Capturing Recordings of Your Medical Encounters

The patient was a middle-aged African American woman with right-sided chest pain. Her situation was what we emergency docs would call “atypical”—meaning that it wasn’t particularly concerning in terms of a potential heart attack. But, nonetheless, it was upsetting and uncomfortable for her, so we did a battery of tests.

The results were reassuring. She didn’t have COVID, pneumonia, blood clots, or a heart attack. In fact, it seemed like she had strained her rib cage during a hip-hop dance class. When I told her and her sister this, they appeared relieved and satisfied.

Then, while pivoting to leave the room, I paused. I recalled a recent conversation and said, “It seems as though you both understand what I just told you, but I know I covered a lot in a short time, and I don’t mind repeating it. You are welcome to use your phone to record me.”

The conversation that came to mind that day was one I’d had with researcher Dr. Paul Barr from Dartmouth College. Barr is an expert in the emerging arena of automated and curated recordings of physician-patient encounters.

On our Zoom, Barr was wearing a red beanie and matching red glasses. There was a punching bag and a road bike perched on a trainer in the background of his home. Young children came and went, and so did his spouse, taking a business call from a few feet away. Barr was hardly fazed. “I’m Irish,” he said, “and I like to talk.”

Barr grew up in Belfast, and as a youngster, he said he “ended up in the emergency room a lot.” Once, it was with a “flattened knuckle” from a Gaelic football match, and the doctor told him he would need surgery or else his finger would end up “looking like a banana.” After he was ushered home and told to come back in a few days for surgery, he wished he could have a do-over of his conversation with the doc because he hadn’t fully grasped the how and why of the situation.

Years later, with colleagues at the Preference Laboratory in Dartmouth, Barr began exploring the nascent phenomenon of patients secretly recording their physician visits. Then, after attending a 2014 lecture given by Sigel Bell of the Open Notes research group (more here), Barr started to see huge potential benefits in openly recorded clinic visits and started to learn more about the idea. A theme that kept popping up was that while many patients felt uncomfortable about making secret recordings, they did so anyway because “some discussions were too important not to record.”

From there, Barr quickly found a productive career in studying the usefulness and application of visit recordings with the Open Recordings research group.

In 2015, he received a grant from the Gordon and Betty Moore Foundation to support his work on what began as the “ORALS” (Open Recording Automated Logging System) project and has since morphed into something now called “HealthPAL.” The concept, informed by a portfolio of case study work, is summarized like this:

Patients and caregivers can make audio or video recordings of clinic visits, store and share them securely, play them back to hear any information they may have missed at the time of recording, and easily navigate through them using HealthPAL.

It remains to be seen whether the enhanced annotation functionality of HealthPAL offers a benefit over a regular smartphone recording (Barr is involved in a three-arm trial of geriatric clinic visits to test just this), but, either way, he is quite sure that the concept of open recordings is here to stay.

“In interviews,” Barr notes, “we have seen a positive reaction to sharing recordings, not just among patients and families, but with also caregivers, health care providers, and even insurers.”

He uses specific examples to back this up:

• A patient with advanced Stage 4 cancer referred to his recordings as his “right-hand man.” If the doctor had given him encouraging news, he would listen to the recordings several times to lift his mood. If it was bad news, he would share the recording directly with his family so that he did not have to experience the pain of retelling it.
• Patients have not only been interested in reviewing what their doctors have told them but also in reviewing what they themselves said, under the lens of, “Was I a good patient today? Did I forget to tell the doctor something?”
• Some physical therapists have adopted using video recordings as well of them demonstrating a rehab technique and also of the patient trying it so that they can pick up on subtle differences and provide corrections. (This is so much more useful, I think, than the stick figure drawings that I have often brought home from my own PT sessions.)
• Anecdotal evidence seems to suggest that malpractice claim risks are lower with available recordings because recordings can improve patient trust, recall, and understanding and seem to encourage a more shared treatment model that can help diffuse a “blame” dynamic if things go wrong.
• Insurers have noticed the above dynamic, and some have started offering incentives to encourage physicians and physician groups to offer patient recordings. [1]

In sum, “When you are used to something, it can be hard to take your head out of the sand,” Barr says, “but when you stand back and look at this, how can you not think that recordings are a good idea?”

I did try to take my head out of the sand with my ER patient with hip-hop chest pain, but she and her sister both smiled at me. “Nah, we are good,” my patient said, “It would be one thing if you just told me I had something bad, like cancer, but this isn’t a big deal. No dance class this week, though, right?”

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“Right,” I said.

So, for now, and until the process becomes automated, I will selectively encourage recordings when it seems helpful for my patients while also looking forward to a day when it becomes standard and seamless.

As Barr and I finished up our Zoom call, a sense of irony dawned. It turns out I had forgotten to hit record on our conversation.