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Open Monday-Friday Branch Surgeries INGLETON WRAY Telephone Enquires Tel: 015242 61202 Repeat Prescriptions Tel: 015242 42497 Surgery Closed Tel: 015242 61202 Out of Hours services are provided by Website updated |
WHY DO WE VIDEO CONSULTATIONS? A very important part of training of doctors is to use videotaped recordings of consultations to assess the doctor’s competence and to help them develop their consultation skills. Video recordings are sometimes used for assessment and examinations and may be viewed external assessors from outside the practice who do not know the doctor or the patient. We follow the the guidelines on video-recording consultations recommended by the General Medical Council and the Royal College of General Practitioners. Our approach is summarised below.
Does video-recording affect the consultaton? Patients have a right to expect that consultations will be devoted to their needs and expectations and that these will not be compromised by the needs to train doctors. If patients do agree to being videotaped, the care they receive should not be compromised by the fact of the recording or the purposes for which it will be used. They also have a right to confidentiality and to be informed about what the tape will be used for, who will see it and what standard of behaviour is expected of the viewers.
Informed consent Every consultation that is video-recorded is done with the informed consent of the patient. That means that the patient understands that the recording is being made, the purposes for which it will be used, who will see it and how long it will remain in existence. No coercion will be used to persuade the patient to agree to the recording. Informed consent must be sought before the video-recording takes place but it must also be confirmed after the consultation is over. Sometimes the patient may be distressed by the consultation and it may be difficult to broach the subject immediately. Equally the outcome of the consultation may sometimes lead to a patient leaving abruptly in an angry or distressed state. Consultations such as these are often invaluable for teaching and learning but this must not be allowed to override the rights of the patient to give informed consent to its use for these purposes. If post-consultation consent is not obtained or is refused the tape should be erased although a case can be made for it to be viewed by the doctor who conducted the consultation for personal learning purposes. While consent for the use of a tape may have been properly obtained, subsequent viewing may reveal that it would be ideal for other purposes. For example, a consultation showing a vocational trainee with a mother bringing her children for immunisation which is approved for viewing by the trainee and a trainer in the practice may be suitable for use as a resource on a local course for doctors, nurses and managers on child health surveillance. It will only be used in this way if the mother is contacted and agrees to extend consent for different professional groups, some of whom are not health care professionals, to view the tape and for the tape to leave the practice premises.
How should informed consent be requested? When consent to videotaping is sought it must be done in a neutral fashion: the wording of the consent form is that is recommended by the Royal College of General Practitioners. A message will appear on the electronic display board in the waiting room saying: “Dr X is video-recording consultations for training purposes, please ask at reception”. The receptionists will manage consent and inform the doctor that consent has been given or refused. No attempt must be made to persuade the patient to consent. Information given to the patient by the receptionist will include:
The patient must have time to consider the consent form and the explanatory leaflet they are given before they enter the consultation. The patient may withdraw consent at any time, at which point the recording must be stopped, and erased if the patient requests. The recording will also be stopped if the doctor feels it is reducing the benefit the patient might gain from the consultation. At the end of the consultation the patient must be invited to vary or withdraw their consent to the recording, at which point, at the request of the patient, the recording will be erased. If the recording is to be used for any other purpose the patient must give explicit, written consent to the recording to be used for that purpose and should have the opportunity to view the recording before giving consent. Completed consent forms must be filled in the patient’s paper record. The final responsibility for obtaining informed consent and for staff training if the task is delegated, rests with the general practitioner responsible for the video-recording. Some patients may have difficulty in giving informed consent and staff must take great care in obtaining consent to video-recording in these circumstances. Vulnerable groups include:
Where patients are unable to give consent consent must be obtained from a close relative or carer. For children who lack the understanding to give informed consent, the consent of a parent or guardian must be obtained.
Confidentiality It is important that patients have an understanding of who will be permitted to watch the tape on the basis of the consent they have given. The patient should will be given a written explanation which should include the name and address of the individual who will ensure that the scope of the consent is not exceeded and who would undertake to contact the patient for permission if any change of use is required. This individual would normally be the doctor who conducts the consultation, or in the case of a trainee the supervising doctor. The patient should be confident that the viewers of the video taped consultation will refrain from discussing what they have seen outside the session in which they viewed it and the contents of the tape would be treated in the same way as material which might be contained in the patient's medical record.
Content of the consultation In general, patients have a right to expect that they will be treated with respect and sensitivity particularly when distressing problems are addressed within the consultation. All patients require safety during the consultation and to know that they will not be asked to do things which will cause distress. Hence they must be reassured that intimate physical examinations are not recorded and that the camera can be switched off the moment they request it.
Carers, friends and relatives Sometimes patients are accompanied during a consultation and these individuals also appear on tape if the consultation is recorded. They are there at the invitation of the patient and they also have rights of confidentiality and consent. At the very least they will be asked if the patient can sign the consent form on their behalf, the purposes for which the tape will be used having been explained to them.
Individuals mentioned in the consultation Sometimes other individuals are named during a consultation and confidential information about them is discussed. For example the patient may complain about the care received from another doctor or discuss the alcohol intake of colleagues at work. While these individuals also have a right to expect that this material will not be widely broadcast they will never be in a position of being asked for consent for the tape to be used. The doctor who is responsible for the tape must decide whether to over-record those portions of the tape that are damaging to third parties before it is released for wider viewing.
Erasures If a patient wishes a consultation to be erased you must do so. However this does pose some difficulties as VCRs do not at present have an erase button to allow it to be done easily. The material must be over-recorded and a guarantee given that the tape will not be used until this has been done. |
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