One of four articles in the Physician, Record Thyself series. Other articles in series:
The Case for Body Cameras: Good for Doctors – and Their Patients by Jeremy Brown, MD
By the numbers: Are Med-Cams Financially and Technically Feasible? by Nicholas Genes, MD, PhD
Cross Exam: The Legalities of Body Cams Raise a Range of Questions by William Sullivan, DO, JD
Maybe you remember the famous video by Simons and Chabris. Two groups of students, one in white shirts and the other in black shirts, are passing a basketball around. You are asked to watch the video and count the number of passes made by one of the teams. You proudly count 13 (the actual number is 18). But what you didn’t notice, during all of your counting, was that midway through the video, a gorilla walked straight through the middle of the scene. Indeed about half of individuals tested in the original study missed the gorilla [1].
A red trauma victim is brought into the ED trauma bay by EMS. The lead paramedic provides details about the crash scene, the patient’s health status, and gives a point-by-point report about the prehospital care. Too bad that only 36% of the key information was accurately remembered by the receiving ED group [2].
What’s happening here?
These two examples highlight how medical care can be perceived differently, and maybe even contradicted, by doctors and patients. We aren’t aware of something we have missed—like the gorilla. You only see things you are focusing attention on. Have you ever had a patient complain ‘the doctor didn’t even examine my stomach’ when you have performed, and documented, several serial exams? How many times have you been told by a patient ‘when am I going to see the doctor’ when you’ve already had several conversations and introduced yourself as THE DOCTOR. Or, are perplexed by a family display of great disbelief when informed that their loved one is sliding towards the end-of-life.
We think we perceive and remember more of the world than we actually do, and different people experience the same inputs differently. We don’t see, hear, and remember alike. Hearing is passive, but listening requires concentration and focus to understand the meaning of another’s words.
Dr. Brown has identified lots of examples where a med-cam can provide an objective view of medical reality – a sort of enhanced photojournalism – where the picture tells the truth. But we need to be ready to have our own behaviors and communications on display. After all, what’s good for the patient should be good for the doctor, too.
Judith Tintinalli, MD, MS is the Editor-in-Chief of Emergency Physicians Monthly
REFERENCES
1. The Invisible Gorilla (featuring Daniel Simons)-Regional EMMY Winning Video http://youtu.be/UtKt8YF7dgQ
2. Scott LA, Brice JH, Baker CC et al ‘An Analysis of Paramedic Verbal Reports to Physicians in the emergency department trauma room’ PrehospEmergCare 2003 Apr-Jun; 7(2):247-51.
3 Comments
Hi Judith
Great post, which draws attention to a very uncomfortable but necessary discussion.
It is essentially self evident that to improve your performance you need to measure it – quantitatively where possible, qualitatively where not. In the absence of such data, improvement processes are based on myth and assumption, almost ensuring they fail.
Interventions such as this are extremely threatening to us as clinicians because this is an upheaval in our culture. However, it has been done in many other industries with great success and eventual acceptance, and its only a matter of time before it happens in healthcare.
The question is, will we take the lead, or be led?
Judith
A patient complains about a doctor not examining a stomach. The answer is get a bodycam and record. Ridiculous.
Do you still work any shifts? I’m sure if you did a handful, you would have a completely different outlook.
EP Monthly has jumped the shark and majority of articles are being written by out of touch ER suits who I assume don’t practice clinical medicine or practice extremely little.
Easy there Glenn! Amateur photovideographers await this new chapter in the next edition of a certain EM academic lexicon! We all could use some pointers in how to set up good camera angles, appropriate lighting, and positioning of props such as mayo stands and bedside commodes.
I can see it now….youtube posts from highjacked ED doc cams showcasing the “best and brightest” ED patients in their full glory – body parts exposed, unruly behaviors, profanity laced religious epitaphs,drunken polypharmacy fueled rages, unrealistic demands, tirades, and projectile vomiting. Should garner quite a few hits with the general public.