“Into as many houses as I may enter, I will go for the benefit from all voluntary and destructive injustice…About whatever I may see or hear in treatment, or even without treatment, in the life of human beings—things that should not ever be blurted out outside—I will remain silent, holding such things to be unutterable [sacred, not to be divulged].”⁴

This distinction between public and private information has been not only integral to the practice of medicine but also fundamental to the idea of democracy.⁴ Patients’ knowledge that physicians, including emergency physicians, will maintain their privacy and confidentiality allows them the liberty to divulge any truths necessary to obtain a diagnosis and provide treatment. It is this confidence that gives physicians the enormous latitude to break otherwise strict societal taboos on asking sensitive questions and touching, sometimes intimately, strangers. It is ironic that Dr. Brown previously stated that one of his “other challenge(s) is to educate the emergency and critical care researcher community about the law of unintended consequences and how it’s very easy to call for a change without realizing that it could bring about the very opposite effect.”⁵

So what would be the unintended, but clearly seen, consequences resulting from universal emergency physician body cam use or even unconcealed audio-video surveillance throughout the ED? I posit that it would decrease open physician-patient dialogue, decrease the number of patients voluntarily coming to the ED, and increase lawsuits involving the ED for both valid and spurious reasons.

Clinicians’ maintenance of patient privacy and confidentiality has elevated the physician-patient relationship to a special status within our social structure and, much more than the wonders of modern science, has given physicians their esteemed status.

The recent advocacy for emergency physicians to don body cameras to take videos of the most private interactions between themselves and their patients—by specialty leaders, no less—raises an awful stink. That stench signals that we are in danger of crossing substantive ethical barriers. Hopefully, Hippocrates will not need to roll over in his grave but smile from above at our maintaining the essence of his Oath.

Dr. Iserson is professor emeritus of emergency medicine at The University of Arizona in Tucson.

References

1. Brown J. The case for body cameras: good for doctors–and their patients. Emergency Physicians Monthly. March 11, 2015.
2. Tintinalli J. The invisible gorilla: are doctors ready to have their professional lives on display? Emergency Physicians Monthly. March 13, 2015.
3. Genes N. By the numbers: are med-cams financially and technically feasible? Emergency Physicians Monthly. March 12, 2015.
4. Miles SH. The Hippocratic oath and the ethics of medicine. New York, N.Y.: Oxford University Press; 2005.
5. Annals Q&A with Dr. Jeremy Brown. Ann Emerg Med. 2014;63(1):A13-A15.