I mentioned in my last post that I wasn’t recording any of my Skype sessions with patients. The reason is not the simple knee-jerk reaction of “protecting the patient’s privacy” but something else.
The fact is, the privacy issue isn’t that hard to address. Lots of medical information is encrypted and encryption is the key enabling technology for electronic medical records, so I don’t think it would be that hard to encrypt all the recordings well enough to keep them from public dissemination, at least to the same level of protection that is afforded to paper records. Whenever anyone starts to get excited about medical record privacy, I also point out that, in my opinion, it’s probably a lot easier to get into someone’s medical records by bribing someone in an institution (this is how the tabloids always do it), or to hire someone to burglarize someone’s office than to hack into most medical record systems.
I can think of a lot of good reasons to record people’s sessions. When I had psychotherapy supervisors, I often used to record sessions, and I thought it was a great way for my supervisor to hear exactly what I was doing and saying. More than once I’ve wished for “instant replay” of what happened during a session. Sometimes I’m astonished by what someone thinks that I said during a session, and other times I’ve wished I could listen to what someone said to me. I would also love to go back to recordings of what happened with some of my really challenging cases.
Gordon Bell says that every patient should have the right to have a recording of every interchange with a health professional: every lab, every MRI scan, all medical records, and a video of every interaction.
This sounds like science fiction, but I don’t thing there’s any valid argument against this from the patient’s point of view other than that it’s a little impractical right now. After all, the data are arguably theirs, not mine, and I’ll bet these rights get enshrined in law sooner rather than later. Yes, I know that medical records for my patients are legally mine, but with HIPAA and other laws, patients can pretty much get hold of all their records anyway.
Recording everything might change the dynamic of the doctor patient relationship more than anything else that I can think of. Can you imagine?
Oh, by the way, why don’t I record telepsychiatry sessions now? I’m worried about the law, not security. Can you see how this would play (pardon the pun) in a malpractice suit? I’m not interested in being a test case, but I’ll bet it isn’t very long until someone else is.
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