Should medical procedures be videotaped?
“As well as detecting unprofessional behavior, [videotaping] has the potential to radically improve quality through increased accountability — as witnessed in other businesses such as child care,” they claim.
“Video recording can also be used for learning and self improvement,” the three medical professionals add.
Makary, Pawlik and Xu claim that video recordings could prevent cases such as that of Baltimore cardiologist Mark Midei, who allegedly put unnecessary heart stents in hundreds of patients. (Although Midei denies any wrongdoing, his medical license was revoked in 2011, and the organization that once owned the hospital where he performed the operations agreed last year to pay $37 million to the patients.)
Why would video recordings help doctors (and other medical personnel) practice higher-quality care? Because of the Hawthorne (or observer) effect — the phenomenon by which people modify their behavior (usually for the better) once they know they are being observed.
As Makary, Pawlik and Xu point out, the Hawthorne effect has already been observed in medical settings:
[One study] examined 98 colonoscopy videos and found a wide variation in measures of quality, including completeness of mucosal inspection and total time spent on the procedure. After it was disclosed to the gastroenterologists that their procedures were being recorded and peer reviewed, these measures improved substantially.
In another example, … a hand hygiene project at North Shore University Hospital increased hand washing from 6.5% to 81.6% after the hospital installed cameras to monitor compliance.
And patients appear to like the idea of having their medical procedures recorded. As Makary, Pawlik and Xu note, a survey taken in Indiana of 248 colonoscopy patients found that 81 percent were interested in obtaining a videotape of their procedure — and 61 percent said they would be willing to pay for it.
“Healthcare can benefit from the power of cameras to improve accountability,” Makary, Pawlik and Xu conclude. “In an era where 86% of nurses report having recently witnessed disruptive behavior at work, hand washing compliance remains highly variable, and many physicians do not use evidence based medicine, recorded video can be an invaluable quality improvement tool. If concerns about consent, privacy, and data security are dealt with carefully, video data can tell a story that simply cannot be matched by written documentation.”
“Devices used for many medical and surgical procedures now have a record button,” they add. “It’s time that we turned it on.”
You can read the commentary on the BMJ website.