 |
|
Videotaping Obstetric Procedures
Assessment of Obstetricians and Family Physicians
Douglas R. Eitel, MD, JD, MBA;
Jerome Yankowitz, MD;
John W. Ely, MD, MSPH
Arch Fam Med. 2000;9:89-91.
ABSTRACT
| |
Objective To compare the attitudes and practice of Iowa obstetricians (OBs) and family physicians (FPs) regarding patients' desires to videotape obstetric procedures.
Design All Iowa OBs (172) and FPs (438) who practice obstetrics received a questionnaire exploring their attitudes and practice patterns regarding videotaping obstetric procedures. Data were analyzed using  2, odds ratios with 95% confidence intervals, and multiple logistic regression.
Setting The state of Iowa.
Main Outcome Measures Degree to which physicians allow videotaping and characteristics that contribute to any differences between OBs and FPs.
Results The response rate was 87.8% (536 of 610 participants). Obstetricians were more likely than FPs to prevent patients from filming medical procedures (40.8% vs 19.1%, respectively, P<.001), modify their actions and conversation when video cameras were present (34.5% vs 25.5%, respectively, P = .046), and be tempted to turn off the camera when complications arose (35.1% vs 14.0%, respectively, P<.001). Younger OBs (aged, 25-40 years) were more likely than older OBs (aged, 41-80 years) to disallow videocameras (52.7% vs 33.3%, respectively, P = .02). Legal concerns were cited by more than 80% of OBs and FPs who disallowed videotaping.
Conclusions A significant difference was noted between OBs and FPs in their willingness to allow video recording of obstetric procedures. Legal concerns were cited by most OBs and FPs who had disallowed videotaping.
INTRODUCTION
A MEDLINE review of the English-language literature from 1966 to the present provides no citations about physicians' views of patients' use of video equipment during obstetric procedures. Yet, patient or family use of videotapes can have complex and significant legal implications.1 Informal conversations with colleagues has indicated that patients frequently ask whether an ultrasound or a delivery can be videotaped and the topic sparks strong and varied opinion among physicians.
Differences in physician style can have an influence from marketing to medical issues. The physician's response to a request to videotape a medical procedure or event can affect the patient's and family's perceptions of their interaction with the physician. This is important because the recent explosion of managed care, with its emphasis on cost control, has forced physicians to become more competitive.2 Physicians who take advantage of patient-centered, cost-effective technology to improve their patient care service may assume a leadership position in a shrinking marketplace.3 Competition for patients is important for business and potential or documented differences in practice styles of obstetricians (OBs) and family physicians (FPs).
Having documented differences in practice patterns between OBs and FPs in use of serum screening,4 we evaluated nonmedical aspects of patient care by testing the hypothesis that there are differences in practice patterns between OBs and FPs related to the videotaping of obstetric procedures. We specifically evaluated legal considerations as a factor.
PARTICIPANTS, MATERIALS, AND METHODS
A questionnaire pertaining to videotaping was developed to explore attitudes and practice patterns of OBs and FPs (Table 1). A registry from the University of Iowa College of Medicine, Iowa City, was used to identify all OBs (n = 172) and FPs (n = 438) who practiced obstetrics in Iowa during 1996. A telephone call was made when the database did not clearly indicate whether the physician's practice included obstetrics. A second questionnaire and cover letter were sent to all physicians who failed to reply to the first letter. Data management and statistical analysis were carried out with Statview 4.5 (Abacus Concepts, Berkeley, Calif) and Stata, version 4.0 (Stata, College Station, Tex). Data were analyzed using 2, odds ratios, and 95% confidence intervals. We used multiple logistic regression to identify independent associations. P<.05 was considered statistically significant. Approval to perform the study was obtained from the University of Iowa Human Subjects Committee.
|
|
|
|
Table 1. Survey Questions
|
|
|
RESULTS
Characteristics of the overall and physician population are responding in Table 2. No significant differences were noted between the respondents and overall physician groups for specialty, sex, degree (osteopathic vs allopathic), age, or rural or urban practice.
|
|
|
|
Table 2. Characteristics of 536 Responding Physicians*
|
|
|
Most physicians (87.3 % [536 of 610 participants]) had been asked by their patients for permission to videotape obstetric procedures. Among physicians who received a request from a family to videotape obstetric procedures (n = 468), OBs were more likely than FPs to disallow filming (40.8% vs 19.1%, respectively, P<.001) (Table 3). The OBs and FPs cited legal issues as a factor for denying patients' requests. Of the physicians who received requests to videotape obstetric procedures, OBs were more likely than FPs to modify their activities and conversation in the presence of video cameras (34.5% vs 25.5%, respectively, P<.046) and OBs would be more tempted to turn off the video camera if circumstances changed (35.1% vs 14.0%, respectively, P<.001). In the multiple logistic regression analysis, no significant differences were noted in refusal patterns based on sex or urban vs rural practice. Younger more often than older OBs tended to disallow filming (aged 25-40 [52.7%] vs 41-80 years [33.3%], respectively, P = .02). No similar difference among the FPs based on age was seen (aged 25-40 [23.1%] vs 41-80 years [16.6%], respectively, P = .15).
|
|
|
|
Table 3. Family Videotaping of Obstetric Procedures (Univariate Analysis) by Obstetricians (OBs) and Family Physicians (FPs)
|
|
|
Multiple logistic regression identified factors independently associated with practices and beliefs about family videotapes. In the multivariate analysis, OBs (P<.001) and younger physicians (P = .002) were independently associated with refusal patterns (Table 4). The OBs were more likely than FPs to want to stop the video camera when complications arose (P<.001). In the multivariate analysis, older OBs (P<.001) and FPs (P = .03) were more likely to require the mother's written consent before allowing videotaping.
|
|
|
|
Table 4. Family Videotaping of Obstetric Procedures (Multiple Logistic Regression)*
|
|
|
COMMENT
Our study supports the hypothesis that there are differences in reported attitudes between OBs and FPs concerning the permissibility of video cameras during obstetric procedures. The OBs are more cautious about allowing families to videotape obstetric procedures and are more likely to ban video cameras. More than 80% of OBs and FPs cited legal concerns as a basis for disallowing videotapes (Table 3); however, this does not explain the differences between OBs and FPs. In exploring legal factors as a role in the decisions, one should recall the legal climate of the past 20 years which would affect OBs and FPs. Since the early 1980s malpractice premiums have increased for OBs and FPs who perform obstetric procedures.5 Our questionnaire was not detailed enough to provide a clear explanation of why FPs are less tempted to modify their activities and conversation in the presence of video cameras or to turn off the video cameras when complications arise.
A possible explanation for our differences is that Iowan FPs may provide obstetric care for lower risk patients.6 Having referred high-risk patients to an OB, FPs may have less concern about complications that might be portrayed by videotaping.
We also noticed a greater reluctance of younger OBs to permit families to videotape obstetric events. It is possible that younger physicians, having graduated during the frenzy of malpractice litigation, are more inclined to be defensive in their physician-patient relationships. This same phenomenon does not repeat itself among the FPs.
As physicians face increased competition for patients, they will need to balance their interest in accommodating patients against the potential evidentiary risk inherent to videotaping obstetric procedures. Physicians who choose to permit videotaping should recognize their increased liability exposure and incorporate appropriate safeguards to limit this risk.1 After completion of our study, the American College of Obstetricians and Gynecologists' Committee on Professional Liability has released the statement that they strongly discourage any recording of medical and surgical procedures for patient memorabilia.7
Our study is limited by the fact that we only surveyed Iowa OBs and FPs. The extent to which our findings can be applied to other physician populations is unknown. However, the surveys were returned by 536 physicians representing a broad spectrum of urban and rural practices. It also included physicians in hospital-based practices, solo practices, partnerships, and multispecialty groups. Given the diversity of the respondents, we believe the results are representative of the physician population at large. We acknowledge that legal climates vary geographically and repeating this study in other areas may be worthwhile. Also, we made many comparisons involving multiple variables; thus, some of our findings may be spurious. Differences associated with P<.01 are more likely to represent true associations. A questionnaire format can be problematic as a study tool. Questions are open to interpretation by the responding physicians. We believe, however, that as initial data concerning nonmedical practice styles, this is an important contribution to the literature.
In summary, we4 and others have shown differences in practice patterns between OBs and FPs for areas in which medical guidelines have been established. Thus, it is not surprising to find differences in practice style, attitudes, or beliefs in relation to nonmedical areas such as videotaping by patients or their families. Our study shows OBs have a more adverse reaction to the videotaping of obstetric procedures than FPs. Legal concerns contribute to this response by OBs and FPs. Studies of practice style can lead to improvement in the physician-patient relationship and theoretically have a positive influence on central issues such as patient compliance or other physician-patient communication. Improving communication can in turn reduce malpractice suits.8-9
AUTHOR INFORMATION
Accepted for publication June 6, 1999.
Corresponding author: Jerome Yankowitz, MD (e-mail: jerome-yankowitz{at}uiowa.edu).
From the Departments of Obstetrics and Gynecology (Dr Yankowitz) and Family Practice (Dr Ely), University of Iowa College of Medicine (Drs Eitel, Yankowitz, and Ely), Iowa City.
REFERENCES
| |
1. Eitel DR, Yankowitz J, Ely JW. Legal implications of birth videos. J Fam Pract. 1998;46:251-256.
ISI
| PUBMED
2. Kronick R, Goodman D, Wennberg J, Wagner E. The marketplace in health care reform. N Engl J Med. 1993;328:148-52.
FREE FULL TEXT
3. Kirton O, Civetta J, Hudon-Civetta J. Cost effectiveness in the intensive care unit. Surg Clin North Am. 1996;76:175-198.
FULL TEXT
| PUBMED
4. Yankowitz J, Howser DM, Ely JW. Differences in practice patterns between obstetricians and family physicians. Am J Obstet Gynecol. 1996;174:1361-1365.
PUBMED
5. Wall EM. Family physicians performing obstetrics: is malpractice liability the only obstacle? J Am Board Fam Pract. 1992;5:440-444.
6. Yankowitz J, Howser DM, Ely JW. A statewide pattern of access to prenatal care. Am J Obstet Gynecol. 1996;174:339.
7. American College of Obstetricians and Gynecologists. Liability Implications of Recording Procedures or Treatments. Washington, DC: American College of Obstetricians and Gynecologists: September 1998. ACOG Committee Opinion No. 207.
8. Hickson GB, Clayton EW, Entman SS, et al. Obstetricians' prior malpractice experience and patients' satisfaction with care. JAMA. 1994;272:1583-1587.
FREE FULL TEXT
9. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. JAMA. 1997;277:553-559.
FREE FULL TEXT
RELATED ARTICLE
The Archives of Family Medicine Continuing Medical Education Program
Arch Fam Med. 2000;9(1):79-80.
FULL TEXT
|
