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Release: Feb. 29, 2000

Physicians are often reluctant to allow videotaping of births, UI study says

IOWA CITY, Iowa – Many Iowa obstetricians and family physicians are hesitant to allow patients to videotape obstetric procedures, such as childbirth, because of legal concerns, according to a study by University of Iowa researchers.

Jerome Yankowitz, M.D., UI associate professor of obstetrics and gynecology and co-author of the study that appeared in the January issue of the Archives of Family Medicine, said that anxiety over lawsuits accounts for much of the physicians' reluctance.

"What many of these practitioners are concerned about is a family using these tapes to mount a malpractice lawsuit," he said. "They may be used to bolster an existing lawsuit, or the families may view them after they return home and become shocked and decide to sue. They may not appreciate that the delivery of a baby involves a lot of anxiety, blood and messiness, and they may perceive that something they see on the tape is a mistake."

The researchers interviewed 610 Iowa physicians and found many practitioners were reluctant to allow taping. However, differences existed among obstetricians and family physicians. More than 40 percent of responding Iowa obstetricians (OBs) reported having prevented patients from filming medical procedures like births, compared to 19 percent of family physicians (FPs). More than 34 percent of OBs and 25 percent of FPs said they would modify their actions and conversation when video cameras were present. In addition, 35 percent of OBs and 14 percent of FPs indicated they would turn off the camera if complications arose.

The differences between the two types of practitioners may be due to the types of patients each sees, Yankowitz said.

"Obstetricians tend to deliver a larger number of babies and more babies that are high-risk," he said. "One hypothesis is that family doctors are used to less risk and normal outcomes in the pregnancies they deliver. They are not thinking of the problems that could arise and be seen on video, so they are less likely to control the videotaping."

According to Yankowitz, determining if legal concerns have any basis is a difficult task, since evidence used is often not described in trial listings. However, previous research found that in malpractice suits known to have videotape evidence, using the tapes helped show the doctor's fault in only some of the cases. In others, they actually showed appropriate care by the doctor.

"It is a theoretical concern that allowing videotaping will make doctors more liable and lead to successful malpractice suits," said John Ely, M.D., UI associate professor of family medicine and co-author of the UI study. "In fact, the opposite is probably true. If a procedure is on tape, it will probably help defend a doctor and the actions taken."

Ely said the issue will remain important as videotaping is a frequent request. Yankowitz notes, however, that requests and what actually happens is often a different story.

"It probably comes up more rarely than people think, since I would estimate half of the dads forget the camera in the car," he said. "The stereotypical dad with the camera may not happen since recording the event and supporting the mom at the same time is often not possible."

Doctors and patients can avoid misunderstandings or tense situations by discussing the procedures ahead of time and setting ground rules for camera use.

"Communication is the key," Yankowitz said. "Doctors need to be upfront about the procedure and let patients know if videotaping makes them, or any of the other staff, uncomfortable since this can affect their performance. Physicians should also sit down with the patients and talk about birth as a procedure, what can and most likely will happen.

"I like to develop some guidelines," he continued. "I tell my patients if they are videotaping that things may become complicated and, if so, I will ask the camera to be turned off, which they should agree to. Also, it may be fine with me but everyone else involved, like nurses and anesthesiologists, must agree as well."

Since the study was published, the American College of Obstetricians and Gynecologists' Committee on Professional Liability produced new guidelines that discourage any recording of procedures for patient memorabilia. Despite these warnings, Ely reiterates the value of communication as an antidote to potential problems.

"It is truly a matter of warning patients up front what may occur," he said. "Most women think their deliveries will go fine and the outcome will be happy. Doctors must tell their patients that things will likely go well but if it doesn't, certain things will need to happen, and the camera will probably be an interference. Things like this are decided quickly, and patients must realize that."

Douglas Eitel, a physician based in North Carolina who is also a lawyer, was the lead author on this study which he coordinated while a student at the UI College of Medicine.