You're sitting in a consultation. Things seem to be going well; you have identified the main issues and are exploring them with careful questioning. But gradually you notice something odd. Occasionally, one of the parents, the mother, appears to be paying attention to something else; something not inside the room. You wonder, fleetingly, if she is hearing voices before you spot that what you'd originally taken to be a small hearing aid is in fact something different. With this realisation you see that her glasses are odd too—bulkier in the frame over the right eye—and with a jolt of shock you realise that not only is she recording video of this consultation, but she is streaming it onto the internet, and being fed questions to ask you by an online panel of confidants.

What are your responses to this scenario, currently hypothetical, but technically achievable with technology you can purchase today? They will include some of the following. Your first may be mine; that it is a breach of courtesy, not confidentiality, since this is unilaterally the family's to break. Reasonable and persistent relationships, professional and private, require mutual honesty and trust, and I hope that a family would seek assent from me before doing this. Other responses will range between extremes; some relishing the challenge that this additional complication brings to the consultation, others expressing the desire to practice within a Faraday cage—a structure which shields electromagnetic radiation and all the data carried thereon nowadays.

However you respond, the truth is that the scenario is not …