The developed world seems to be consistently moving down the path of increased recording and surveillance of almost everything; an interesting question is when will this start to extend into clinical care?
Obviously, revelations of US government intelligence capabilities have been extremely controversial, with obvious references made to Orwell’s 1984. However, somewhat in opposition to this concern about expanding surveillance, there is actually increased demand for ability of the populace to surveil the actions of the government. There is also increased interest in what is termed sousveillance, rather than monitoring from above (sur), monitoring/recording from the individual level, that is below (sous). Beyond efforts in generally increasing government transparency, there is also a big effort to expand recording the activities of government personal, particularly law enforcement. Individual stories highlight instances when video recordings have helped individual citizens, and reviews of police groups using increased video recording of activities have shown reductions in complaints of misconduct and violence, while at the same time increasing the speed and efficiency of prosecuting criminals. Basically, the idea is that the police are less likely to act out if they can be monitored, people are less likely to make false accusations against the police when the whole interaction was recorded, and finally additional recording enables police to capture footage of perpetrators in the act of committing crimes, expediting the whole judiciary process. This is obviously not without controversy, and many are opposed to this idea of increased sur/sous-veillance, both potentially making the lives of the police more unpleasant and making their jobs harder; at the same time there are potentially many opportunities for abuse with violations of privacy. If data is collected, there is the possibility it can be leaked. There is also a case that can be made that this limits the ability of individual police officers to use judgement in being somewhat lenient in the enforcement of certain infractions for the overall greater good. However, I would suspect that the long term changes will all push for increased video recording, including more body cameras, dash cameras, and city wide surveillance systems. If we follow current trends on the expansion of dash cams, things like body cams are likely in the future of most police in the US.
Given that our views of what is standard for policing are evolving, and the expansion and increased acceptance of almost ubiquitous video recording (obviously things like Google Glass is not without controversy), an obvious question is whether something similar going to happen in clinical care. Currently, patient encounters are typically not recorded. Some aspects of clinical care may be recorded, such as surgical procedures, radiological imaging certainly records the patient (sometimes with motion) or in the case obstetrical ultrasounds the patientS, and we may take photographs of surface anatomy and wounds (dermatology loves to take pictures of the skin). Video recordings of functional behavior may be recorded, such the use of videotapes of a patient’s gait by the neurologists treating movement disorders. However, these are all isolated bits of recording. It would be very different for the entire clinical encounter to be recorded and included as part of the medical record. What if all healthcare providers had body cams? What if all exam and procedure rooms were wired for video and sound?
What would be the advantages? It might be possible to facilitate some of the record keeping which occupies so much of provider time. Procedures could be routinely recorded in explicit detail, and if anyone wanted to refer back to a particular point, they could just access that instant. Patients could be more easily compared across time, in behavior, appearance, and functional ability. It would be easier for peers to help coach providers on improving care, not just at morbidity and mortality rounds when things have gone wrong, but making things better when they are already okay, much like Atul Gawande’s writing on the value of coaching and achieving and maintaining peak performance. It would clear up a lot of ambiguity in medico-legal issues, as what happened would be much more straightforward in most cases (it wouldn’t necessarily clear up what exactly the correct thing to do was, however). It might improve quality and consistency of care in general.
What would be the downsides? Certainly, there many issues of privacy here. Many patients would feel even more reluctant to reveal personal details. There wouldn’t be the ability of physicians to filter out a bit of what personal information gets into the medical record. What about patients with psychiatric problems? Those recordings could persist in time and be leaked in the future. Illness is a particularly vulnerable time, when people often appear at their worst, and often act out because of pain, stress, and simple diminished competency due to illness. Providers, would generally feel very limited in their ability to control their own work and lives, possibly leading to much decreased satisfaction and poorer patient interactions. It’s much harder to have a genuine heart to heart with someone if you know a video camera is rolling. These are just a few downsides.
However, it is interesting to speculate that as social norms and expectations change. Our feelings about issues of privacy and what is normal often seem to evolve. It will be interesting to see what the future holds and what changes will take place in the recording of encounters with healthcare providers.
