The anonymous quality control person will hear you now

Moscow now requires doctors to record audio of patient visits. Officials say it’s nothing to worry about.

In mid-December, the Moscow Health Department issued an order making it mandatory for medical clinics to keep audio recordings of patient visits. City officials said they had decided to implement the rule after conducting a “successful” pilot experiment in two Moscow clinics.

Under the new policy, which came into effect on December 28, 2023, every doctor in the city’s clinics is required to record all patients’ appointments (with the exception of dentists).

According to the Moscow authorities, doctors should already have all the equipment they need to record patient visits. The government’s official recommendations do not say that doctors should verbally warn patients that their words are being recorded, but there should be signs on display to inform them.

The Telegram channel “Ostorozhno, Novosti,” citing chat groups for medical professionals in the city, reported that “as soon as a patient enters the office, the [doctor] must press the ‘Start appointment’ button, after which everything will be recorded on audio. At the same time, no new equipment has appeared in doctors’ offices, leading medical employees to speculate that the audio recordings are being made through their personal computers.”

Patients will not be allowed to opt out of being recorded. The Moscow Health Department’s order says nothing about doctors obtaining patients’ consent — and it’s unlikely that the doctors even have the ability to turn the recording devices off.

If the new system works exactly as the Health Department’s order prescribes, it will technically not violate patient confidentiality as defined in Russian law. The Moscow Health Department has promised that the recordings will be stored on secure servers for no longer than a month and that they won’t be traceable to specific appointments, meaning it will be impossible to identify specific doctors or patients. But this doesn’t mean it’s not possible for this information to leak.

The policy has received criticism from doctors, many of whom have warned it could be used to facilitate repressions or who simply oppose the idea of a third party listening to patients’ personal information on principle. The Moscow Health Department, however, has said the recordings will improve the quality and safety of patient visits, increasing patient satisfaction overall. According to the agency’s official Telegram channel:

We get complaints from patients about the formal and not always respectful treatment they receive from doctors. No less common are complaints from doctors about the disrespectful behavior exhibited by patients.

In general, both sides are right. To increase the level of trust between doctors and patients, what we need is a culture of communication.

Recommendations for how doctors should interact with patients have already been sent out to all of the city’s clinics, but ensuring the guidelines are followed requires additional measures, the department continues:

The heads of more than half of Moscow’s health clinics formally reached out to the Health Department and asked for an assessment tool and to conduct depersonalized audio monitoring. And the Department supported the initiative.

Each institution’s chief physician will choose some of these “depersonalized” audio recordings to be reviewed and evaluated by a specially trained employee, who will then determine whether doctors are meeting official recommendations for how to correspond with patients and will notify their colleagues of their mistakes.

In other words, the initiative won’t concern specific patient complaints, and patients won’t be able to use the recordings of their visits to prove their case if a conflict arises.

The authorities’ set of communication recommendations for doctors includes not talking down to people; not criticizing patients, colleagues, or superiors; not using complex terms; and avoiding an entire list of words and phrases that includes “Impossible,” “Get up,” “Enough!” and “What’s wrong with you?”

It’s unclear whether authorities in other parts of Russia are planning to implement policies like this one. Meduza was unable to find information about any similar initiatives outside of Moscow.