The rapid advance in digital video and still camera technology has found its way into the operating room.

There is the potential to capture and record just about every minute of every surgical procedure in some way. The newest endoscopic camera systems and operating microscopes have integrated systems to record video footage. Storing all that data is just the press of a button away.

The advantages for surgeons are obvious, like the ability to record interesting pathology, new techniques, to document surgical process, to teach, and, last of all, to see with hindsight where mistakes might have been made.

But it is that last potential that opens up some serious, and unanswered, questions:

* Given that a whole procedure may be recorded in some way, where should the recording start and end? As the patient is wheeled in, and then wheeled out?
* Who “owns” the recording? The hospital, on whose equipment the recording is invariably made, the doctor, or the patient? Who controls the recording – the owner?
* Can, or should, the recording be edited, cut or deleted in any way, particularly when things go wrong?
* Does a surgeon have the right to refuse being recorded, or to turn it off when the surgery does not go to plan?
* Consent to record must be taken, but does a patient have the right to refuse?
* What about procedures on intimate areas of the body? What controls on recorded data should be in place to protect patient dignity?
* Does the doctor have a right to refuse his patient’s access to the recorded data?
* Does the presence of a procedure recording enhance or suppress potential litigation?
* How do the malpractice insurers feel about this technology? Do they embrace it, or warn against it?

I have found my recording of procedures extremely useful in showing pathology to my patients, and in demonstrating what was done during their procedures. The consent I take is as “bullet-proof” as I can make it.

I don’t know how comfortable I would be showing my patient the exact moment of a mistake or complication. Currently, I am selective as to what I record, and never attach an associated audio recording.

I would have an uncomfortable sense of “Big Brother” in the operating room if such technology was made mandatory. On the other hand, airline pilots have had to cope with every word and decision being recorded on flight recorders in the interests of safety, and it may be argued the same should apply to the operating room. In an era of a drive towards greater transparency, recording seems to be an appropriate control. We surgeons at least have the ability to turn off the recorder when it is to our advantage to do so, something airline pilots cannot do.

The technology is here, in use, and growing. There may be a demand for it, and we would be wise to deliberate and define answers to the questions posed above before a mandatory “record everything” policy is one day thrust upon us.

Martin Young is founder and CEO of ConsentCare.

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