Lights, Camera, Scalpel: Should Surgeries Be Recorded?By
Retailers install surveillance cameras partly because workers who know they’re being watched tend to behave better. Baseball players scrutinize videos of their at-bats to improve their swings. Surgery should be recorded for the same reasons. That’s the argument that Dr. Marty Makary, a surgeon at Johns Hopkins Hospital in Baltimore, makes in an op-ed published on April 17 in the latest edition of the Journal of the American Medical Association. Simply recording the many procedures that already involve cameras, such as colonoscopies and heart stent procedures, will mean better care for patients, he says.
“We’re now at a point in modern medicine where most procedures are video-based,” Makary says. “I’m just suggesting that instead of leaving the record button off, we turn it on.” Recording—with patients’ consent and in accordance with privacy laws—could reduce “a lot of the unnecessary cost and harm [that] is due to the wide variations of quality” in health care, he says.
In a 2010 Indiana University study that Makary cites, gastroenterologists spent 49 percent more time inspecting patients’ colons when they knew their colonoscopies were being recorded and would be reviewed by peers. North Shore University Hospital in Long Island saw an even more staggering increase in hand-washing rates when it put cameras at washing stations, according to an additional study: The share of workers who followed hand-washing guidelines jumped from 7 percent to 82 percent. Britain’s National Health Service began placing cameras in some hospitals last year.
Video cameras offer both carrot and stick: Like ball players, doctors can benefit from reviewing their technique. Like retail workers, they apparently behave differently when they know they’re being watched. The trick to getting doctors on board with the idea that video can enhance performance, Makary says, is to present it as a tool for improving care, rather than as a surveillance apparatus. In other words, treat surgeons like baseball players, not retail clerks.
“How can we get doctors to recognize that this is a doctor-to-doctor, peer-based review and there’s no punishments?” Makary says. A few hospitals use recordings in limited circumstances, but he says the practice is the exception. When asked if his own surgeries are recorded, Makary told me, “I haven’t been commenting on own procedures.”
The need to protect patients’ privacy keeps hospitals from using video recording more broadly, says Nancy Foster, vice president for quality and patient-safety policy at the American Hospital Association. But she says taping can improve quality, particularly in chaotic trauma situations. “This is helping people understand exactly what went on,” she says. “When they went back to review, they weren’t simply relying on memory.”
Both patients and doctors may resist wider use of recording. “Many patients are not comfortable providing such authorizations,” says Elisabeth Belmont, the corporate counsel at MaineHealth, a nonprofit hospital group based in Portland, Maine. (Belmont is an unpaid contributor to Bloomberg BNA.) Doctors and hospitals are wary that recordings could invite malpractice lawsuits if something goes wrong. While some laws protect information that hospitals collect for improving quality from becoming evidence in malpractice suits, those measures may not apply to video recordings, depending on the statute, Belmont says.
A camera can’t record every aspect of care that’s meaningful to a lawsuit. “While a video may be able to capture certain risks of a procedure (e.g., nicked bowel in the case of a hysterectomy), it would not capture whether that risk was appropriately handled post-op (e.g., appropriate monitoring of vitals signs and symptoms),” Belmont wrote in an e-mail.
Makary says doctors voiced fears of lawsuits when hospitals began storing digital images from CT scans and MRIs and making them available to patients, but a flood of litigation never came. Cameras—and the transparency they offer—could influence behavior in a way that no degree of education can. Think of speeding, Makary says: Cameras are more effective at keeping drivers within the speed limit than decades of campaigns to highlight the risks of driving too fast ever were. “The government has tried to educate drivers. That has not worked. It has absolutely not worked,” he says. “In health care we have the same struggle.”