Can you imagine it? You arrive at the hospital, torn between dread and hope, to discuss with the consultant whether he or she thinks your Down's syndrome baby is suitable for heart surgery. There will have been examinations and tests and finally you are there, sitting across the table with your stomach churning waiting for the verdict. Then somebody - perhaps a nurse, perhaps the consultant - puts a tape recorder on the table and turns it on.

This is the recommendation of the inquiry into the treatment of Down's syndrome children at the Royal Brompton hospital in London. The inquiry found that doctors who declined to operate to mend the holes in the hearts of Down's children had not meant to discriminate against them, but that in failing to go the extra mile and pursue all the options for them, that was effectively what they did.

The parents have been outraged. So hurt and appalled are they that tape recording consultants - to get the evidence if there is bias or a bad judgment - must feel like a good idea. If only they had secreted a machine in a jacket pocket, there would have been no argument. Perhaps they could have got the guilty party sacked. That's how you feel when things have gone wrong. Some of the parents whose babies were sent for heart surgery at the Bristol Royal Infirmary and did not survive, at a time when some doctors were aware that the hospital's success rates were unacceptably low, may feel the same.

But what does that tape-recorder on the table do to the conversation between consultant and parent? It puts a barrier of suspicion between them. That tape says that the patient does not trust the doctor. It may also come to say that the doctor does not trust the patient. It's a step further towards the sort of litigation culture that prevails in the US. The doctor is not going to have a full and frank conversation with the parent - he or she is going to say what they know they can defend in court.

The sort of "key consultations" the inquiry report has in mind are emotional affairs and they need to be. Parent and doctor both usually care passionately about the fate of the child. That needs to be let out. There has to be trust and there has to be an exchange of feelings. How will that happen with the tape going round and round and somebody occasionally checking to make sure the red recording light is still on?

Tape recorders are the tools of the police interview. They are not suitable for the consulting room. But the fact that an inquiry can think they might be is a devastating indictment of the state we are in. Huge improvements in communication need to be made and trust in doctors needs to be rebuilt. More openness is needed, less paternalism and encouragement to parents and patients who want a second opinion. Tape recorders will make many doctors shut up like clams. They are not the answer.

To HRT or not to HRT. The question becomes increasingly difficult. A recent study has shown that women who take hormone replacement therapy in the shape of oestrogen for 10 years have an increased risk of ovarian cancer. In fact, their death rate from it was twice that of women who had not taken oestrogen.

But the numbers are still small. The Cancer Prevention Study in the US recruited 1.2m women, of whom 944 had died within a decade from ovarian cancer. But it's a particularly nasty cancer because survival chances are not good.

This isn't the only risk now recognised in taking HRT. Taking oestrogen alone, without progestin, increases the risk of endometrial cancer - cancer of the lining of the womb. It can also lead to bloodclots and gallstones. Last year it was also found that taking combinations of hormones for several years increases the risk of breast cancer.

But there are health advantages to taking HRT. Not only does it relieve the menopausal symptoms of hot flushes and sleep disturbances, but oestrogen can help prevent the bone-thinning of osteoporosis. Several studies have found that it also reduces deaths from heart disease.

So what should women of a certain age do? It's a tough one. The official line is that they should weigh up the risks and benefits of their own case, but there will always be an element of uncertainty. It's not a good situation for the anxiety-prone.

The latest study from the US may increase women's alarm, but at least it is good to know that the effects of HRT are still being studied. Huge numbers of women are now taking it, but as with any long-term medication, they are effectively taking part in an experiment. It may be as well to remember that.