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
Scrubs —- 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 .
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 .
This was not an isolated finding. A report funded by the Department of Justice concluded that “cameras may have a civilizing effect .” 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 .
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 . In fact, the average physician spends almost 11 percent of a 40-year career with an open malpractice claim . 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.
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 . 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 .
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) .
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.