iPhone app makes doctors iRate

By Ford Vox
March 15, 2010

vox– 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.

23 comments

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Why should doctors be insulated from the checks and balances – that the rest of us are subject to?

How many employee workplaces are subject to taping of phone conversations, monitoring of emails and computer use etc. – for ends and organizational purposes that are far less critical than life, health and well being.

This is another example of how we coddle doctors in this society, when in reality most people’s health is not enhanced or protected by doctors, and by far, the greatest influence on anyones health and well being comes from thier own personal lifestyle choices and living habits.

In fact (or at least in my view) our societies over-reliance upon doctors, drugs, the perfunctory McDoctor visits that have become the ubiquitous cornerstone of “health care”, has been the greast detriment to the cultivation and maintenance of health. As practiced today, “Health Care” is in reality, a marginally effective, partially palliative, and obcenely expensive form or “Disease intervention”.

What doctors (generally) do is not “Health Care” and taking potshots at means of patient empowerment – or any kind of consumer safeguard is entirely beside the point.

Posted by Jordy10 | Report as abusive

“Warm” must be the new buzzword for physician consultations in the U.S: I’ve been polled several times by medical gatekeepers as to the “warmth” and “caring” of doctors I’ve seen recently. I’d be more impressed if I was asked whether the doctors were interested in discussing my health generally, rather than in being “warm,” “caring,” and.. oh yes, quick. Everyone in my family has been misdiagnosed for years… one didn’t have asthma, but hayfever that was “cured” by an over the counter remedy. Another didn’t have a mysterious unknowable ailment that caused limping, but a foot bone fracture (really, this took multiple doctors and years to discover), another wasn’t simply catching virus after virus but had a bad gallbladder, and finally a years’ long itching turned out to be something that was cured with the right medicine. And we’re folks with insurance who see doctors regularly. It’s my belief that these appalling lapses were due to the fact that no doctor had time to figure out what was going on. Instead each was trying to meet that 15 minute appointment time and hoping against hope that they were right. Forget “warmth.” Take some time to be right.

Posted by Shoreline | Report as abusive

If they can do it with cars, the day is nigh when there’ll be black boxes for everything, including crucial healthcare interviews. For sheer horror value, though, I’d be much more interested in widespread publication of rejection conversations with so-called health insurance companies.

Posted by HBC | Report as abusive

OK, I am a physician. I guess I just as well might videotape every exam of every patient whether they want to or not. This way what I do and how I do it will also be recorded, and the patients’ cooperation or lack there off will also be recorded. This will help me avoid frivolous lawsuits.

Everyone on board?

Posted by Zeronine | Report as abusive

Zeronine, if you’re really a doctor and I were your patient, I would say go right ahead and record everything – and give me a copy as I walk out of your office after ever visit.

Posted by DigitalSoapbox | Report as abusive

For certain diagnosis and treatment explanations I think it would be a recording a great help in recalling just what was said. I had a colonoscopy/endoscopy a while ago, and was awake but really not “with it” when the gastroenterologist came in and described what he found. The follow up discussions also left questions when I tried to recall certain points. (and I’m not yet 50 so I think Alzheimer’s is out). I understand the fear, but it’s a pity that open discussion would be cut short out of fear of litigation. If you’ve done nothing wrong, you shouldn’t worry…in a perfect world.

Posted by justone | Report as abusive

Asking for a recording of your colonoscopy is just plain sick, dude.

For background music I’d suggest the Star Wars tune.

Posted by Tikibob | Report as abusive

Why is it that physcian’s are not accountable for their mistakes? Or not paid for performance? Physicians should be paid for by how well their patients are doing, period. Every working person in America is held accountable for the work they do, yet doctors aren’t. That is absolute nonsense, especially for a profession where someone’s life is literally at stake. Yes, tape record them, people might be shocked at the number of times doctors make the wrong diagnosis, and that to for $300 dollars an office visit. Perhaps, if physicians actually had to demonstrate how efficacious their prescribed treatments are, they would get the diagnosis the first time around, not the fifth, fifteenth, for fiftieth.

Posted by BB1978 | Report as abusive

Is it just me, or is Reuters sounding fishier and fishier lately?

Posted by Crrystaphir | Report as abusive

Digital, I am actually ok with that too.

Posted by Zeronine | Report as abusive

Surreptitious recording of anyone, without their permission or knowledge may breach that person’s privacy unless the practice is explicitly allowed by law and in line with any procedural requirements. If not done correctly, the recording will not be admissible in court and will cast the patient / family in a hostile light to any future provider that is visited. This could impair future care.

On the other side of the argument, doctors might want to be more aware that at least some of the folks they are treating feel the need to take action to protect themselves. As a profession, this perception should be a call to action.

Either view presents increased potential for exposure of confidential information. If doctors start recording more patient interaction, there is more PII to protect and another expense that will be passed along to the patient, insurance and society.

If the patient or family member records interactions, then they are responsible for protecting that information. When an iPhone or other device is lost or sent in for repairs, the stakes are higher since the potential loss of confidential information also increases.

If patients are in an arms race with health care providers, costs will rise proportionally. Providers being held accountable is important but doing it right will make the effort more meaningful and effective.

Posted by KarlW | Report as abusive

I once went to a Dr. years ago for a cold and flu that would not get better. I knew it was a contageous illness as everyone on the workforce had the same cough and cold-some people got well quicker than others.
The Dr. decided I needed an x-ray. At the time I thought it was for tb.
The Dr. told me I had asthma. That was a crock as I had no difficulty breathing and 12 years later still do not.
When I have to be forced to buy my insurance I hope this does not come up on my data base.
Why should I have to pay extra on my monthly premiums for an educated guess or endanger myself because some Dr. wants a kickback from a pharmacutical company?

Posted by Anna123 | Report as abusive

“home videos of hospital deliveries”… Does anyone else find this idea rather sick? Who would want to video their wife convulsing in contractions, about to give birth? Who would VIDEO the event and make the poor woman more nervous, instead of providing much-needed support? A bit of reverence is called for here, methinks.

Who doesn’t make mistakes? Is it not rather sick that lawyers are out there waiting for victims, and even laying out snares for professionals who are almost all doing their best to serve?

My wife gave birth last year, to our first child. The midwives were far from perfect in the care they provided. They made half a dozen real mistakes, but after almost 24 hours active labour, our child was delivered naturally and safely, with competent help from some different midwives who had personal experience of our particular situation.
Do you think we wanted to sue the pants off one inexperienced midwife and one or two apathetic/ unsympathetic midwives? Do you think we wanted to line the pockets of some lawyer? Do you think we wanted to ruin the midwives psychologically and/or professionally? NO WAY. What effect do you think that would have? One of the main things the midwives did WRONG at first in our case was they were really cagey and appeared frightened to take control of the situation when they needed to do so most of all (when things got frightening.) A lawsuit would never make the midwives less nervous or more professional. It would hardly make hospital care better value for money.

A few well-placed, thoughtful words got us an invitation to see the head of midwifery at the hospital for a long but friendly debriefing and discussion; followed by a promise to discuss matters generally with the medical staff and improve practise, and also do better for us next time around. We’re not frightened to have another baby. We’re not wasting our time and attention on some lawsuit. Kudos to the midwives who helped us; they were wonderful, and most of the others probably did what they thought was their best, and learned a lesson from a very hard 24 hours. We have a wonderful baby daughter who is developing well- she deserves our attention.

Posted by compsci | Report as abusive

Doctors perform a service, like anyone else, and should be held accountable if they make mistakes, as so many other people are, in the industries they work in. Tort reform is needed, yes, but if a medical practitioner, of any kind, is properly doing their job, they will have nothing to fear if they are voice or video recorded. The outrage is both hilarious, because it shows just how much the position of a doctor is elevated in America, and also telling. If doctors weren’t afraid of being caught making mistakes, there would be nothing to complain about.

Posted by Adam_S | Report as abusive

Over the years they have had a lot of tort reform. I do not know of nor do I hear of any frivilous lawsuits.
This is just an excuse for eliminating a lot of tests.
This administration along the state of Texas feels that if people just drop dead they cannot have to worry about paying ss. and the medicare benefit can go to the young.
There is no real cure for cancer and I do not see the justification in eliminating screenings unless people are of a certain age.
Early detetection is the most important in eliminating cancer.

Posted by Anna123 | Report as abusive

I am a physician in the US. The vast majority of medical ailments in this country are a result of over-eating and unhealthy behaviors/substance use (high blood pressure, sleep apnea, heart failure, coronary disease, stroke, diabetes, kidney failure, emphysema, STDs). The treatment of these does not rely on medicine, yet on an individual’s self control and ability to keep a healthy weight and keep healthy habits. I have very little to offer for treatment other than information on how to live well — the “cure” resides in the patient’s behavior and willpower.
There is an unhealty expectation that for a $10 copay, one may be granted a miracle without any responsibility to help fix the problem – and without any regard for the limits of science and the power of nature (i.e. fixes for chronic medical problems in the elderly). Unfortunately it is this selfish and unreasable expectation of American society, not the unintelligent political arguments, that make solving health care so challenging.
The tone of the comments above are very hostile to physicians — yet, few professions have such tremendous responsibility and liability focused onto just one individual (and not diluted across a corporate organization). Those who quickly believe that the monetary reimbursement physicians recieve adequately balance that personal liability should pause.
Americans would have much more respect for their life/health/healthcare — and physicians rightfully held more accountable — if we extracted third-party payers from the equation and let individuals shop/pay for their care. This would help solve the problem mentioned in the first paragraph. Currently we have a system that works much like the morally deranged “bailout nation” our government has created over the last couple of years: those who are responsible paying for those who are irresponsible/corrupt.

Posted by Jason246 | Report as abusive

To imply that doctors are just raking in the money is a huge misconception. I am not a doctor. But I know many. for a general practitioner it is not uncommon to have 50,75 or even $100k in student loans. A specialist can be a multiplier of those amounts. Add the cost of malpractice insurance, facilities etc and their monthly bills would blow most peoples minds. I have an Aunt that works in the Insurance industry. She has made it known that lawyers are out of control. I myself have experienced this. I had a guy run out in front of me doing 45mph @ night. He got a ticket for crossing against the light. He sued me for damages. even though I had an airtight case. The reason? the insurance company was afraid of the jury. So they settled for the maximum of my coverage.
Doctors are not mechanics, or accountants. How can we imply that they should be held libel as such.

Posted by bcorner | Report as abusive

Recording a discussion with a health professional can be very useful for care, when everyone knows the recording is taking place. Then relatives who aren’t present when the discussion occurred can listen later to the what was said, and the patient can review it to understand the instructions better.

However, secret recording by patients who are just waiting for a mistake creates an adversarial relationship from the start. A good relationship with a health professional is based on honesty, willingness to follow recommendations, and trust in their skill and knowledge (or ability to refer elsewhere for the proper skill & knowledge). Secret recordings for litigious purposes is not part of that plan!

I totally agree with jason246 that most of the issues we see in health care today are influenced by lifestyle: obesity, poor sleep, stress, bad habits. We need a public health makeover on the order of what sanitation did 100 years ago for health. Get people exercising, eating healthy foods, etc.

The author of the article is charged with triaging patients to make sure that a precious resource is adequately and appropriately used by the patients who most need it. Another problem with the cost of health care in the country is the belief by many patients that they need, or are entitled, to the most expensive tests & drugs & treatment (or easy access to disability payments) without regard to cost. If they truly need it, fine. But trying to game the system to justify MRIs on the 2nd day of mild back pain, CT scans for every headache, or prolonged workmen’s comp payments hurts all of our fellow citizens in the long run.

Posted by epector | Report as abusive

In my opinion, every single word a doctor says to a patient should be able to be recorded. This is not about the risk of iphone apps but the privacy that doctors think they should be entitled to. The call here should be in the hands of the patient, not the doctor.

Posted by TerryNorris | Report as abusive

‘The call here should be in the hands of the patient, not the doctor.’ (Terry Norris, above). Well said, and a doctor with nothing to fear has nothing to hide.

I think there is an underlying ‘dynamic’ in the perceived problem: it represents patients’ taking an initiative as regards their own healthcare which doctors cannot ‘control’, and that just doesn’t suit some doctors’ sense of self-importance. Well, docs, I don’t see easy digital recording going away any time soon. Would it not be better to, er, grow up and get used to it?

Posted by thinkmaw | Report as abusive

We in the UK complain about the NHS, but I cannot get my head around a healthcare system that allows a doctor to ‘fire’ the patient!

The British nurse in the original article, by the way, was re-instated after a huge public outcry and petition. The CEO of the hospital (where hundreds suffered and died unnecessarily) walked away without punishment with about a million pound in his pocket. No justice!

If you think your doctors are not accountable, it is the same for the UK. A doctor found guilty (it did take the authorities 12 years to achieve this, but only because the families didn’t give up) of killing a fair few elderly patients with diamorphine is still allowed to practise! Our NHS/stupid government even allows doctors from the European Union who hardly speak a word of English (European Law says it is not legal to subject them to a language test) to kill UK patients whilst they practise out of hours cover and get paid huge sums to boot.

Neither healthcare system sounds good to me.

Posted by Pheme | Report as abusive

As regards the UK, it looks like Nick Bostock from: http://www.healthcarerepublic.com/news/1 002363/GPs-warned-patients-recording-con sultations-posting-internet/
is on the right track.
Why on earth shoudn’t a patient be allowed to record the advice which, one way or another, he\she has paid for?

Posted by thinkmaw | Report as abusive

Open recording of healthcare providers will result in one thing. Worse health care that is more expensive.
You are going to have doctors who are going to go by the book on everything. Only going to give you the FDA, standard treatment. Start low, go slow etc etc and order every freaking test known to man “just to be on the safe side ma’am.”

Whoever said there is no tort reform needed is crazy. Lawyers run this country. I am a malpractice lawyer and life is good. The public is stupid and easily fooled. Now that I am ready to retire, I am completely behind tort reform because otherwise this country will collapse under the weight of healthcare costs. Or you are going to see the best doctors only treat the richest…see concierge care.

Posted by MiniTruth | Report as abusive