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Is there a place for audiovisual recording in medicine?

Martin C. Young, MD
Physician
March 4, 2024
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Some years ago, I came across a very useful little device – a thumb (flash) drive that also had the ability to record sound. It powered up simply by being slotted into a USB port. Inserting the drive did not raise any suspicion that I was recording.

Sometimes I used this overtly, such as when obtaining informed consent or giving instructions that were vital to be followed.

Rarely I would use it covertly when I found a patient (actually a parent – I’m a pediatrician) becoming hostile or abusive, or when they were clearly lying about something that might later be important. Also for meetings with administrators (useful when they lied and later denied what they had actually said).

Following an incident in which a ward nurse claimed she had given me critical information over the phone when she had not, I began to record all such telephone calls. I used an online company that issued me a special phone number; when the hospital called this number, my home phone would ring, and recording would begin as soon as I picked up.

In every case, I was able to record others legally because I live in a one-person consent state – as long as one party in the conversation is aware that recording is taking place and has consented, then it is legal.

I did so for my self-protection.

Since then, the technology for audiovisual (AV) recording has progressed astonishingly, and nearly all of us now carry cell phones/mobiles that can record sound and vision in high definition. Car dashcams have saved many a motorist from improper prosecution, police misconduct, and road rage.

Recording individuals as they interact with you can have a profound effect on their behavior – usually beneficial.

YouTube abounds with examples of where perpetrators of road rage have been quelled by the realization that they are being recorded. Most shocking are those videos showing how abruptly the behavior of police officers changes when they suddenly realize their interaction is being recorded. Peace officers acting unlawfully often suddenly begin behaving appropriately, and where they don’t, citizens have successfully used their recordings to support civil prosecutions against these individuals and their employers.

However, in certain situations, whipping out one’s phone to record a situation can seem like an act of aggression, so it may be preferable to wear the recording device, for example, a body cam. Up until now, these have been bulky, obtrusive, and expensive, and therefore confined to use by police and security services, but smaller, cheaper devices have started to appear.

One such device incorporates a 1080p/30fps wide-angle video camera, a microphone, plus 4G/5G and Wi-Fi modules. It is smaller than a cigarette lighter and can be clipped to the user’s jacket or shirt.

A press of a single button puts the device in standby mode, as indicated by an LED ring on the device, which illuminates white, with the general idea that this will alert the other person that a camera is present. This action alone may be sufficient to mollify any aggressive or confrontational action on their part.

If things escalate, a second press of the button makes the ring turn red and causes the camera to start transmitting footage to a cloud-based server, where it’s recorded for possible future use.

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Additionally, a predetermined emergency contact is automatically notified via an app on their smartphone, which displays a live audio/video feed, shows the user’s location on a map, and allows the contact person and the user to have a two-way conversation.

The value of such an AV device, which costs under $100, should be obvious to those working in the emergency room or other areas at high risk of staff abuse from patients and their families. The smartphone transmission in such a case could be to the security officer who would instantly know what is going on and could respond.

A less sophisticated alternative is camera glasses. Though most are marketed as sunglasses, they can be obtained with clear lenses and appear little different from regular glasses. They could be kept in a scrub or white coat top pocket and put on unobtrusively when needs be.

Obviously, there may be some legal issues to consider in using such devices. I am not an attorney, but I would find it hard to understand that I could not use such a device for my personal protection in any place or situation.

Another situation in which I think that AV recording might serve a helpful purpose is in the process of obtaining informed consent.

Formally recording the event would have a strong effect on the physician to ensure that this was done correctly and completely and would also provide the latter better protection if the event of an adverse outcome. For example, if I were a surgeon recommending a procedure to a patient that carried a high risk of a significant adverse outcome or complication, a recording of me discussing this in detail face to face with the patient would surely be in my interest should this occur. (Interestingly, in the past year, I have signed at least three consent forms for procedures given to me without any accompanying interaction with a health care provider.)

I believe that technology has advanced to the point where AV recording in some hospital settings is now easily performed and may well have a place, especially when it comes to protecting providers in the increasingly adversarial and dangerous place of U.S. health care.

Martin C. Young is a pediatric endocrinologist.

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Is there a place for audiovisual recording in medicine?
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