Showing posts with label Exposure. Show all posts
Showing posts with label Exposure. Show all posts

Thursday, August 7, 2014

Patient Dignity 14: Video Recording Patients

There has been some ongoing debate about teaching institutions recording patients for "research" or "teaching" purposes. I am not addressing those issues here. What I am going to address is that:

 NO PATIENT SHOULD EVER BE RECORDED, PHOTOGRAPHED, etc. WITHOUT EXPRESSED, SPECIFIC, PRIOR CONSENT

The patient can revoke consent at any time, should be given a copy of the "raw" recording, and must give final approval of the finished product.

On October 28, 2013, Bob Wachter M.D. posted an article on KevinMD titled: "How video can reduce medical errors and improve patient care." The article was originally posted on his web site "Wachter's World" titled "Lights, Camera, Action… In Healthcare" where you could buy his books, book him for a speaking engagement....




He starts out by telling the store of how he improved his golf swing with video recording. He goes on to list the beneficence of video recording. He states:
Yet we hardly ever use this extraordinarily powerful tool in healthcare. Thankfully, that’s beginning to change. Earlier this year, Johns Hopkins surgeon Marty Makary published a JAMA article entitled “The Power of Video Recording.” It’s a thoughtful and eye-opening piece, well worth a read.

It seems that Johns Hopkins is leading the nation in the video recording of their patients. Take another Johns Hopkins advocate of video recording patients: Dr. Nikita Levy.

Dr. Nikita Levy had secretly taken videos and photos of his patients' sex organs. A federal investigation led to discovering roughly 1,200 videos and 140 images stored on computers in his home. 
This is one of the largest on record in the U.S. involving sexual misconduct by a physician, $190 million. It seriously threatened the reputation of one of the world's leading medical centers (that advocates video recording of patients).  
62 girls (children) were among the victims, and that Levy violated hospital protocol by sending chaperones out of the exam room.   
Hopkins sent out letters to Levy's entire patient list last year, apologizing to the women and urging them to seek care with other Hopkins specialists (who also video record patients, maybe?) 
But hundreds were so traumatized that they "dropped out of the medical system," and some even stopped sending their children to doctors, the victims' lead attorney, Jonathan Schochor said.

You can read more about Dr. Levy here:

Update: Auguse 14, 2014

I just came across the following article, "Google Glass Enters the Operating Room" on the New York Times website.


DURHAM, N.C. — Before scrubbing in on a recent Tuesday morning, Dr. Selene Parekh, an orthopedic surgeon here at Duke Medical Center, slipped on a pair of sleek, black glasses — Google Glass, the wearable computer with a built-in camera and monitor. 
He gave the Internet-connected glasses a voice command to start recording and turned to the middle-aged motorcycle crash victim on the operating table. He chiseled through bone, repaired a broken metatarsal and drilled a metal plate into the patient’s foot. 
Dr. Parekh has been using Glass since last year, when Google began selling test versions of its device to thousands of handpicked “explorers” for $1,500. He now uses it to record and archive all of his surgeries at Duke, and soon he will use it to stream live feeds of his operations to hospitals in India as a way to train and educate orthopedic surgeons there. 
“In India, foot and ankle surgery is about 40 years behind where we are in the U.S.,” he said. “So to be able to use Glass to broadcast this and have orthopedic surgeons around the world watch and learn from expert surgeons in the U.S. would be tremendous.” 
At Duke and other hospitals, a growing number of surgeons are using Google Glass to stream their operations online, float medical images in their field of view, and hold video consultations with colleagues as they operate. (Source: NY Times website)

Surgeon tests Google Glass in the operating room




SEATTLE -- When Dr. Heather Evans, a trauma surgeon at Seattle's Harborview Medical Center, stepped into the operating room wearing an eyeglasses-like, Internet-connected device known as Google Glass, she quickly realized its potential and its pitfalls... 
...Like other surgeons, Evans is excited about the potential of this new device. But she also has learned that Glass has technical issues that, for now, make it less than ideal in the operating room, as well as difficult privacy concerns.
Some arise because of complex federal privacy laws, which govern the transmission of patient information, including photographs or videos. Other privacy issues come up just from wearing Glass. 
If she wore Glass down the hospital hallway, Evans said, she could be accused of violating privacy. 
Glass has particularly prickled privacy advocates, even earning its own Urban Dictionary epithet -- "Glasshole" -- for those who flaunt their early access, wear Glass into private spaces such as restrooms or instruct the device -- "OK, Glass, take a video" -- in public.Despite such fears, Evans had some specific tasks for Glass in mind when she applied to be an early explorer. 
To win her spot, she linked to a YouTube video showing an event rarely caught on camera: a man's heart attack and resuscitation. A BBC crew, shooting a documentary on an emergency helicopter service, had just arrived at its office when the dispatcher suddenly slumped. 
The crew kept the cameras rolling as emergency workers gave the man CPR and shocked him with a defibrillator, saving his life. (Source: TH Online)



I can see the advantages that Google Glass to look up something quickly, I can even see the advantages for teaching. Here is the problem:

All information is transferred and stored on Google's servers, if a violation occurs, there no way to delete and guarantee the images/video are deleted.




Don't believe me? Consider Google's own policy on the Glass:

Google accused of hypocrisy over Glass ban at shareholder shindig 
Google's directors were accused of hypocrisy over a regulation banning attendees at its annual shareholder's meeting in California from wearing Google Glass hardware at the event. 
"Cameras, recording devices, and other electronic devices, such as smart phones, will not be permitted at the meeting. Photography is prohibited at the meeting," attendees were told, something that rankled with Consumer Watchdog's privacy policy director and Google shareholder John Simpson. 
"Google Glass is a voyeur's dream come true," Simpson said, citing the need to protect children. "It seems to me to be a little bit hypocritical to actively abet and aid possible privacy violations by so many others outside but so jealously protect your own privacy." (Source: Iain Thomson, The Register)

A Voyeur's Dream Come True




The potential for abuse is staggering and there are very few laws to protect people.

Existing laws need to be rewritten as they are not phrased well enough to deal with these immoral and reprehensible acts. The Massachusetts highest court ruled last week that a man who took cellphone photos up the skirts of women riding the Boston subway did not violate state law because the women were not nude or partially nude. The court ruled that existing Peeping Tom laws protected people from being photographed in dressing rooms and bathrooms when nude or partially nude, but did not protect clothed people in public area. (Source: Lucius on Security)

 Even Nudists Fear Google Glasses
Nudists already know about the way that camera-equipped cell phones have altered the balance of privacy on beaches and in clubs.  While clubs have rules regulating their usage, it’s not always easy to tell the difference between someone holding a normal conversation and one who is trying to invade others’ privacy by taking unwanted pictures.  Imagine if the world becomes heavily populated with people who depend on their Google Glasses for directions and communications.  Now imagine trying to determine whether someone wearing such glasses on a nude beach is simply texting a friend or uploading footage to a You Tube account. (Source: Bare Platypus Blog)



Google glasses prompt personal privacy fears
Nick Pickles, director of privacy campaign group Big Brother Watch, said: “Google Glass doesn’t just challenge our assumptions about consent, it challenges whether we even have a choice any more. 
“It makes it seem perfectly normal to collect data on other people, without ever asking their permission and that is a dangerous step that poses a fundamental threat to our current notion of privacy. 
“People wearing Google Glass don’t own the data, they don’t control the data, and they definitely don’t know what happens to the data.
“This is turning members of the public into a Google army, collecting data for the sole benefit of selling advertising and boosting Google’s profits.” (Source: Irish Examiner)


Video Voyeurism is a Crime in Some Places Already


Before his original March 11 sentencing on five counts of video voyeurism, Hughes, 28, apologized for sneaking around with his smartphone and recording about 30 videos in the women's bathrooms at Patch Reef and Red Reef parks. 
In his April 30 motion for a reduced sentence, the attorney asked Burton to consider that another judge on April 3 imposed only a one-year jail sentence and five years probation on former Florida Atlantic University librarian Seth Thompson, 40, of Lake Worth. 
Thompson secretly filmed men while they urinated in campus bathrooms and then uploaded videos onto pornographic websites, according to court records. (Source: Sun Sentinel)


Patients expect more privacy in a hospital/doctor's office than in a public restroom. What else can I say???

--A. Banterings

Thursday, July 24, 2014

Patient Dignity 08: "I am a professional," and "I have seen everything before."

How many times has you as a provider said, or you as a patient heard "I am a professional," or "I have seen everything before" when (you as) the patient has been apprehensive about undressing or exposing a body part.

This is unprofessional, demeaning, uncaring, and offensive. These may produce some positive results for the caregiver but not the patient. One thing they do is shut down the dialogue prematurely.

Newsflash: It's NOT about how you feel, I is about how I, the patient, feels!

Unless I, the patient, am a work as a "standardized patient" or (perhaps) a porn star, I am NOT a professional and I have NOT shown it to a bunch of strangers. These statements nullify my feelings and marginalize my dignity as a human being. 

This demonstrates that you are as a incompetent as a provider, and borders on malpractice. 

Healthcare providers (physicians, nurses, PAs) are taught observation, auscultation, percussion, and palpation. The first two are look and listen! The patient is alerting you to a problem. Perhaps the patient does not understand the procedure, it has not been explained, or the patient has an underlying emotional trauma.

One never knows who has been sexually abused, (so please do not ever trivialize a patient's need to avoid unnecessary exposure). Missing the signs of possibly being a surviver of sexual abuse are no less egregious and incompetent as missing a tumor on a thyroid.

It is easy for you to dismiss the patient's feelings, fears, and anxieties about dignity and modesty when you are the one in the room wearing clothes. 

Nurse Ratched was a professional too...


"Operational efficiency" is not an acceptable answer. When it is genuinely argued (as opposed to disingenuinely justified) that patient exposure is necessary, then it is a valid reason. On the other hand, simply for the purposes of efficiency is NOT a valid reason.

"Because that is the way it is always done," is NOT a valid reason either. For years black people (not just of African decent) and white people were not allowed to legally marry "because that is the way it is always done." If you are going to site data or research, it better be current and it's premise (thesis) not called in to question by other research.

Consider the the standard procedure for prepping a patient for all surgery, including outpatient: naked wearing only a gown, wheeled into the OR on a gurney. Consider what LDS Hospital in Salt Lake City, Utah did as part of their overhaul of healthcare delivery in 1998:

SOME PATIENTS were especially bothered to spend half the day without underwear -- for shoulder surgery, say. Ms. Lelis was convinced this longstanding practice was meaningless as a guard against infection, persisting only as the legacy of a culture that deprived patients of control. "If you're practically naked on a stretcher on your back," she says, "you're pretty subservient." The nurses persuaded an infection-control committee to scrap the no-underwear policy unless the data exposed a problem; they have not. Source: The Wall Street Journal
If you further reason infection-control has not studied this, that is NOT valid either. Other providers are looking at this, why not you. Patients will not accept "not your responsibility." Part of your job as a provider is to advocate for the patient, if you are not pushing for a study on this, you are not doing your job.

If you have initials after your name (MD, DO, PA, RN, LPN, etc.) and you use phrases like "I am a professional," "I have seen everything before," "because that is the way it is always done," or "operational efficiency," that only marginalizes you as a professional and nullifies all the time, money, effort, and study that you put into your education. If you are so smart and educated, how can you NOT understand my feelings and my point of view?

You are the professional, patients are NOT. Patients are real, live people who in all probability have never been in a hospital in their entire life and what happens is pretty distressing. This is your job, some would even say their home. You come here everyday, you are familiar with the sights, smells, and sounds.

You are not totally devoid of any curiosity, emotions or feelings.  You have the same feelings that we do, so you can't deny that to us as much as you try, and simply saying that you are a professional does not negate that.

First and foremost you are human. The patients are human too. We know what human reactions are. You can probably control them a little better than us, but you WILL have them.

It would help if you were naked while invading our privacy, but I guess thats just realistic.

One could say we have seen it all also so why not be naked in there with us? I know its stupid, but perhaps your getting the idea. It is soo much easier to be the clothed one while we have our gentiles exposed, worked on, and pontificate on our childish behavior.


If they’ve seen it all before, then they DON’T NEED TO SEE MINE!

This is how we really feel. When you refuse to acknowledge our feelings, you are lying to us. Why do we have to justify our feelings to you? It is common sense, we cannot understand why educated, intelligent people do not understand why we feel this way.

When we say things like "It would help if you were naked while invading our privacy," we are only trying to get you to understand us. Obviously you know what we say to be true, or you would not be so offended when we suggest this.

I have always stated: "Medical treatments and procedures would be radically different if the providers had to be in the same state of exposure as the patients."

You cannot argue that point. You would have to have a major mental defect or cognitive disability to believe otherwise. The tolerances for infection control would drop. Questioning of is that exposure necessary would predicate every protocol. Here is proof:

In the above example what  LDS Hospital in Salt Lake City, Utah, the WSJ article stated that a 15 year ER nurse saw behavior in patients that did not make sense. To understand the disconnect, she needed additional education (an MBA) that her nursing degree did not give her.

The healthcare system cannot comprehend that what they perceive as the patient's priorities, in fact are actually NOT the patient's priorities. They blame the patient for not having the (expected outcome) priorities that they expect. Physicians (providers) are to make decisions with out emotion, so that the decisions are based on sound, scientific principal. That is why they can not understand why a patient has an issue with being helpless and naked in front of a room full of people when they are undergoing a lifesaving procedure. All they think that is important is that your life is being saved.

 In the case of LDS Hospital, cost  and an increasingly competitive surgical market were the driving force for change. It was not about the patient, it was about money. Why was the option of patients keeping their underwear on not looked at when the initial infection control study was done? Answer: "Because that is the way it is always done."

Further proof: The Endoscopy Camera Capsule (info at: NY Daily News). This is another advancement that further preserves patient dignity. This was developed because many people were opting to forego the undignified process of a colonoscopy. Again it was "money first, not patient first." The PillCam costs $500, significantly less than the roughly $4,000 rate for colonoscopy.

Speaking of professional...

What was considered appropriate and professional 25+ years ago, would be UNACCEPTABLE today. Remember "strip-as-you-go" exams?

The fallacy of "Patient First"

How many times have you told a patient this? How many times have you said this to people who were not patients? Do you really believe this? If so, does your facility have a written policy that allows outpatients to keep their underwear on? No? I thought you said "Patient First?"

If you counter with something can go wrong, incase of emergency, ...blah...blah...blah, remember what I said about being up to date? As of 2014, despite thousands of outpatient procedures, not a single patient has died as a result of wearing underwear during an outpatient procedure. Confirmed by: LDS Hospital. 

Do Not Dismiss My Experiences

I know through my experience what happened to me and how I was treated. Trying to dismiss my experience tells me that I am wrong to feel the way I do. I do not choose my feelings, they are what they are.

Saying "that can never happen because medicine is a profession" or "that is impossible in a professional setting" only further undermines our trust in you and the system. Is it that you just don't believe me? Perhaps you are complicit in the cover up and system-wide denial that this does happen.

Even worse is saying that "never happened to you." Just because it never never happened to you does NOT mean it didn't happen to me.

You are not me, despite how deep you pry into my lifestyle, history, an my past (while vehemently protecting your privacy) you do NOT know what I experienced, how I reacted, or how I feel. Does it matter, you are dictating my feelings to me anyway.

Do No Harm

Do you think that dismissing me as childish, nullifying my feelings, marginalizing me as a patient, or making this all about you does no harm? 

It is this attitude that has caused me not to trust the healthcare system or anyone in it. Before my previous first bad experience, I walked in trusting you. The subsequent bad experiences only reinforced that in me. I will not let myself get hurt like that again. Now I assume that you are bad. You can either reinforce what I know through my experience, or you can win back my trust.


Tips on How to Be a Better Provider

Here is "An open letter to all hospital staff" by  Carolyn Thomas,  a heart attack survivor> The letter details how she was treated and how providers can better serve the patient. She says,  It’s not so much that they were openly rude. It was their insufferable lack of people skills..." 



I wasn't born a difficult patient....I was turned into one


Thank you for thinking.

--Banterings