These days recordings can be made at just the touch of a button, meaning practitioners and patients now have an extra tool at their disposal. Dr Jim Lafferty, Dentolegal Consultant at Dental Protection, discusses how this may affect consultations in future
Remember those old spy movies? It was cutting-edge technology to conceal a lapel microphone so that HQ could listen in as the evil genius revealed their plans for world domination. Nowadays most patients entering our rooms carry a potentially much more advanced recording device in just their pocket or handbag – a smartphone.
This technology makes it increasingly easy for patients to record conversations whether we like it or not – most phones have a record function and there are also increasingly sophisticated apps designed specifically for recording voice conversations.
What does this mean for dental practice, especially if the idea of having a consult recorded seems invasive, suspicious or threatening?
Reinforcing patient-centred care
The first and most important point is to approach this phenomenon with a degree of acceptance. We need to be mindful of the possibility and indeed embrace the fact that if every conversation with a patient might be recorded then this can be an incentive to ensure that we always communicate efficiently, effectively and compassionately with the wellbeing of our patient first and foremost.
It is also important to take the patient’s perspective and understand how recording conversations could be beneficial for them. Patients don’t always understand or recall all the information given during appointments and recordings offer the opportunity for increased engagement and adherence by reviewing the discussions at a more convenient time.
Throw into the mix barriers to effective communication that we encounter in practice everyday such as anxiety, cognitive decline, English not being a first language and even simple distractions such as the noisy dental environment – then it is easy to see how a recorded conversation could be a significant assistance to effective communication with our patients.
Additional weight can be given to use of recordings for conversations where the stakes are higher - discussion of complex treatment plans such as full mouth rehabilitations for example, procedures with serious risks like orthognathic surgery and where there is an increased potential for an emotional response shutting down the thinking part of the brain, such as giving an oral cancer diagnosis.
To this end, apps have been developed in medicine such as Abridge, which will not only record the conversation, but use AI to transcribe and define medical terminology and highlight key points such as medication instructions and follow-up times. This can also give an opportunity for family members or significant others to be involved in the process and facilitate support and understanding, as required.
Maintaining trust within the dentist-patient relationship
We have until now considered overt recording but what about covert recording, done without our knowledge? Again, I go back to the point where the dental team should always behave in a responsible and professional manner and consequently any recording should provide evidence of that.
It is important not to let knowledge that you could potentially be recorded create a sense of distrust or defensiveness towards all patient interactions. At the same time, it is understandable that if you discover, later, that a specific conversation has been recorded, it has the potential to alter the trust base of that dentist-patient relationship, especially if you believe it was done with negative intentions.
There is a legal component to consider - the legislation regulating the making and use of audio recordings, challenging the patient can be a complicated process. Consent and privacy stand as the most obvious issues but also relevant is how the recording is used, such as sharing with third parties, publishing or posting on social media, or editing or using selective excerpts.
The legislation is not consistent across all countries and should an issue arise then specific advice should be sought based on your individual circumstances.
What should you do if a patient asks to record a consultation?
First, be appreciative that they have asked and then consider the reason or intention for the request. If you agree, you may ask for a copy of the recording so that it can be placed in their dental records. You should verbally date and time stamp the recording and state who is present so it can act as a contemporaneous record.
It may be important to set some context on the information given, just as you might do on a written treatment plan – the advice you are providing is based on the circumstances and information you have to hand at that time and may be subject to change as more information becomes apparent.
If you feel that the recording could be brought to a third party such as another dentist for a second opinion, then it may be wise to acknowledge that different dentists might have different opinions or treatment philosophies, for example variations in orthodontic opinions and treatment modalities between practitioners.
You need to be mindful that the non-verbal part of the communication will not be captured by the recording so any diagrams, pamphlets, written plans given need to be attached. You may also need to specifically verbalise parts of the interaction that can’t be conveyed by voice recording alone, such as: “I’m showing Mr Smith a model of a cracked tooth, a pamphlet on RCT and a demo model of a crown.”
In summary, the potential for recorded conversations should not be viewed as a threat but, crucially, a motivation for better communication. If we follow the ‘as if’ rule, and act ‘as if’ there is a smartphone with the record button on, that should act as an incentive to efficient, effective and courteous communication with our patients at all times, and any overt or covert recording should provide evidence of that.