Patients will ask to record instructions
Legal risks may be overblown -- Recording can't be used in a court of law
Do you mind if I record your instructions so I can remember them?" If a patient pulls out a tape recorder and asks this of her physician, the answer is likely to be "no," according to Carolyn Oliver, MD, JD, founder of the Oliver Center for Patient Safety and Quality Healthcare in Galveston, TX.
"Doctors are an incredibly risk-averse group. They are terribly afraid of doing anything that they haven't done before," she says.
The biggest grievance doctors have is that patients are non-compliant, Oliver says. "Yet, there are probably 50 studies that have been done over the last 30 years showing patients don't remember what their doctors tell them," she says. "I encourage doctors to look at the statistics."1,2,3
To improve patient compliance, Oliver developed "Your Doctors Advice," a website that allows patients to use any cell phone to easily record themselves repeating the advice given by the physician. "The patient just pulls out his phone and says, 'I'm going to make a note to myself of your advice,'" she says. (For more information, see resource box, below.)
The recording doesn't increase legal risks for physicians, in part because it can't be proven in a court of law that it's a complete, accurate representation of what the doctor said that day to the patient, according to Oliver.
Many oncologists have been allowing patients to tape detailed instructions for years, adds Oliver. "It may take 45 minutes to say it, so doctors want to say it once," she says. "Doctors do not have to be scared of it. They're going to get less callbacks and more satisfied patients."
She notes that physicians were all taught the "teach back" method in medical school. "This is a really good way to ensure you have communicated with the patient," she says. "Audio recordings are the no. 1 best way for patients to remember instructions. And it doesn't take a minute, as a rule."
Oliver compares the current resistance to allowing patients to record instructions, to fear of lawsuits when family members first started to be present in labor and delivery rooms in the 1970s. "Doctors thought, 'the family members will all sue us,' but people started stepping out of the box because it was the right thing to do," and those legal concerns subsided over time, she says.
"The best way not to get sued is to develop a good relationship with your patient," says Oliver. "This is one of the ways to do it." (See related story on a pilot program involving patients recording instructions, below.)
References
- Jansen J, Butow PN, van Weert JCM et al. Does age really matter? Recall of information presented to newly referred patients with cancer. J Clin Onc 2008; 26(33): 5450-5457.
- Kravitz RL, Hays RD, Sherbourne CD et al. Recall of recommendations and adherence to advice among patients with chronic medical conditions. Arch Inter Med 1998; 153:1869-1878.
- Van der Meulen N, Nienke JJ, Dulmen S, et al. Interventions to improve recall of medical information in cancer patients: A systematic review of the literature. Psycho-Oncology 2008; 17:857-868.
Sources/Resource
For more information on patients recording physician instructions, contact:
- Meredith Masel, PhD, MSW, Program Manager, Oliver Center for Patient Safety and Quality Healthcare, Galveston, TX. Phone: (409) 747-6009. Fax: (409) 747-6010. Email: [email protected].
- Carolyn Oliver, MD, JD, Oliver Center for Patient Safety and Quality Healthcare. Email: [email protected].
- Steve Q. Quach, MD, Chief Medical Officer, University of Texas Medical Branch Health System/Director, Oliver Center for Patient Safety and Quality Healthcare. Phone: (409) 772-5108. Fax: (409) 772-5119. Email: [email protected].
- The Your Doctors Advice program allows users to register a cell phone number to record and play back advice given to them by a physician. A "record advice" phone number is dialed for the recording, and a "play back advice" phone number is dialed to play back the recording, which can be done from any cell phone. After a six-month free trial, the cost of the program is $15 for one year. For more information, go to www.YourDoctorsAdvice.org.
No added legal risks seen with recordings When physicians in the departments of hematology, oncology, and family medicine at the University of Texas Medical Branch in Galveston were given the chance to participate in a pilot project involving patients using "YourDoctorsAdvice," a website allowing them to record instructions given by their doctor, it was understood that some might be wary of legal risks. "We are careful to consider risk with any new program," says Steve Q. Quach, MD, chief medical officer of the University of Texas Medical Branch (UTMB) Health System and director of the Oliver Center for Patient Safety and Quality Healthcare, both in Galveston. Because the tool helps the patient remember and understand the treatment advice of their doctor, Quach says he expects to see increased patient compliance with the plan of care and ultimately, better health outcomes. "Bad outcomes are one of the drivers of liability and risk," he adds. "As such, it stands to reason that this tool could reduce risk as opposed to increasing it." In previous years, healthcare providers nationally were concerned that disclosure of medical errors to patients would expose them to increased litigation, notes Quach. "However, it appears that studies have not shown that to be the case, and it is a practice that is spreading," he says. "That is an example of another initiate where liability was an initial concern, but studies did not show that to be the case." Meredith Masel, PhD, MSW, the Oliver center's program manager, says that when physicians express concerns about liability risks, she informs them that the program has been vetted by the institution's compliance and privacy experts. Five providers have participated to date by offering their patients the chance to record instructions with a handheld recorder or "YourDoctorsAdvice." "Of course, liability is always a concern. But at this point, we do not have objections to our providers participating," says Masel. Positive feedback The pilot identified that providers and patients in oncology, the acute care for the elderly unit, and family medicine practitioners all thought the tool was valuable. "One unexpected result is that family members involved in elder care are particularly interested," says Masel. "I have not received resistance from physicians, except regarding concerns about this taking extra time. There are ways to work around that, so those concerns can be eased." Masel says that to save time, patients can record themselves at the same time the physician is documenting in the medical record, when the physician is reviewing the visit with the patient, or when the patient is asked to repeat instructions back to the physician as part of the "teach back" method. Several departments have opted to use handheld digital tape recorders instead of the patient's cell phone. "This is not a new concept in oncology," says Masel. "Previous research at UTMB has shown that patients like this technology." During phase two of the pilot, patients will be given the choice of using "YourDoctorsAdvice" or a handheld recording device, and patient adherence with follow-up care and treatment plans will be tracked. "We want to know if the recordings are being used, shared, or enhance the perception of care," adds Masel. |
Do you mind if I record your instructions so I can remember them?" If a patient pulls out a tape recorder and asks this of her physician, the answer is likely to be "no," according to Carolyn Oliver, MD, JD, founder of the Oliver Center for Patient Safety and Quality Healthcare in Galveston, TX.
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