that could possibly be detained for the local authorities. They stated that I was not allowed to record anything with my Dr.’s while on government property. I do agree that everyone should be able to record their appointments due to the fact that a lot of times what is said to the staff isn’t documented properly. I hope that in the future this will change. I don’t understand that the VA staff is allowed to listen to the Veteran and note what they want but the Veteran doesn’t have a leg to stand on in recourse.

    Comment by Drew — January 24, 2016 @ 6:42 pm

  10. “…my patients have come to me stating that they didn’t understand anything that was said by the specialist. Occasionally they are so distraught they come in on the way home from the specialist visit. A tape recorder there would not have made anything clearer.”

    On the contrary; you could have listened to the recording and explained it to the patient. I’m surprised you think recordings wouldn’t be helpful! How do you resolve these situations with “distraught” patients–do you contact the specialist for a report so you could reassure them?

    If a patient didn’t understand what a health care provider told them, there’s a good chance they won’t be able to accurately repeat it to anyone who could clarify it for them.

    Comment by PJ — April 12, 2018 @ 5:48 pm

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