Yaledoctor:Body cameras could address medical racism concerns

Aug. 12—Calhoun, a child psychiatry fellow at Yale Child Study Center at the Yale School of Medicine, said she was thinking about the effects of medical racism on patient outcomes when an idea popped into her head: what if medical professionals wore body cameras to provide documentation and create accountability?

"I felt like these people really feel comfortable saying this and it really is going unchecked. People who hear it are either laughing along and think it's fine or they're afraid to report it because it's your word against theirs," she said. "There's a lot of power dynamics there."

Calhoun published an opinion piece in The Emancipator in July calling for doctors and nurses to wear body cameras in hospitals in the same way a growing number of police departments are requiring officers to wear the recording devices. Calhoun said that, although she stands by her idea, she recognizes that there would need to be feedback from stakeholders and a significant amount of planning before such a concept could be implemented; initially, she thinks it would be best as an opt-in pilot at a hospital.

In her column, Calhoun listed a number of ways that health outcomes are worse for Black patients than for white patients, including that Black patients are three times likelier to die from pregnancy-related complications than white patients and that Black children are more likely to be physically restrained in emergency departments than white children. Racist statements and attitudes contribute to and cause these disparities, Calhoun said.

"I think comments like making jokes about a Black child being in a gang definitely trickles down into how they treat that Black child, if they're diagnosed correctly, how they are viewing that child," she said.

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Dr. Marian Evans, an associate professor of public health at Southern Connecticut State University, said she has encountered racism as a physician and as a patient.

"As a physician I have experienced, been privy to and been in the company of my other colleagues being blatantly racist," she said. "Dealing with the medical system with my family, I usually make a concerted, intentional effort when I deal with the health care system to initially not tell them I am a physician because I think of the thousands of people who walk through those doors who don't have the benefit of the knowledge or the skills to advocate that I do for my family. Many times I do have to tell them, which changes the dynamic, and it shouldn't."

Addressing a concern

Evans is one of several local medical experts who said Calhoun's proposal is an interesting and unique way of addressing a real concern in the medical field that has led to longstanding unequal care in the health care system.

"I think the true essence of Dr. Calhoun's writings is that she is trying to move people to do something," Evans said. "She's saying there's a problem with people's behavior, and the problem with people's behavior is because of racism and systemic racism we have in our society. Body-worn cameras might be a way to document that."

Evans said she believes there are critical differences between the role of the police and the role of health care providers, and literature on the lasting effectiveness of body cameras in reducing police misbehavior is inconclusive.

"I think body-worn cameras could be a tool, but whether it is the best use of dollars I would say it would remain to be seen," she said. "We'd have to go through a period just like we're doing with body-worn cameras with police."

Evans said there also are privacy concerns raised by the proposal.

"If you've been in the ER or had any type of surgery you know the set-up in the health care system is not the best set-up for privacy at all," she said. "A curtain screen is not best for privacy; you might not see them, but you can hear them talking."

Calhoun said she believes HIPAA concerns could be addressed with a consent form.

"In my mind, patients would have the ability to decide whether they wanted their medical team to wear body cameras," she said.

Further, she said the footage would need to be redacted before it is released to the public, just as it is with police body-camera footage. The advantage of having body-camera footage, she said, largely would be for internal review if were any claims made about misconduct or discrimination. The footage also could be used for training purposes to provide real examples for cultural competence.

Karl Minges, assistant professor and chair of the Department of Population Health and Leadership at the University of New Haven, is a health services researcher on disparities in health care, including race and ethnicity.

"Studies have shown Black patients who are taken care of by Black doctors tend to do better, and this isn't a shock. I think a lot of it comes down to cultural competence," he said. "A lot of it comes down to understanding and treating people with respect and dignity, ultimately treating patients with person-centered care and seeing them as people as opposed to a race or ethnicity."

Minges said the body-camera proposal is a "novel approach to addressing a centuries-old problem."

He said hospitals already have technology that accounts for patient privacy, so devising a program that accounts for HIPAA may not be outside the realm of possibility.

"Just like we see with police officers, it provides accountability and it allows for that self-awareness of one's actions knowing there's a camera involved," he said. "This boils down to the basics of why Target has cameras in its stores: it makes people aware of that."

Minges said it is ordinary for hospitals to have patient advocates, "but oftentimes [racist health care interactions are] under-reported, lack evidence and lack follow-through."

"From a pilot stage it would be really interesting and intriguing to see the rollout. Maybe with accountability we'd see Black Americans suffering from less medical violence and misdiagnosed care," he said.

Dr. Lyuba Konopasek, senior associate dean for education at the Frank H. Netter MD School of Medicine at Quinnipiac University and a member of the American Association of Medical Colleges Anti-Racism Task Force, said the idea of equipping health care providers with body cameras is commendable as "an out-of-the-box solution" to an important issue that has troubled medical professionals for a long time. However, she said she has concerns about feasibility to adding a camera to conversations between health care providers and their patients.

"I think there's something very personal about the physician relationship that takes a lot to nurture it. It's very different from a police relationship in the street and it carries with it an awesome responsibility," she said. "That's true of police, too, but it's a different kind of relationship. My sense is a camera steals from that."

Konopasek said a true test of cultural competence and improved outcomes in the medical field is the ability for health care providers to identify and mitigate their biases through regulation.

"For me, I would much rather see a huge effort go out to training our physicians both in implicit bias and recognizing their biases and how to mitigate them, and communication skills," she said. "You might feel you're being unbiased, but how you communicate verbally and nonverbally" is what's important.

Calhoun said she doesn't feel as though surveillance steals from the relationship between physician and patient because of medical racism's long history.

"I think the doctor-patient relationship, when it comes to Black patients, has been ruptured since the beginning. I feel like as a Black patient I am under surveillance all the time in what I say," she said. "I think the problem actually lies in the relationship between medicine and the dehumanization that's happened to Black patients, and not a camera. I would feel more comfortable with a camera there as potential evidence."

Evans said she believes an important distinction between police and health care providers is that, as government employees ,police in most states have some degree of qualified immunity, which shields them from individual liability in lawsuits.

"It's something that is extended to law enforcement but isn't extended to health care practitioners," she said.

Evans said there already is a problem in the medical establishment of "practicing out of fear" of potential consequences.

"That's a problem in and of itself: it's a practice that already damages doctor-patient relationships," she said.

Minges concurred that the pressure for health care providers already is so high that video recording them is likely to do very little to reduce that tension — something that makes it unlikely for the proposal to receive support from medical establishment voices.

"It opens the door for more lawsuits," he said. "Malpractice insurance is already super high."

Calhoun said that, although it provides more surveillance of health care professionals, it could also be protective if providers can argue that the footage demonstrates that they responded to a situation appropriately.

As to whether the medical institution is capable of regulating itself and holding health care professionals accountable, Calhoun said there would need to be conversations about potential consequences before a body-camera program is rolled out.

Not the only tool

Calhoun said she does not intend for her idea of equipping health care professionals with body cameras to be "the end-all-be-all" solution to the issues contributing to medical racism, but she does believe it could have a significant impact and make a positive difference.

Other medical experts agreed that any solution to medical racism would need to be multi-pronged.

"Doctors and nurses aren't necessarily all the sources of racism, because it's a societal issue," Minges said. "This can be one part of the solution, but it's going to have to be multi-tiered."

Konopasek said bias "comes in all sorts of subtle forms" and "the hardest part" is that medical professionals need to be in constant dialogue about various solutions.

"This is not something that is going to be solved one way," Evans said. "These systemic issues are not going to be solved in a day or a month or a couple of years. It is many, many layers of many, many different things."

Evans said she believes one effective way to address disparities is to decrease the difference between the "two worlds of private insurance and Medicaid."

"I think it'll take a little of everything. I don't know of one thing to solve the issue," she said.