This week I was asked whether it is prudent to give patients videos of their surgery in digital format to promote transparency. My knee-jerk reaction was of course it is; how can giving patients access to details of their health care not lead to greater transparency? Having video of a procedure an individual has undergone augments the detail of the written operative report. There is no better example of images being worth thousands of words.
While thinking about this I consulted the opinions of leaders in the field. One of the leading proponents of promoting transparency in this manner is Martin Makary, MD, MPH. Dr. Makary is an academic surgeon, author, a pioneer of minimally invasive procedures and a proponent of patient safety – a man after my own heart. He rightfully believes that transparency aids in educating patients, enhances the completeness of their electronic medical records and improves their satisfaction. But this is the 30,000 foot view; there is a lot more intricacy when you get down in the weeds.
Although I am a strong proponent of transparency, simply giving patients a video of their surgery on a thumb drive does not achieve this. Transparency not only requires access to information but also an understanding of the information. A video of procedures performed may not be comprehensible to all patients. In my community patients are critical thinkers and ask questions. This is not unique, many in the 21st century are savvy health care consumers. If they do not understand something they will ask you about it. This critical thinking would undoubtedly result in many questions relating to surgical videos. In addition, there may be images or sequences that would be disturbing to many because of a lack of explanation or context when independently viewing a video. We will not have increased patient satisfaction if patients are incompletely informed, confused, or disturbed.
This scenario immediately brings with it a spate of questions. If explanation and context are to be provided to patients who provides it? A logical answer is the surgeon or a member of the surgical team who performed the procedure(s). What part of the provider’s schedule should be devoted to these explanations? From where do we take this (substantial) time? How do we weigh the relative benefits of taking time to explain surgical videos versus using that time to increase access and see more patients in clinic? Is the time the surgeon spends to go over videos with patients compensated? If so, by whom – the patient, health insurance or some other party?
Additional questions arise: How are videos of extremely long procedures handled? Is it ethical to edit out portions of patient procedure videos? What is done in cases of patients who do not have the intellectual capacity to fully understand the explanation and the context of what is going on in procedural videos? How do we handle the emotional aspects of the videos? Is any aspect of the surgeon’s technique proprietary? These and other issues would also need to be addressed.
After careful consideration I do not think dispensing patients videos of their surgeries should be universal (or even widespread) policy at least until we account for some of the foreseeable consequences. What do you think? I look forward to hearing your thoughts on this subject.