In reply, another meeting attendee said: “Why don’t we just put video cameras in the unit, record all the time, and just let the insurance companies drown in the data.” He was, of course, being facetious, but I and others understood exactly what he was trying to say. Much of modern medicine (and, I would argue, most of it in some institutions) consists of “treating the chart” for legal and payment purposes rather than treating the patient.

I recalled this interchange while reading a great pair of books recently: Total Recall: How the E-Memory Revolution Will Change Everything by Gordon Bell and Jim Gemmell and Delete: The Virtue of Forgetting in the Digital Age by Viktor Mayer-Schonberger. You can pretty much guess the topic of the books from their titles, and the authors’ viewpoints on these topics. Bell and Gemmell are taken by just how data about our lives can be collected and stored, even with current technology, while Mayer-Schonberger is carefully warning us to be careful about what we save. Both books are well thought out and carefully written. The authors of the first book are not Pollyannas, the author of the second is not a Luddite. All the authors have thought carefully about how the future will look like in a world with ubiquitous webcams and in which every email, text message, photograph we take and our physical location can be captured and recorded digitally with no intervention on our part required. I recommend both books highly, and it’s definitely fun to read one after the other.

I know there are multiple applications for recording Skype calls, so I know that I could potentially record all my Skype sessions with patients digitally and preserve them. My yet-to-be-approved informed consent form for telepsychiatry explicitly forbids me or the patient from making recordings of our sessions. However, I think the decision to go this way is not a simple knee jerk “patients need privacy so that’s that,” but has some real pluses and minuses that merit some serious discussion, just like the books I’ve been reading.

In my next post, I’m going to blog about the problem of whether interactions between patients and doctors should be recorded. My prediction is that now is not the right time, but that recordings will become part of the standard of care in just a few years.