The Case for Body Cameras: Good for Doctors – and Their Patients

13 Comments

One of four articles in the Physician, Record Thyself series. Other articles in series:

By the numbers: Are Med-Cams Financially and Technically Feasible? by Nicholas Genes, MD, PhD
The Invisible Gorilla: Are doctors ready to have their professional lives on display? by Judith Tintinalli, MD, MS
Cross Exam: The Legalities of Body Cams Raise a Range of Questions by William Sullivan, DO, JD

Brown 288 wScrubs —- check. Stethoscope — check. Body camera — check.
That’s a list I’d like to see more doctors and nurses check off before they start their shifts. The New York Police Department recently announced an accelerated program to equip their officers with body cameras, and the President is supporting initiatives to increase the number of police who wear them [1].

These devices should also be worn by health care providers. Think of them not as web-cams, but as med-cams. Although the introduction of this new equipment is relatively recent, these tiny cameras already appear to influence the behavior of both the public and the police. In one recent study, officials in Rialto, California randomly assigned officers to wear the camera while on patrol while others did not. After one year, it was found that the officers who wore body cameras used force only half as often as those who did not the body cameras. And, when cameras were introduced, the number of complaints made against officers fell from 24 per year to just three [2].

This was not an isolated finding. A report funded by the Department of Justice concluded that “cameras may have a civilizing effect [3].” Because people generally behave better when they are told they are being filmed, the need to use force, deadly or otherwise, is reduced.

While most doctor-patient interactions end to the satisfaction of both parties, many do not. In certain “high risk” medical specialties like neurosurgery and obstetrics, almost every practicing doctor will be sued at least once [4].

Reducing Malpractice Claims?
For those in non-surgical specialties like pediatrics or psychiatry the forecast is almost as grim; three quarters of these physicians will be sued at least once by the time they retire [5]. In fact, the average physician spends almost 11 percent of a 40-year career with an open malpractice claim [6]. A physician worn body camera — a med-cam — might considerably reduce this number.

Most malpractice claims involve allegations of a missed diagnosis or an error in surgery.

In many cases, claims are made months or years following the interaction, and because it can be very hard to recall what was actually discussed, the case may hinge on the medical record. While this offers some insight into what the doctor and patient may have said, it only tells part of the story. The med-cam could be used to show what was actually discussed, and we would not have to use the often unreliable testimony of either plaintiff or practitioner. In cases where the claim was a botched surgical procedure, the med-cam would allow expert review based on the visual record rather than an attempt to reconstruct what happened from a mix of medical notes and memory. Cases with no merit would be rapidly dismissed, while those situations in which there was video evidence of malpractice would be settled more quickly.

Reducing Violence?
When faced with violent patients, the med-cam might offer the same benefits to medical staff as it does to the police. Nearly half of all emergency physicians (myself included) have been assaulted, and ER nurses are verbally abused and physically attacked so often that this violence has shamefully come to be seen as just another part of their job [7]. Informing these violent patients that their behavior is being recorded on a personal med-cam will de-escalate many confrontations, to the benefit of all the parties, and help to support the actions of staff when, as a last resort, physical or chemical restraints are needed.

Are we ready for this next step on the path towards the panopticon? The truth is, we have already taken it. For years now, cameras have recorded the behavior of staff (and patients) in ER trauma room, during newborn resuscitations9 and even in the colonoscopy suite [8,9]. And when asked, most patients support the ideas of having such recordings [10].

Of course, it’s a giant leap from recording some procedures with a wall-mounted camera to recording all medical interactions with a body-mounted cam. Like cameras worn by the police, the med-cam would require thoughtful regulation, and its deployment should be carefully piloted. As with any new technology, there is sure to be opposition (remember, early adopters of the stethoscope faced ridicule when they introduced that device) [11].

But, bottom line, this kind of recording will be good for patients, their families and the medical teams who care for them. We all behave better when someone is watching.


Jeremy Brown, MD
is Director of the Office of Emergency Care Research at the National Institutes of Health. His opinions do not necessarily represent those of the Office, NIH or any other branch of government.

REFERENCES
1. http://www.whitehouse.gov/blog/2014/12/01/building-trust-between-communities-and-local-police
2. http://link.springer.com/article/10.1007%2Fs10940-014-9236-3
3. https://ojpdiagnosticcenter.org/sites/default/files/spotlight/download/Police%20Officer%20Body-Worn%20Cameras.pdf
4. http://www.nejm.org/doi/full/10.1056/NEJMsa1012370
5. http://content.healthaffairs.org/content/32/1/111.short
6. http://onlinelibrary.wiley.com/doi/10.1111/jhq.12011/abstract;jsessionid=127CDEF844F1596B35525EFFF72AB76A.f03t02?deniedAccessCustomisedMessage=&userIsAuthenticated=false
7. http://onlinelibrary.wiley.com/doi/10.1111/jhq.12011/abstract;jsessionid=127CDEF844F1596B35525EFFF72AB76A.f03t02?deniedAccessCustomisedMessage=&userIsAuthenticated=false
8. http://journals.lww.com/jtrauma/abstract/1988/04000/video_recording_trauma_resuscitations__an.3.aspx
9. http://pediatrics.aappublications.org/content/106/4/654.short
10. http://jama.jamanetwork.com/article.aspx?articleid=1673991
11. http://books.google.com/books?id=yhw4AQAAMAAJ&dq=duncan%20contributions%20to%20morbid%20anatomy&pg=PA303

ABOUT THE AUTHOR

Jeremy Brown, MD is the Director of the Office of Emergency Care Research at the National Institutes of Health. His opinions do not necessarily represent those of the Office, NIH or any other branch of government.

13 Comments

  1. Keith Raymond on

    Are you just a little crazy? Point by point> Complaint reduction, no. HR would have a field day. Reduce Malpractice claims, no. Increase as each action is scrutinized for standard of care compliance. Reduce violence,no. That’s what they said about kids with glasses. HIPAA violation, you bet. Replace MD Notes, No. Added benefit, none. Risk, oh yeah. Since this is not a selfie cam patient and staff responses to actions are one sided and misinterpretable. Not in my ED!

  2. Peter Shieldhouse MD on

    There was a Gynecologist in Baltimore who did just that and when the victims found out they sued him for millions. I think he had different motives than the writer of the article.

  3. Silly idea. Why do we shoot ourselves in the foot by suggesting further ways for business men to regulate us? I’m in my fifties and would leave Medicine today based on the progressive stupidity if I could afford it.

  4. gene saltzberg on

    The day this requirement goes into effect is the day I start doing insurance xams. Who will store, review and ultimately judge me by this technique? Finally, who will pay for it all. The answer is: we (ED Docs!) will with our fees lowered by yet another overhead cost to the hospital!!

  5. I agree. This is insanity. I understand the sentiment, but talk about a privacy and confidentiality issue. I bet the patient would love that video of the rectal exam shown to the jury.

    As for complaint reduction, that is simply laughable. Because the video wouldn’t be viewed until there was a complaint. Duh. My last shift I had a patient call the State Police because I wouldn’t give narcotics. No kidding. Do you think that person would be deterred by a body cam?

    As for malpractice, well, we all know they’re usually due to a poor outcome, with emotions stoked by lawyer infomercials, rather than poor medicine, so unless the cams have some healing effect, I’m not sure they’ll help.

    As for the trauma room cams, they’re basically a prurient voyeur’s paradise, obtaining cool pics to show at conferences, and not useful for much else. Also, I think the statement that “the patient’s support such recordings” was referring to an article on HANDWASHING for goodness sake, not the filming of their pelvics and rectals.

    My bottom line disagrees with Dr. Brown’s, namely that this is not good for patients and everyone else. It is sinking to the lowest common denominator, and further demeaning the medical profession, while likely supplying copious grist for the malpractice, insurance review, and “quality” mills. I truly do not believe any good would come of this.

    Of course, it would be a boon for all those medical voyeur TV shows, where docs eager to whore out their patient’s privacy can get their 15 minutes of fame.

  6. Christian DenOuden on

    Going to have to agree with Keith. I see no role for body cams in the ER. The amount of complications would be unbearable. People demanding video as part of their medical record. It would make my work intolerable. How much of patient hx taking is physician gestalt. What about the patients that need the doctor to adjust their hx for what is really going on. Oh yeah, +CP on ROS? Well Dr, they stated they had chest pain and you did not work it up. Yeah it was a 21 yo w an ankle sprain. The chart is our guide and our record and we control it. You want to give that last bit that we control up to the lawyers? Game over.

  7. Glenn Hubbard on

    When an ED staff is abused or violated by a patient, the hospital administration tries their best to blame it on the staff. Then they refuse to do anything about it and will not file charges or support the staff member, despite several witnesses (employees and nonemployees alike). A Bodycam will not help. Does EP Monthly support the ED clinician’s innate right to self determination any more? Or does this Journal pander to Team Health and other Contract Management Groups who want to choke/enslave the ED physician.

  8. Dr. Common Sense on

    Hell no. There is no upside to a physician from this for reasons already listed in the previous post.

  9. I’m a thrice abem certified md
    I’m retired now
    In 22 years I’ve seen a lot of changes in medicine
    BUT it’s idea of webcams is a joke
    Or ,if serious, sheer madness!!

  10. Suit — Check, Stupidity — Check, Sycophant — Check. Thats the list our current ED director checks off before starting his day at 9:30am. The above items are the devices that he/she seems to be wearing day in and day out to keep the title in check.

    ‘A physician worn body camera — a med-cam — might considerably reduce this number.’ —- where are you getting this idea from? The NIH?

    The medcam can only be used against us. Admin rarely supports the physician during a patient complaint. Things get twisted and turned when there is only one camera angles. #Ferguson

  11. I’m in the same camp as the other responders above. This sounds like more of the same – administrator think tanks with too much free time and not enough clinical exposure. Any ED doc in their right mind would never support this initiative! And to use DOJ or police studies as a comparison? Really? Nuts! Sounds like a flawed study to this old ED salt. I also agree that the malpractice lawyers would have a field day with this. Maybe the only positive would be that we could use the “live ED” tape of unruly ED patient behaviors to ban them from coming back…oh wait, EMTALA and other mandates prohibit us from expecting patients to conduct themselves in a civil manner. More and more our “leaders” are sell-outs to the corporate jibberish that is taking the focus away from the real practice of medicine. Slipping away is the honor, respect, and independent craft of the practice of medicine. Maybe someday we, the physicians,will re-claim the high ground and reconnect with the “art” of medicine instead of the modern day falacies being put forth by delusional fools.

  12. Gregory Lampe on

    Open up your minds a bit folks. If we could use it to replace the medical record, eliminate charting, reduce computer time as we know it, and extract billing data from it, then I might be interested. Then we could just take care of patients, and a heck of a lot more of them.

  13. The day they make me wear a camera will be the day I quit, and take care of people who need and appreciate the care I provide. South America, Africa? Who cares. Won’t be any place I am wearing a camera.

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