“Knowledge is power. Information is power. The secreting or hoarding of knowledge or information may be an act of tyranny camouflaged as humility.”
– Robin Morgan
Fifteen years into the future, in 2030, a patient returns home after a stay in the hospital. He powers up his mobile device and finds a file that was created during his surgery.
“Let’s see,” he says. “I think I’ll turn off the ‘commentary’ for now. Maybe I’ll watch it in HD first and then try it in 3D.” He scrolls to the point where he is rolled into the operating room. He watches every step of the operation until he is wheeled back out. The images follow him to the recovery room and eventually to the hospital floor. He takes a few notes. “I don’t remember any of this,” he says to himself.
This scenario will almost certainly occur. Video cameras are already in every hospital, but the data have yet to be fully mined.
The use of images in health care began decades ago. The textbooks and medical journals of the early 20th century included diagrams but very few photographs. During my career, the technology changed. As an otolaryngology resident in the 1980s, our department had a Kodak Instamatic camera that used flash cubes and slide film. For some reason, I was the resident usually sent to retrieve the camera and bring it to the OR. If the photos were adequate, nothing was said; however, if they were overexposed, out-of-focus or off-center, I heard about it. Occasionally, one of the senior surgeons would schedule a camera team to come to the operating room to film an interesting procedure for later use at meetings or in lectures, but the disruption and the bulky equipment, film, and hot lights made the process cumbersome and rare.
Over the years, of course, technology evolved from film to video to digital. Radiologic images and medical records are no longer on film or paper. Patients look up their labs and reports online. Endoscopic procedures, catheterizations, and arthroscopies are routinely recorded. The information from piles and piles of films and paper records can now be contained on a flash drive. Despite the gnashing of teeth by many physicians, the digital age had arrived.
How might physicians and patients react to having a record of every hospital encounter? Studies of workers demonstrate that they are more compliant with guidelines and protocols when they know they are being observed. Mark Makary, a surgeon at Johns Hopkins University, recently wrote in the British Medical Journal, that “health care can benefit from the power of cameras to improve accountability. In an era where 86 percent of nurses report having recently witnessed disruptive behavior at work, hand washing remains extremely variable, and many physicians do not use evidence-based medicine, recorded video can be an invaluable quality improvement tool.” In another essay , Makary suggested that a recording “also offers a valuable opportunity for coaching. In the same way that athletes learn from coaches when jointly watching videos of past games, physicians can also learn from their performance by viewing with a coach.”
Patients might find it very useful to have all of their experiences recorded. A recent example has attracted a great deal of attention. A Virginia man undergoing a colonoscopy left his cell phone on. He later discovered that the anesthesiologist and gastroenterologist had “mocked and insulted him as soon as he had drifted off to sleep” and had “placed a false diagnosis in his chart.” The physicians’ behavior led to disciplinary action and substantial malpractice settlements.
The Virginia man’s experience made me wonder: What if every hospital worker wore a body camera and what if each operating room, corridor, and patient floor had devices capable of capturing and archiving high-quality video and audio? What if every operating and procedure room had the video capabilities of an NFL stadium? If we work through all of the HIPAA issues, would we make all of the files available and searchable to patients? Could the information be added to enormous databases?
This magnitude of data storage and dissemination would be a sea of change. Medicine, historically, has been paternalistic; physicians from the generations before mine routinely hid dread diagnoses such as cancer and fatal infections from patients. As my peers and I entered the profession, though, we were taught that patients and their families are partners in care and should participate in all decisions. The openness accelerated as search engines brought health information (and disinformation) to everyone’s fingertips.
A 24/7 video world of cell phones and ubiquitous cameras would take this partnership between patients and physicians to a new level. Physicians would no longer filter and interpret data; the data will be available to patients and families unfiltered and, doubtless, in real-time. The physician’s roles will change. As would the roles of patients and their families.
Our patient in 2030 settles into his chair and watches the radiologist interpret his PET scan, sees a replay of his own cancer surgery, reviews all of his office visits and listens to the discussion about his case at the cancer conference. An algorithm samples the files and reports that the scan interpretation is 89 percent accurate, the surgery was 74 percent efficient, the doctors failed to suggest a clinical trial, and the suggested treatment is consistent with only 63 percent of the recommendations given to patients nationwide with the same diagnosis and underlying conditions. He jots some more notes, and he formulates questions. Soon, he has a list of topics for his doctor to address when he logs on for his virtual, on-demand follow-up appointment.
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