Irreverent opinions: Should you wear a body cam?

October 19, 2015

I recently read about a physician that allowed a patient’s wife to video her husband’s surgical procedure and when complete, posed with the young couple for a nice photograph and YouTube video.

I was astonished – I was horrified. Something deep in my soul tells me this is just plain wrong. 

But then I thought about how many of my friends enjoy turning the television screen around to allow patients to see their own nose from a rhinoscope and will make them a DVD. And then I thought of all the joy a young family has in presenting the black and white sonogram picture of their unborn baby to their family. Isn’t it the same thing really? How far do we go in sharing?

Our definitions of transparency and sharing have dramatically changed in the last couple of years in spite of the government’s false and naive pretense about HIPPA. They look inside us at airports and record our movement on cameras everywhere. There’s almost no human alive with a rash who has not taken a picture of it with an iPhone. Sometimes they publish that on their Facebook – sometimes they bring it in to me. I’ll have to admit it helps me a lot. 

I delved into the subject of documentation and sharing about 25 years ago when I received the one and only complaint to the medical board I’ve had in a practice stretching back to Eisenhower. The young lady complaining was most unhappy with me for not giving her a steroid injection on her first visit as all her other doctors had done. In those days I was much smarter and much more rigid about my criteria for pleasing patients bordering on paternalism. Her story to the medical board was so much different than the actual visit that I was stunned. The board reprimanded me for poor communication in spite of spending more than an hour with her. 

For a while I did surveillance background recording as protection much like policemen do today with body cams. I notified each patient, had them sign a release and recorded and kept it for about two years with audio of every single patient visit. Technology being poor in those days, the volume of recording overwhelmed my ability to store and access it after a couple of years. I quietly gave it up and went back to an older practice. It’s not the same thing as home surveillance camera footage – you don’t keep recordings there for a long time before recycling. 

On the other hand, I’ve always had a practice since the beginning to have a small handheld recorder in every exam room where I could record visits for special people. This was particularly helpful when there was a divorced couple where only one parent came with the child. The recording tended to be an unbiased effort to grant the absent parent unfiltered information from the source. I never had a complaint about that, in fact, I got a lot of appreciative notes. 

I don’t do that much anymore because every living human being that comes to my office has the latest smart phone that can record audio and video. I prefer audio recording and see that video adds very little and takes up a lot more space. I state on my new patient forms that people are welcome to record visits at any time if they want to do so. I am sort of as guilty as the first example except that I do not pose for Facebook. 

So while I am horrified about a surgeon performing like a monkey with an organ grinder, recording is likely to become a standard operating procedure. The government really wants telemedicine. Telephone calls get you nothing, but add a facial picture and there is value? If you think you are squeamish now, every syllable, every eye gesture will now be recorded by the patient and you and kept in perpetuity. It’s not Big Brother paranoia to think that cameras will invade the exam room. Would you have guessed that every traveler would be imaged every visit through an airport? Do you think it’s impossible that airport images will be enhanced to medical grade quality?

“He’s got keys in his pocket and a lot of calcium in that left carotid artery – give him an appointment with the vascular department and run him through again – I want a better shot of the left hip!” I can hear the TSA of the future saying it now. Scary or wonderful? 

Wearing a body cam – scary or wonderful? If it took away some of the onerous useless documentation, I might be more inclined. Either way I am betting it will happen. Giving up privacy while preaching it is the way of the future.

Bobby Lanier MD, FACAAI, Executive Medical Director