A digital advocate? Reactions of rural people who experience homelessness to the idea of recording clinical encounters

Abstract

BackgroundAre the benefits of recording clinical encounters shared across different groups, or do they vary based on social position? Studies show that educated patients record their clinical visits to enhance their experience, but very little is known about recording benefits among “hard‐to‐reach” populations.ObjectiveTo examine the reactions of homeless people to the idea of using a smartphone to record their own clinical encounter, either covertly or with permission from their physician.MethodWe conducted semi‐structured interviews with individuals at a temporary housing shelter in Northern New England. A thematic analysis identified themes that were iteratively refined into representative groups.ResultsEighteen (18) interviews were conducted, 12 with women and six with men. Initial reactions to clinical recordings were positive (11 of 18). A majority (17 of 18) were willing to use recordings in future visits. A thematic analysis characterized data in two ways: (i) by providing reliable evidence for review, they functioned as an advocacy measure for patients; (ii) by promoting transparency and levelling social distance, this technology modified clinical relationships.DiscussionRecordings permitted the sharing of data with others, providing tangible proof of behaviour and refuting misconceptions. Asking permission to record appeared to modify relationships and level perceived social distance with clinicians.ConclusionsWe found that while many rural, disadvantaged individuals felt marginalized by the wide social distance between themselves and their clinicians, recording technology may serve as an advocate by holding both patients and doctors accountable and by permitting the burden of clinical proof to be shared.

Should consultation recording use be a practice standard? A systematic review of the effectiveness and implementation of consultation recordings

“…In 1 survey, 15% of the respondents reported having covertly recorded a consultation, and 35% admitted that they would consider doing so . If increasing numbers of patients are desiring to record consultations on their own, should clinical centers establish policies and procedures for addressing this trend? In most western nations, anecdotal legal opinion suggests that the law supports the right of citizens to record personal communications with a second party without second party consent, as both parties engaged in a mutually agreed to conversation are said to “own” the conversation.…”

Do you mind if I record?: Perceptions and practice regarding patient requests to record clinic visits in oncology

“…Potential benefits of recording visits include improved patient and caregiver education, recall of information, and improved engagement and satisfaction 9‐13 . However, both access to recording and its value are contingent on state laws and institutional policies that govern recording, on physician permission to record, and their comfort with being recorded.…”

“…If physicians vary in the acceptance of recording, or if they change the content or the manner in which they convey information, this could lead to differences in care. Although patient surveys suggest widespread interest and perceived value in recording, 9,11‐13 the limited available literature regarding physician views suggests concerns over the impact of recording on their relationships with patients and the content of conversations 8,12‐15 . Regardless of whether or not such concerns are well founded, they could translate into unwitting conflict with patients at a time when building trust is paramount 10,16‐19 …”

“…To date, virtually all of the existing empirical literature on recording visits has focused on patient perspectives. Individual studies and systematic reviews have found higher patient satisfaction when provided with recordings of their visit, even when those recordings are associated with limited improvements in recall of information or quality‐of‐life 1,9,11‐14,20‐25 . In contrast, there is a surprising paucity of studies evaluating the views of the other half of the recording dyad, the clinician.…”

What to do when a patient wants to record a patient-physician interaction in the emergency department

“…14 Another study proposed that recording technology could help advocate for marginalized patients by helping to overcome clinical misperceptions while also holding patients and their physicians accountable. 15 There is little in the medical literature to provide guidance to physicians on how to best approach these situations. Regarding patients making surreptitious recordings, Rodriguez et al suggest that the first and most essential strategy entails being aware of and embracing the possibility that every conversation with a patient may be recorded.…”