Physician experiences and perceptions of patient-initiated recording in emergency departments: a multi-center survey in Southwestern China

With the widespread use of smartphones, patient-initiated recording in emergency departments (EDs) has become an increasing concern. In the high-pressure EDs environment, physicians frequently perceive such recordings as being motivated less by a desire to enhance understanding and more by a defensive intent to preserve evidence for potential disputes. This study investigates emergency physicians’ exposure to and perceptions of this phenomenon in Southwestern China. A cross-sectional survey was conducted via online snowball sampling among 306 emergency physicians from tertiary hospitals in Southwestern China between September and October 2025. The study assessed the frequency with which physicians encounter patient-initiated recording, associated clinical scenarios, response strategies, and perceptions of ethical and legal implications. A total of 90.20% of respondents reported encountering patient-initiated recording within the past year. Among these physicians, 90.22% reported experiencing covert (undisclosed) recording, identifying the behavior through observation rather than patient disclosure. Commonly reported scenarios by the affected physicians included emergency diagnosis and treatment (77.90%) and dispute mediation (59.06%). Regarding attitudes, physicians rated perceived risks significantly higher than benefits on a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree); while acknowledging moderate utility for elderly patients (mean score = 3.29), they indicated that recording was perceived to promote defensive medical behavior (mean score = 4.82) and induced psychological pressure (mean score = 4.74). Moreover, 72.55% believed the practice negatively impacted the physician-patient relationship. Furthermore, 90.20% expressed a strong demand for professional training, prioritizing case-based analysis of legal disputes (88.89%) and informed consent protocols (88.24%). The high reported exposure to patient-initiated recording—particularly in covert forms—among the surveyed emergency physicians in Southwestern China highlights physicians’ prevalent concerns about a perceived strain on trust and their self-reported association with defensive medical behaviors. Moving beyond strict prohibitions, healthcare institutions should consider prioritizing transparent governance and standardized communication protocols. Furthermore, targeted medico-legal training is essential to clarify rights and obligations, which could potentially help establish clearer institutional boundaries for managing patient-initiated recording. Not applicable (this study is a cross-sectional survey and does not involve any health care intervention).