2017-08-18 11:04:02
 The New Old Age: The Appointment Ends. Now the Patient Is Listening.

The next time you see your cardiologist or internist, what would happen if you took out your smartphone or a digital recorder and said you’d like to record your appointment?

The doctor might be startled, might bridle, might have visions of a supposedly confidential discussion showing up on YouTube — or in a malpractice lawyer’s files.

Or the doctor might think more like Dr. James Ryan, a family practitioner in Ludington, Mich.

With his patients’ approval, Dr. Ryan routinely records appointments, then uploads the audio to a secure web platform so that patients can listen whenever they need to recall what they discussed with him. They can give family members access to the recordings as well.

Sheri Piper, who has seen Dr. Ryan almost monthly for a host of medical problems — gout, high blood pressure, hypothyroidism, anxiety and depression — has come to rely on this system.

“As aging continues, it’s harder to not be overwhelmed by what you hear in a doctor’s office,” said Ms. Piper, 63, a retired administrative assistant.

An extended round of hospitalizations and operations in 2013 affected her memory, she said, so “you can tell me something today and I won’t remember tomorrow.”

Thus, last month, straining to recall what Dr. Ryan had said about how often to take allopurinol for gout, she turned to the recording (annotated so that patients can easily locate specific topics of conversation) for clarification.

When she changed blood pressure meds, she asked her daughter, who lives nearby, to listen to Dr. Ryan describe side effects to watch for.

“At some point, it will become a normal thing, recording these encounters,” Dr. Ryan said — though given physician resistance, he thinks that might take 20 years.

But it’s not a crazy idea, especially for older patients. Like Ms. Piper, they typically contend with several health conditions, so they visit more doctors more often and take more drugs.

They may also have hearing loss, and research shows that they struggle more than younger patients to recall information from doctors’ visits.

“There’s more to remember and difficult words to decipher and interpret,” said Dr. Glyn Elwyn, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice and lead author of a recent JAMA editorial on patient recordings.

Often, when older patients want to tell a faraway relative what a doctor said, “they struggle and fail because complex language was used and they don’t have a record,” Dr. Elwyn added.

But in most states, the editorial points out, they could have one. Under wiretapping or eavesdropping laws, 11 states require that all parties consent.

In those states (California, Florida, Illinois, Maryland, Massachusetts, Michigan, Montana, New Hampshire, Oregon, Pennsylvania and Washington), you’d need the physician’s O.K. to hit “record.”

But in 39 states and the District of Columbia, the law requires just one party’s consent. Nor does the Health Insurance Portability and Accountability Act, the federal law protecting health information privacy, forbid recording by patients, who are not “covered entities.”

In these jurisdictions, physicians who are uneasy about recording can either swallow hard and agree, or terminate your visit (some legal experts argue that they can’t do that, either). But if you’re the patient, you can legally proceed.

And you might find that useful. A review of 33 studies of recorded visits concluded that most patients listened to their recordings, shared them with caregivers and reported being better able to retain and understand information.

You could record sneakily, as already happens now that recorders — a.k.a. cellphones — sit in so many pockets and purses. In a survey of 128 patients in Britain, Dr. Elwyn and other researchers found that 15 percent acknowledged surreptitiously recording a visit.

But he doesn’t like the idea. “It fundamentally disturbs the relationship,” he said, undermining trust between doctor and patient.

Better, he thinks, to make recording an open practice, while cautioning patients to be thoughtful about how they use the results (and pointing out that they can hit “pause” at any point, should there be issues they don’t care to share with anyone).

Physicians’ fears about recordings finding their way into lawsuits aren’t completely unfounded. In Britain, Dr. Elwyn said, some recordings have been admitted as evidence in court cases. Here, “it’s untested,” he said.

But in 2015, a Virginia jury ordered an anesthesiologist and her practice to pay $500,000 to a patient who sued after he inadvertently recorded the medical team’s insults while he was sedated and undergoing a colonoscopy.

Moreover, widespread recording would raise questions about who owns and can use this growing archive of patient-doctor interactions, and for what purposes.

Dr. Ryan, for instance, thinks such data — stripped of identifiers — could help researchers and future physicians improve medical communication. But the information might also be used for less welcome purposes, like marketing campaigns.

Still, several practices and institutions already record patient visits — the Dartmouth institute is studying their approaches and results — and report few problems.

The University of Texas Medical Branch at Galveston buys recorders and batteries in bulk, offering them to patients at cancer clinics. About 300 new cancer patients a year agree to use them, said Dr. Meredith Masel, director of the Oliver Center for Patient Safety and Quality Healthcare, which started the program in 2009 and will soon expand it to internal medicine and geriatrics.

At the Barrow Neurological Institute in Phoenix, Dr. Randall Porter, a neurosurgeon, prefers video. He uses plastic models of the brain and spine during office visits and shows patients (half of them over age 60, he estimates) their M.R.I. scans.

With their consent, he records the session on an iPad, then offers them the video to watch later on a web platform he founded called Medical Memory. They can choose to make the video accessible to family or friends, as well.

Without recordings, “patients forget 80 percent of what we say by the time they hit the parking lot,” Dr. Porter said. He understands why that might be: He’s often talking about cutting open their skulls, an emotionally laden subject.

In his survey of 333 patients, about half said they watched their videos more than once, and two-thirds shared it with others. Most said it helped them remember details and feel more “at ease” with their conditions.

Far from heightening litigation risks, Dr. Porter said, use of the system has actually cut the institute’s malpractice insurance costs in half. Since 2015, more than 400 doctors have signed on to use Medical Memory, recording 28,000 visits.

While doctors sometimes balk at recording, patients in these practices seldom have. Of 500 patients Dr. Ryan has asked, only four declined to be recorded — and one later changed his mind.

When patients agree — or bring a recorder and initiate the process themselves — “it’s not because they’re trying to catch us,” Dr. Porter said. “It’s because they’re desperate to remember everything we tell them.”