A Cowardly New World

Last month, the National Post’s Tom Blackwell reported that a growing number of hospitals say patients and their families are secretly recording doctors and nurses. Some say it’s a symptom of the breakdown of trust being patients and their physicians.  Welcome to a Cowardly New World.

The biggest examples that reported in the National Post included a video camera installed in a clock radio to secretly record doctors and nurses as they treated a patient.  The footage was used as evidence regarding substandard care at Sunnybrook Health Sciences Centre in Toronto.  At Toronto’s University Health Network, a video camera was reportedly concealed inside a teddy bear.  A camera concealed in a wrist watch was used to record evidence against a Calgary psychiatrist.  Smart phones are also being used overtly and also surreptitiously.

I have experienced this first hand in the ER.  On one occasion during a night shift, as I was about to stitch up a patient’s cut, his buddies asked if they could record me doing it.  I thought it was kind of cute and innocent.  The recording took place in a closed room away from other patients so there was no risk anyone else could be filmed surreptitiously.

To be clear, that example was overt.  I had another patient encounter that was quite different.  I remember seeing an elderly patient who came to the ER with a medical problem.  Both the patient and a relative were present in the room the first time I saw him.  I came into the room a second time to give the patient and the relative some test results.  As I walked into the room, I noticed that a cell phone was on a chair in the room; it was seated in the middle of the seat cushion, sort of like an invited guest.  I paid no further attention to it.

The relative said the patient’s daughter (a physician) and was en route the hospital to speak with me.  I started to tell the patient and the relative my working diagnosis and my management plan.  Suddenly, the cell phone talked!  A voice emanated from the smart phone’s speaker disagreeing with me!  The daughter had been surreptitiously listening in all along.

My reaction?  Surprised and embarrassed but I took it in stride.  I answered the daughter’s questions regarding my diagnosis and allayed her concerns.  Secretly, I was glad I’m not the kind of person who speaks without thinking, and that I hadn’t been rude or condescending to the patient and his wife.

But make no mistake:  the surprise element bothered me.  The most charitable explanation I can come up with is that the threesome were speaking to one another when I walked into the room.  Perhaps they thought of fessing up at that moment but didn’t.  Then, with each passing moment, it became more and more awkward for them to let me in on the secret.

The less charitable explanation is that the daughter and perhaps her family believe doctors are not to be trusted and that they needed a secret weapon.  If patients believe that, it means they have lost trust completely. And yet, trust is fundamental to the doctor patient relationship.  More than that, if you don’t speak up about you feel, then how do you expect your doctor or the hospital to respond in a positive way?  How do you expect them to fix things you feel need fixing?

Don’t get me wrong.  I believe there’s a huge role for recording what goes on inside the hospital.  I have no problem being observed.  I was an early proponent of allowing family members in the room during lifesaving treatment.  On White Coat Black Art, Dr. Teodor Grantcharov, a surgeon at St. Michael’s Hospital in Toronto said he is developing a device based on the black box or flight data recorder found in aircraft cockpits that helps crash investigators figure out the root causes of airplane disasters – for the operating room. Since his days as a resident in surgery, Grantcharov has been recording himself during performing operations.  He did a study recently in which he videotaped colleagues doing surgery — to determine how many mistakes the average surgeon makes and how to reduce them.  Open recording might also help patients remember better the doctor’s advice.

There may even be a place for secret recording – for instance – where there are serious allegations of sexual misconduct against a health professional but no proof.  A forensic psychiatrist named Aubrey Levin is accused of sexual misconduct; a video recorded surreptitiously via a video camera placed inside a wrist watch recording what prosecutors say is pretty damaging evidence.

Patient advocacy groups like the Patients’ Association of Canada think videotaping is a legitimate tool to keep hospitals on their toes.

Overt, yes.  Covert, not so much, in my opinion.  As we speak, hospitals across Canada are developing policies that prohibit videotaping without the consent of health care workers and patients. As reported in the National Post,  Alberta Health Services may also ask people to hand over or delete unauthorized images if discovered.  Winnipeg Regional Health Authority is likewise developing a policy.

You can understand why.  Whoever does the recording might unintentionally shoot footage of another patient who happens to be admitted to the same room.  Imagine recording your loved one walking down a hallway on a patient ward and accidentally recording images of ten or fifteen other patients and family members along the way.  That would be a gross violation of patient privacy.  If hospitals don’t actively discourage that sort of thing, then they’ll be held accountable if such recordings are released to the public.

If secret recordings become the norm, I suspect the practice of defensive medicine – ordering lots of unnecessary tests and x-rays to avoid lawsuits – would go up.  Those aren’t the only legal issues to keep in mind. Defensive medicine drives up the cost of health care.  And even if recording is permitted, there are other issues to resolve.  Is the recording part of the patient’s record, as I think it should be?  if so, how should it be stored and for how long?

Couple our voyeuristic interest in other people’s business plus the potential fame that can come quickly from a piece of video that goes viral, I see surreptitious recording as an inevitable development.  That makes me sad and not a little concerned.

Dr. Brian Goldman is a veteran ER physician and host of White Coat, Black Art, a CBC radio show that reveals the culture of medicine and the health care system from a physician’s perspective. He is also author of The Night Shift and blogs at Dr. Brian’s Side of the Gurney. This post first appeared at his blog.