Smartphone standoff: a qualitative study exploring clinician responses when a patient uses a smartphone to record a hospital clinical encounter

Abstract

ObjectivesPatients are initiating recordings of their clinical encounters using a smartphone. While this is an important, universal issue, little is known about the clinician viewpoint. Understanding clinician perspectives and behaviours is key to ensuring the protection of patient and clinician interests. This study aimed to gain a deep understanding of clinician attitudes and behaviours to patient-led recordings of hospital clinical encounters.DesignSemistructured interviews were conducted with 20 hospital clinicians. Participants were recruited using a combination of purposive and snowball sampling. Interviews were digitally recorded and transcribed. Transcripts were analysed using thematic analysis.SettingThis study took place at two hospitals in the metropolitan area of Gold Coast, Australia.ParticipantsParticipants included clinicians with varying levels of experience, or clinical managers in the roles of: medical, nursing and midwifery, and allied health staff.ResultsThe 20 participants interviewed were from a range of health disciplines and clinical areas and most had experienced a patient-led recording. Three themes emerged when exploring participant attitudes. First, that recording was a significant and controversial topic. Second, that experiences often informed clinician attitudes and many clinicians held conflicting views. Finally, a perceived loss of control was a significant stressor. A further three themes emerged relating to clinician behaviours when a patient asks to record. Decision-making involved balancing multiple factors often in pressurised situations. Shared decision-making was shaped by power dynamics and, finally, decision-making was not informed by hospital policy.ConclusionsWhile patient-led recordings were viewed as beneficial, clinician welfare and patient safety may be at risk when a patient records a clinical encounter. Current safeguards, such as hospital policies, are not used and may not meet the needs of clinicians when decision-making is complicated by power dynamics. More research is needed to better understand how clinicians can be supported in this critical domain.

‘What are you hiding from me?’ A qualitative study exploring health consumer attitudes and experiences regarding the patient‐led recording of a hospital clinical encounter

“…[40][41][42] Clinicians who regularly refuse recordings may need to both re-examine their practice, consult hospital guidelines as to consumer-clinician rights and consider how to mindfully communicate a refusal if that is still their preference. 3,6,13 Our findings revealed that consumers are not aware of their rights or responsibilities when it comes to recording a clinical encounter. This is both a barrier to them using a potentially beneficial tool and a reason why they may not verbally seek consent, with the potential to lead to more covert recording.…”

“…4,5,7,14 Patient-led recordings have been found to mirror the benefits of service-led recordings, which include increased recall and understanding, support for decision-making and increased patient empowerment. 5,7,[9][10][11][12] Although clinicians recognize some of the benefits of recording, 3,12,13 clinicians cite several concerns of patient-led recording, such as confidentiality risks, potential changes to the consumer-clinician dynamic and possible medico-legal ramifications, which can act as barriers to consenting to the recordings. 3,5,12 Previous studies have sought to investigate ways that recordings can be integrated into service, including the use of clinical champions 12 or the use of a smartphone app which aims to mitigate some of the medico-legal fears held by clinicians.…”

Defining covert recording: A qualitative study exploring the experiences of clinicians when a patient records a hospital clinical encounter using a smartphone without consent

“…7 , 8 Clinicians are, therefore, required to make difficult decisions and take actions with limited direction or training. 9 …”

“…10 Despite the relaxation of restrictions, there is an enduring fear among clinicians regarding patients using their smartphone cameras to record hospital experiences. 1 , 9 , 10 Some clinicians may decline a recording due to their own preference not to be recorded, others due to the recording being a distraction or putting the confidentiality of others at risk. 9 Covert recording is of particular concern to clinicians, who are reported to hold mainly negative attitudes due to medico-legal implications, fear regarding loss of control of the encounter and material, and confidentiality issues.…”

“… 1 , 9 , 10 Some clinicians may decline a recording due to their own preference not to be recorded, others due to the recording being a distraction or putting the confidentiality of others at risk. 9 Covert recording is of particular concern to clinicians, who are reported to hold mainly negative attitudes due to medico-legal implications, fear regarding loss of control of the encounter and material, and confidentiality issues. 1 Policy makers and hospital leaders need to consider how to support patient access to recordings, as a valuable intervention, whilst also considering risks to patient safety and the well-being of the clinicians.…”