Body Cameras on Physicians and Nurses?
I understand the point but I'm not a fan.
I recently saw this article suggesting that in the battle against racism, physicians and nurses should be compelled to wear body cameras in the same way that police wear them. The author, psychiatry resident Dr. Amanda Calhoun, believes that review of recorded interactions could highlight biased, racist behavior by physicians against people of color.
https://www.bostonglobe.com/2023/07/05/opinion/what-if-doctors-wore-body-cameras/
When I first read the piece I was a bit taken aback. I don’t like the idea of cameras, for a number of reasons. I have argued this in the past. https://www.medpagetoday.com/opinion/rural/89525
Physicians and nurses are frequently on camera. In fact, I’ve seen cameras on walls and ceilings, not only in the hospital hallways, ambulance entrances, parking lots, emergency department but even in break rooms. Although, admittedly, these are not typically enabled for audio. In one hospital where I worked, the nurses were constantly surveilled to ensure that they weren’t eating at their desks. Security officers (no doubt eating in front of their screens) would call to remind them of their misdeeds.
The constant monitoring and tracking of physicians and nurses is an exhausting reality of modern healthcare. Some facilities require staff to wear RFID badges, so that their every step or pause can be subject to analysis of how much time they spent on various activities; including going on break.
Some years ago I pondered the idea of physicians and patients on camera. On one hand, I felt that done well it could basically create the chart without the need for data entry.
However, I generally imagined that it would be oppressive to have a camera record all of my clinical interactions as a physician. In fact, I wrote a story about at least one potential implication of this monitoring in an imagined world where physician satisfaction was taken too far. It was published in Emergency Medicine News. (It was pretty amateurish, dystopic short fiction. I’m not really a Sci-Fi writer and I wrote it in 2001, so read at your own peril...or not at all, which is just fine.)
https://journals.lww.com/em-news/Fulltext/2001/05000/_The_Suffering_Prevention_Act_.22.aspx
Still, the more I thought about it I tried to understand a bit of what the writer was saying. Dr. Calhoun tells us that she has seen terrible instances of racism and bias in the hospital…even to her own family. She wants them brought into the light since they are not only immoral but dangerous.
Who am I to disagree? While I don’t recall ever seeing overt racism, or dangerous bias, in the places I have worked, it’s possible I missed it. Or that I wasn’t looking for it. Or that having not experienced it myself, I’m not sensitive to it. Mind you I’m not suggesting we’re all angels. There are certainly bad people in healthcare who are capable of cruelty and racism.
So I appreciate the passion that this physician in training brings to the table. The desire to see justice done by monitoring, real-time, those who bring medical care to vulnerable groups.
However, I fear that this suggestion, that we all wear body cameras in our clinical care at all times, might not be quite the solution that the author believes.
Indeed, we could catch some very bad actors doing very bad things. Or, the presence of the cameras would change behavior through the knowledge of being monitored. Those are possibilities.
On the other hand, it could also catch bad patients doing very bad things. Many of us, working in hospitals where patients are too often violent or rude or angry, have longed for a camera to record what we experienced. It would be nice to have a camera to show the lewd male patient touching the frightened female nurse. Or the obnoxious intoxicated college student who is loud, profane and uncontrollable. It might help explain the police shooting when the agitated patient is waving a knife around staff and other patients.
Frankly, we’d love to be able to document the behaviors we experience. The threats of violence or litigation; the cruelty (“I don’t care if someone just died; that’s not my problem!”). The nurses or physicians in tears due to stress and exhaustion. Camera’s could do all of that, in addition to identifying racism or other forms of bias.
The video montages could be stunning and heart breaking on many levels.
But problems arise even from that. Would the author be comfortable with those cameras being used to help prosecute criminal behavior? Would the camera, meant to protect the vulnerable, also serve to highlight the very stark reality that everyone, even someone from a from vulnerable demographic, is capable of bad behavior?
Furthermore, who would be charged with monitoring these images? Maybe AI? Or maybe an entirely new career field, akin to drone pilots, would spring up to watch screens and identify racism, sexism and other (and ever expanding) forms of bias. Would these same individuals be willing to identify dangerous, or deceptive behavior and report it? Would these persons be themselves unbiased, or would they look for the behaviors that the cameras were installed to find, and in the process create bias themselves?
Perhaps most important of all, would such a system of cameras and monitors be able to preserve the privacy and dignity of patients and healthcare workers alike? Dr. Calhoun suggests that these images, due to the HIPAA privacy rules, would only be available by permission of the patient. Still, the video and audio files would be stored for who knows how long.
Computer files can be stolen, shared, hacked or manipulated. Would we be willing to spend sufficient dollars to prevent this, and would we relentlessly prosecute those who stole, sold or otherwise compromised those images? Images which could be very embarrassing, depending on the complaint, the person, the professional interaction? Images, in a new age of virtual reality, which might easily be reconstructed to cause harm?
I certainly would want justice of people I loved were neglected or abused. I undertand the point. I just
don’t think such an expanded form of surveillance is the answer. But I also don’t doubt that it may arise. We live in a society where cameras are everywhere. A city dweller is likely on a screen dozens or hundreds of times daily. I don’t think that will end soon. I don’t think it will end well either.
It’s odd though. Those of us who are theistic have always lived with the belief that God was watching us. That all of our behaviors were seen and known. That they had an impact on our relationship with the creator and might well resurface to impact our eternal destinies.
This became passe.’ It became so unscientific. It was perceived as archaic and cruel. ‘What sort of God is always watching you and judging you? That’s ridiculous. Humans are basically good.’
But here we are. We’ve rediscovered the idea that maybe we aren’t so good, and maybe we need to know someone is watching. All the time.
The problem is that we have omnicient cameras. But we the lack divine love and divine wisdom and divine justice that must accompany our ability to see everyone all the time.
As such, I don’t think cameras are the answer. But the real answer requires more than a change in tech. It requires a change in hearts.
That may be much harder to achieve than the cameras.
Edwin
The author ought to be careful what she wishes for. Police body cams were also proposed as a way to identify the police racism that was assumed to underlie all of the racial disparities in outcomes, but what they've shown in reality is that police are generally professional and that the people who struggle with them are overwhelmingly in the wrong. It's likely that medical body cams would reveal something analogous: professionals are usually professional and patients can be a royal pain in the ass sometimes.
You lost me at “ psychiatry resident.”