Cellphones and Medicine: What Would Hippocrates Do?

Hippocrates of Kos was a Greek physician of the Age of Pericles, credited as the first person to believe that disease was not a punishment inflicted by the gods, but rather the product of environmental factors, diet and living habit.1,2 Hippocratic medicine was notable for its strict professionalism, discipline and rigorous practice, recommending that physicians always be well-kempt, honest, calm, understanding and serious.3,4

Hippocrates is often referred to as the “Father of Medicine,” and the use of the rectal speculum as discussed in the Hippocratic Corpus constitutes the earliest recorded reference to endoscopy.Despite his progressive nature, we have reason to believe that Hippocrates never had to deal with cellphones.7

Cellphones represent an occupational hazard to the professionalism and discipline of medicine. In Hippocrates’ time, it was technologically impossible for patients to surreptitiously record conversations with their physicians. This is no longer the case. We have recently encountered the following scenarios in clinical practice, and ask “what would Hippocrates do?”

Scenario #1: A physician is in the middle of performing a screening colonoscopy procedure when his cellphone rings. The nurse documents that the phone rang, and that the physician continued the procedure. The physician identifies and removes a 0.5 cm polyp in the sigmoid colon. Two years later, the patient presents to her primary care physician with complaints of rectal bleeding, abdominal pain and a change in bowel habits. Colonoscopy reveals a 3.5 cm ulcerated mass in the ascending colon. During discovery, the plaintiff’s counsel asks the endoscopist “were you paying attention at all times during the endoscopic procedure?”

Scenario #2: A physician performs an endoscopic procedure. One week later, while speaking with the patient about the results of the procedure, the spouse states “Doctor, I recorded the entire procedure starting when my wife went from the waiting area to the preparation room, to when you discussed the findings with us in the recovery room. What you are telling me now isn’t what you told us the day of the endoscopy.” You had no knowledge that the conversation was being recorded.

Federal law only requires one party to a recording to be aware it is taking place. 8“One party” consent, which may include either the person operating the recording device or others, could allow for secret recording without a doctor’s knowledge, without fear of legal repercussions. Several states, such as California, Florida, Michigan and Pennsylvania, broaden that protection by requiring the consent of every party involved in a recorded interaction.9

When a conversation is recorded without a physician’s consent, the nature of the relationship between patient and physician can change. Physicians who suspect secret recordings or learn of them after the fact may believe that their perceived right to consent to recordings — and the trust of the physician-patient relationship — has been violated. They may feel vulnerable because of the protections conferred by law to patient-physician communications. This can threaten the integrity of an existing patient-physician relationship and predispose a physician to assume a posture of distrust toward future patients.10Another concern is that recording could undermine the privacy of the visit, as a patient may be less open if they know their family members will hear the recording later, or if they fear the recorded content is at risk of being shared without their knowledge.11


Physicians and their staff should be aware of the possibility that every conversation with a patient or his or her family may be recorded.


How can physicians protect themselves from surreptitious recordings? Physicians and their staff should be aware of the possibility that every conversation with a patient or his or her family may be recorded. This can be used as an opportunity to develop effective communication skills, and to ensure that sensitive information is communicated efficiently and effectively. If a physician suspects that a conversation is being recorded, the physician can ask the patient and family if they are recording the conversation. This can provide the physician with the opportunity to note constructive uses of such recordings, demonstrating the physician’s desire to strengthen the relationship with the patient.12

What about the risk of distraction? When healthcare professionals are on their smartphones, they are “no longer in the room.”13-17 The ECRI Institute identified “caregiver distraction from smartphones” as being a top health technology hazard.18 In view of such, we recommend that physician offices, endoscopy centers and other facilities consider a policy stating that to minimize distractions, all phones must be silenced at the start of patient care and may only be used for patient care or a personal emergency. Importantly, it is critical for the physician to inform the patient when they are using a smartphone, and for what purpose.19

In this era of transparency, it is critical to establish trust. Patients should feel free to explain that it is hard to remember medical information and treatment instructions, and ask their physician or other health-care professional if it’s okay to record the conversation. In return, physicians should honor that trust and silence their phones while treating patients. That’s what Hippocrates would do.

Dr. Brill has no conflicts to disclose.

References

1. Adams, Francis (1891), The Genuine Works of Hippocrates, New York: William Wood and Company

2. Grammaticos PC, Diamantis A. (2008). Useful known and unknown views of the father of modern medicine, Hippocrates and his teacher Democritus”. Hell J Nucl Med 11 (1): 2–4

3. Garrison, Fielding H (1966), History of Medicine, Philadelphia: W.B. Saunders Company

4. Margotta, Roberto (1968), The Story of Medicine, New York: Golden Press

5. Strong, WF and Cook JA. ”Reviving the Dead Greek Guys.” Global Media Journal Summer 2007.

6. Jani, P.G. (2005), “Management of Haemorrhoids: A Personal Experience”, East and Central African Journal of Surgery 10 (2): 24–28

7. Reed, Brad. “Meet the guy who made the first cellphone call 40 years ago today.” Network World, May 9, 2011.

8. Interception and Disclosure of Wire, Oral, or Electronic Communications Prohibited, 18 USC §2511 (2011)

9. Reporter’s Recording Guide. A state-by-state guide to taping phone calls and in-person conversations. The Reporters Committee for Freedom of the Press. 2012 Arlington, Virginia.

10. Rodriguez M, Morrow J, Seifi A. Ethical Implications of Patients and Families Secretly Recording Conversations With Physicians. JAMA. 2015;313(16):1615-1616

11. Goldstein J. Patients poised to record doctor’s visits. June 26, 2015. Available at http://www.thompsoncoburn.com/news-and-information/health-law-checkup-blog/

12. Weiss BD. How to bridge the health literacy gap. Fam Pract Manag. 2014;21(1):14-18.

13. Page L. 10 New Malpractice Concerns, and How to Avoid Them. Medscape Business of Medicine. November 4, 2015. Available at http://www.medscape.com/viewarticle/852200_1.

14. Feuerbacher RL, Funk KH, Spight DH, Diggs BS, Hunter JG. Realistic distractions and interruptions that impair simulated surgical performance by novice surgeons.Arch Surg. 2012;147:1026-1030

15. Katz-Sidlow, R. J., Ludwig, A., Miller, S. and Sidlow, R. (2012), Smartphone use during inpatient attending rounds: Prevalence, patterns and potential for distraction. J. Hosp.Med., 7: 595–599.

16. Gill PS, Kamath A, Gill TS. Distraction: an assessment of smartphone usage in health care work settings. Risk Management and Healthcare Policy. 2012;5:105-114. doi:10.2147/RMHP.S34813.

17. Westbrook JI, Woods A, Rob MI, Dunsmuir WTM, Day RO. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med. 2010;170(8):683–690

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