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CCTVs in the OT -Pros and Cons

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In today’s tech savvy world we are all dependent on gadgets for minor as well as major tasks, be it ordering groceries or registering for a voter ID. So why not for a significant event in life like surgery ? There is always condemnation of such sensitive topics — as CCTV in the OT is commonly seen as a breach of privacy — but they are worth diving into.

Exactly a year ago, in September of 2023 The Republic Korean passed a bill that made it compulsory to equip Operation Theatres (OTs) with CCTV [closed circuit television]. The use of CCTV in OTs in India is not as common. There have been instances where some institution did adopt and maintained it while others put a halt to equipping OTs with CCTV s due to various reasons like patients’ right to privacy, surgical teams’ right to privacy, inadequate budget, etc. Other countries , including countries in the technologically advanced West have also not yet legalized the strict use of CCTV in the operation theatre.

Like every coin has two sides , this debate has its two aspects:

PROS

  • Assurance to patient: Majority of the patients trust their physician and surgeons, but the human mind is such that there remains a slight hesitancy and uncertainty. Thus surveillance and recording of their operation may give the patient a sense of complete satisfaction.
  • Monitoring Sterilization : Sterilization before, during and after surgery is essential for an infection-free hospital stay and healing of the patient . Monitoring may help the institution and doctors to improve, maintain and advance their care-giving.
  • Prevention of misconduct: We live in a world where misconduct subsists, while it is not common it is certainly prevalent. Installation of CCTV may generate fear among healthcare personnel and prevent misbehavior, abuse, illegal procedures, and ensure ethical medical and surgical practice.
  • Medico-legal Aspect: CCTV footage can be an important piece of evidence in medical negligence cases. The physician can use it a proof of his innocence or the patient can use it as evidence of their mistreatment, thus helping in delivering justice to the truthful party.
  • Supervision of the Procedure : Senior surgeons and management could evaluate and monitor the procedure and keep an eye on the conduct of their subordinates in OTs, especially in teaching hospitals.

CONS

  • Breach in Privacy: This is the biggest concern when it comes to CCTV in operation theatres. The recording of surgery is a violation of the privacy of patients, who are in a state of unconsciousness and exposure. Being recorded in such a compromised position may make one uncomfortable. Also, medical ailments are personal and private, which one might not want to a video record of.  Privacy violation of surgeons and their team is also seen due to installation of CCTV. Their skills, their work preferences etc. come extensively under the radar due to constant supervision.  Privacy protection is eminent point of concentration in this discussion, the reason being the centrality of human dignity. Traditionalists believe that a man’s dignity keeps society civilized and vice versa. So as physicians who took the Hippocratic oath, though no harm is done to the patient physically, mentally and socially, the legal and other aspects of healthcare must also be looked after.
  • Increase in the distrust of patient towards the surgeon and his team: As Pope Alexander said, ‘’ A little learning is a dangerous thing’’. Applying this to a person having half or minimal knowledge about surgical procedures, CCTV has the potential to create perpetual doubts about their caregivers. This causes a deterioration of the doctor patient relationship. It is true that the camera doesn’t lie, but does tell the whole truth? That for all us to ponder.
  • Skill development of residents: Residents, though being competent and proficient, are required progress through a steep learning curve when it comes to surgical skills. The constant monitoring may expand this curve due to apprehension. However, this is a gray area. For some, the supervision may be helpful but for others it would add to already high academic pressure of the very physically and mentally demanding surgical field. CCTV for residents are not entirely a curse, as the video recording of some rare cases, emergency cases, complex protocols may aid them to develop a better understanding of the OT environment and can be used as instructional/training videos.
  • Undue pressure on the surgical team : The art of surgery has a perplexing niche. Not every case is same even if it is a case of common ailment. Protocols are made to make the treatment easy, and hassle free but are not exclusive. Sometimes a surgeon has to take steps outside of those mandated by protocol, which one as patient might not find satisfactory. This puts undue pressure on the surgical team , to think only inside the box.
  • Cost and Maintenance of Equipment: As a developing country, where 63.64% of our country comes under rural distribution, the cost and maintenance of these CCTV is a big ask from the tertiary healthcare center’s, considering the massive workload and limited resources. But on the contrary, in private institutions where capital is not an issue, installation of CCTV should be implemented so as to increase the transparency of patient care and treatment. This would aid patients in their health insurance claims, avoid malpractice, etc.
  • Data storage facility and workforce; Even if institutions do manage to cross the above two hurdles, the storage facility for this video may require physical hard drives, servers, which requires a complex niche of temperature regulation, 365 days of electricity supply, regular supervision thus requiring additional manpower to operate smoothly.

In conclusion, weighing all the pros and cons, institutions or private practitioners must choose the option that is most congruous with their resources, requirements and make a move that is best for their patients’ overall healthcare.