By Dr. (Prof.) Mahesh Baldwa,
M.D, D.C.H, FIAP, MBA, LL.B, LL.M, PhD (law)
SENIOR PEDIATRICIAN & MEDICOLEGAL ADVISOR
Formerly Assistant Professor of Pediatrics at T.N. Medical College and Nair Hospital, Mumbai-
400008
Ex. Asst. Professor JJ Hosp, Grant medical college
Ex. Professor, paper setter & examiner of law to postgraduate students of University Department of
Law, University of Mumbai
Baldwa Hospital, Sumer Nagar, S.V. Road, Borivali (West) Mumbai 400 092
2. Dr. Sushila Baldwa, MBBS, MD, consultant, Apollo clinic (part of Apollo Hospital),
Kandivali west, Mumbai
3. Dr Namita Padvi, MBBS, MD,DNB, PGDML, Fellowship in pediatric anesthesiology,
Assistant Professor of Pediatric medical s at T.N. Pediatric medical College and Nair
Hospital, Mumbai-400008
4. Dr Varsha Gupta, MBBS, MD, PGDML, Senior resident in department of pathology,
Government medical college, kota, Rajasthan
Introduction:
Indian patients are not so illegally inclined in recording Doctors consultations as compared to western countries. In fact Indian doctors have fitted CCTV camera’s in clinic and hospitals displaying signs boards that the areas under CCTV surveillance.
Indian scenario recording doctors talk
In India rarely when a mishap occurs some patients use their smart phones / pen recorders to record talk with doctor as piece of evidence to be produced in court, without permission of doctor.
doctors in west cannot record doctor patient talk consultation:
In western countries legally doctors are not permitted to record consultations without the consent of Patient party. in India some doctors install CCTV camera’s in their consulting rooms but not in examination rooms/area. In the United States, recording is subject to the laws developed for wire-tapping. in western countries because of legal restriction on doctors to record consultation , doctors should encourage patients to record consultations.
Compulsory or mandatory recording of consultation should be done for
- When both parties agree that they wish to record the consultation.
- when a patient is unable to write or read notes written by doctors, which is the case in India more often than usual
- The recording consultations for training purposes and review purpose. In the case of training, there are strict rules governing who may play the recording and when and how it must be destroyed so the identity of patient is not revealed to strangers.
General negative effects of encouraging patients to record consultations:
a. It is presumed that the doctor does not know everything on first consultation/ occasion . it requires series of consultations before arriving as justifiable diagnosis.
b. It is wrong for either doctor or patient to record consultations with the intention of deliberately entrapping or tripping up the other party, and this implies that ending of doctor-patient relationship .
c. usually recording of consultation is becomes sham, with one party intending to catch the other out. It does not matter whether there is litigation in prospect. This is not what doctors or patients should do to each other to outwit each other.
Consultations Recording may change in behavior of patient as well as doctor:
1. the act of recording becomes like measuring of performance, alters the way the doctor-patient discussion goes on.
2. medical consultation/advise alters if recorded. When doctor speaks ,he is slower and with half an eye to posterity, even though consent from the patient is received or tacit. Patients are also inhibited, even if they say they are content to be recorded, and they speak and act in a more guarded way.
3. Consultations may take longer and both parties are more circumspect in what they say.
4. The interference with the consultation goes beyond the professional relationship.
5. recording interferes with the precious doctor-patient relationship making doctors react defensively
Misuse of recording
1. With any recording comes a risk of misuse.
2. The recording can be given to third parties without both parties’ permission; it can be used as evidence about the doctor, the patient, or other people who are being discussed in some way by the patient, or rarely, by the doctor during the consultation; it can be published as
“entertainment” on social media; or it can be (mis)used by the
media.
3. The only way to mitigate these risks is for the doctor and patient to have a copy of the recording so that both know what truly transpired.
situation in western countries versus india
1. Although doctors should usually permit recording by patients (because it is the patient’s consultation and a legal right), they should not encourage it.
2. Any recording should be done with mutual consent and copies
given to both parties.
3. recording , if done it will lead to better practice and shared decision making. What concerns doctors in India that if recording is given to patient routinely it may lead to defensive medical practice and also put doctor-patient relationship in jeopardy.
4. in western countries doctors encourage patients to record their meetings openly to help improve patient care, encourage more evidence based medicine and shared decision making, and increase trust and openness.
Will to recording all consultations lead to improved patient care
1. By far the strongest argument for encouraging patients to record
Consultations is that it is likely to improve the quality and safety
of patient care. No studies have shown improved patient, but it would be odd, if clinicians did not adhere to good practice if recording is done.
2. There may be some negative effects on doctors if consultation recording given to patient became Routine thing in India. Doctors might order more tests and generate more referrals and more follow-up visits. This kind of
defensiveness may well lead to over-diagnosis, over-treatment, and increased costs to patient party.
3. Routine consultation recording will lead to better practice, greater
reliance on evidence, and greater patient engagement, which
prevents unwanted medical treatments.
Will to recording all consultations lead to Shared decision making
1. Routine consultation recording can not only be reviewed by patient party, other doctors as well as treating doctor himself for self-assessment.
Treating doctor if forgot to mention alternative approaches, he can rectify the situation.
2. Treating doctor may share more information to help compare alternatives in next visits.
3. Treating doctor may indicate about probabilities of harm as well as the
likelihood of benefit o treatment proposed.
4. Treating doctor may can look for evidence sources and see where such medical references are cited.
5. Treating doctor may look for national or local guidelines when he reviews his recorded consultation.
6. Treating doctor may use recorded consultation as tool to help the patient party to make informed decision.
7. Treating doctor will automatically become patient centric and help patient to achieve his health preferences.
8. Treating doctor can practice evidence based medicine and shared decision With patient party
9. Treating doctor should keep in mind the possibility of medico-legal use by him or patient party both.
10. Recordings of recording all consultations considered as admissible evidence in law courts in western countries as well in india.
conclusions:
Recording all consultations can lead to Trust and openness. Doctors who are willing to be recorded will be viewed as having nothing to hide. A similar development is the Open Notes concept in the United States, which enables patients to comment on the accuracy of their electronic medical record.
