The dilemma: A patient with symptoms of anxiety and depression is insisting that he wants to record his consultations. If I refuse he says he will record them covertly using the audio recording device on his mobile. How should I proceed, and is the advice the same if the patient wanted to record it using the video camera on their device?
It is likely that technological advances and the ability to record easily with mobile devices will lead to increasing requests from patients to record consultations.
Patients may wish to audio record consultations so that they can replay them and remind themselves of what was discussed, rather than trying to take notes or bringing a friend or relative with them.
The recording of consultations may also be advantageous to clinicians, as it is likely to be more complete than a written clinical note and could therefore provide helpful evidence if the account of events is disputed.
Clinicians acting ethically and professionally should have no reason to be concerned about being recorded in consultations. It is possible that in many years’ time, the recording of consultations, with copies held by doctor and patient, will be commonplace.
Legally, patients do not need to seek a clinician’s consent before recording a consultation themselves, because they are processing their own personal information.
A consultation should not be refused if a patient wishes to record their consultation, as you have a duty of care to the patient and could face criticism if you didn’t consult with them and they subsequently came to harm.
A consultation should also not be terminated if a patient is found to be recording it - instead, it is an opportunity to explore whether the patient has any concerns about their care or has a lack of trust in their treatment.
How to proceed in this case
In this particular scenario it would be first helpful to try to ascertain the reasons for the patient’s request to audio record the consultation. It could well be the case that his mental health symptoms are affecting his memory, or causing other concerns, and he feels that recording the consultation would be helpful to him.
Once you have discussed the patient’s views, it would be sensible to agree to the patient recording his consultation using his mobile phone. Otherwise, the patient may choose to record the consultation covertly, and it is better for doctor and patient to be honest with each other.
The GMC advises doctors: 'You must give patients the information they want or need to know in a way they can understand. You should make sure that arrangements are made, wherever possible, to meet patients’ language and communication needs.'
If the patient chooses to record the consultation, you should ask for a copy of the recording made if possible, so that it can be placed in the patient’s notes to form a permanent record of what was discussed. This may help to ease the patient’s concerns. You may also wish to consider advising the patient that the recordings should be for personal use only.
Video recording by patients
Similar principles would apply if the patient expressed a wish to record the consultation using the video camera on his mobile phone or another device. However, before agreeing to any request to video record a consultation, it would again be important to explore the patient’s motivation for doing so. For example, what would a video recording add that audio recording wouldn’t capture? How would it assist the patient further? Why specifically does the patient want to use video?
If you feel uncomfortable regarding the use of video recording, you should discuss this with the patient. As with audio recordings, you may also wish to specifically request that such a recording is only for personal use and not disseminated, including on social media.
Video recording by doctors
The GMC also provides specific advice about when a doctor wants to make audio and visual recordings of consultations.
Patient consent must be obtained when a video recording is undertaken as part of the patient’s investigation or treatment. Doctors should explain to the patient why a recording would assist their care, what form the recording will take, and that it will be stored securely within the medical records.
Documentation of consent should be kept with the recording.
Video recording of consultations has been an integral part of general practice training for some time. Its purpose is to assist doctors in improving, and assessing, their consultation skills. The GMC advises that consent must be sought before making recordings for teaching, training or assessment.
Patients should be given enough information as to the purpose of the recording, who it will be shared with, how long it will be kept, how it will be stored and when and how it will be subsequently destroyed. Patients must also be reassured that they can withhold or withdraw consent and that it will not affect the quality of their care.
Your medical defence organisation, can offer further guidance if you have any concerns about requests from patients to make recordings of consultations.
- Dr Rachel Birch is medico-legal adviser at Medical Protection