iPhone app makes doctors iRate
— Ford Vox is a medical journalist and a physician. The opinions expressed are his own. —
That iPhone 3G you’re packing comes with a truly killer app: one guaranteed to hurt your relationship with your doctor if you use it to secretly tape your appointments.
That’s what happened recently inside one Washington state hospital, according to the irate physician, who complained about his experience to colleagues on Sermo, an MD-exclusive social network.
Dr. Anonymous examined a woman recovering from surgery to see if she needed rehabilitation. He found signs his new patient might not handle all the therapy that goes along with a spot in a rehab hospital. After discussing her choices for about 15 minutes, Dr. Anonymous discovered that the patient’s daughter’s iPhone displayed a metering bar moving as he spoke. “I had no idea I was being recorded,” he wrote.
Fellow doctors chimed in with near unanimity: call the hospital’s risk management officer, call your malpractice carrier, and fire that patient! While it’s a rare event, doctors can “fire” any patient from their care after supplying 30 days notice and a referral.
“Other than having an attorney in the room taking notes, I don’t see any bigger red flag than this” for an impending lawsuit, wrote an Ohio-based obstetrician-gynecologist.
Shocked, Dr. Anonymous didn’t say anything to the patient’s daughter, but knowing he was being recorded made him less open for the remainder of the consultation, and afterward he notified his malpractice insurance company.
As a rehab doctor myself, I’ll sometimes detect tension in the room when family members recognize me as the gatekeeper to the care they want for their parent or child. But we follow guidelines for good reason: rehab is a limited resource, and we must fill our hospitals to capacity with the neediest cases. According to 2008 numbers provided by the congressional agency MedPAC, Medicare spent $5.84 billion on inpatient rehabilitation that year (averaging $16,649 per patient). If the country needs doctors like me to control costs, we need tort reform, and folks need keep their voice recorder apps off.
Surreptitious recording laws vary by state. Dr. Anonymous’s unwelcome surprise occurred despite laws against such recording in his state. Forty-five physicians reported similar experiences in an accompanying poll on Sermo. One Colorado pediatrician volunteered that a secret recording, legal in his state, drew him into a legal fight over a child’s custody. An outraged obstetrician-gynecologist asked a patient why she wanted to videotape her appointments: “She said her lawyer told her to tape every visit, [because] sooner or later I’d make a mistake and then she could make lots of money. I dismissed her from the practice.”
Secret recordings aren’t known to instill good vibes among health care workers. Even home videos of hospital deliveries have ended up as courtroom evidence. Some hospitals have attempted to craft policies to limit their risk.
Yet secret recording can become a useful tool in the right hands. When a British nurse got permission from families to document the substandard care she witnessed, her undercover video led to a shocking BBC Panorama documentary that prompted sweeping change at the hospital. Sadly the UK nursing council concerned itself with her sneaky methods rather than her good works, banning her from the profession.
Republican Senator Tom Coburn, himself a doctor, wants to legislate something similar, if less sensational, here in the United States: deploying undercover “patients” to catch wasteful Medicare providers. The idea made it into the president’s final health care overhaul negotiations.
But make no mistake: If you’re recording your doctor because you don’t trust her, do yourself a favor and go find somebody you can believe in. A recent Lancet paper dissects how factors like a warm, confident doctor who employs “thoughtful silence” can influence recovery from disease, modulating some of the same brain networks as recommended drug treatments.
In short, you’ll get a little help from the treatment and a little more boost from a supportive doctor-patient relationship, and the two together can sometimes mean the difference between recovery and disability.
Given what we know about the power of the therapeutic placebo effect, you don’t want to do anything that prevents your doctor from trying her best to raise your expectations about realistic outcomes, while remaining open about common risks. If you prefer legalese to that human touch, simply slide out your iPhone, then open that trust-busting app.