Why it pays to invest your quality cash
Nick Norwell advises on how to operate within the law if telephone calls to your practice are recorded
The MDU is often asked for advice about the legal and ethical implications of recording patients' telephone conversations.
Recording has a number of advantages, especially in a large practice with a high volume of calls. Messages can be replayed if, say, there is confusion about an address, and recorded conversations can settle disputes about what was said, when and by whom.
The most common question is about consent: must the telephone operator inform patients that their calls are being recorded?
Anyone using a telephone is subject to the conditions imposed by their service provider. These require you to make a reasonable effort to inform patients that the call may be recorded, and to keep a record of how callers are informed.
In response to the growing popularity of recording technology, the GMC produced guidance in May 2002 with specific reference to telephone calls. It states:
'Given the sensitive nature of calls to medical advice lines or similar services, you should pay particular attention to ensuring that callers are aware that their call may be recorded. You must not make intentionally secret recordings of calls from particular patients.'
Many businesses use a simple recorded warning before the caller is connected informing them that the conversation will
be taped. Doctors might be advised to
follow this practice, which is, apart from being a basic courtesy, consistent with a doctor's desire to be honest and open with patients.
Patients could in addition be informed through practice leaflets, surgery notices and your website. A simple message might read: 'In the interests of patient safety the practice records incoming telephone calls. These recordings are strictly confidential and dealt with in the same way as patients' medical records.'
The GMC advises that patients should understand the purpose of the recording, who will be allowed to hear it including names if they are known the circumstances in which it will be played, whether copies will be made, the arrangements for secure storage and how long it will be kept.
It's worth bearing in mind that a tape recording made for clinical purposes forms part of the medical record. It also contains 'sensitive personal data' under the data protection legislation. The GMC advises that you treat the recording in the same way as any other part of the medical record by seeking the patient's consent before disclosure, in most circumstances. In the event of a complaint, claim or some other formal investigation, the doctor may be ordered to or have a duty to disclose all relevant records, including the entire conversation recorded. In these circumstances, GPs would not be allowed to select which portions are relevant and only disclose those parts. Remember that in any legal proceedings an 'original' document carries more weight than a transcript or copy.
Tape recordings should be retained for the same period as medical records, in accordance with Health Service Circular HSC 1998/217.
A 77-year-old woman was found collapsed in her home by her daughter. The daughter rang the practice, a doctor attended promptly; the patient was admitted to hospital and died a few days later. The daughter wrote a letter of complaint she said she knew that her mother had rung the practice that day. The daughter mistakenly assumed that her mother was informing the practice of an illness. In fact, as the recording of the telephone call showed, the patient was simply ringing to ask for a repeat prescription. At the same time the patient sent congratulations to the doctor on the birth of his first child. When the practice received the daughter's letter of complaint it invited her in to listen to the recording, after which the daughter withdrew the complaint.
Nick Norwell is a medicolegal adviser with
the Medical Defence Union
The case mentioned is fictitious, but based on cases from the MDU's files. Doctors with specific concerns are advised to contact their medical defence organisation for advice.