BehindTheMedspeak: Virtual Chaperone

What's this?

It's the new new thing in the U.K.

The chronically underfunded, understaffed National Health Service just doesn't have enough nurses to assign one as a chaperone whenever a patient prefers not to be examined one-on-one.

They're considering rolling out a videocamera that records, in real time and living color, with sound and everything, the events that ensue in the examining room.

I wonder how this would fly in the U.S.?

Not well - at least at first.

Consider that central London is full of surveillance cameras, designed to prevent crime, and that Londoners apparently have accepted and even welcomed this 24/7 video monitoring.

And that Tony Blair's government has just announced a 2008 rollout of a national identity card which must be carried at all times by inhabitants of the U.K.

I guess they're not quite as sensitive to the intrusion of the state into the individual's private sphere as are we.

Read the virtual chaperone story for yourself; it's from this week's Economist.

Big Sister Is Watching You

Virtual chaperones may help both doctors and patients

If you can't trust a doctor, who can you trust?

Sadly, though, neither doctors nor patients are always trustworthy.

That leads to abuses by the former during intimate examinations, and false accusations of abuse by the latter in the hope of making large sums of compensation money.

To combat both phenomena, Britain's National Health Service (NHS) is considering a plan to force doctors to have a nurse present as a chaperone in any situation with the potential to turn compromising.

That, however, replaces one problem with another.

Chaperoning is hardly the best use of a nurse's talents, even when lots of nurses are available.

And at the moment the NHS has a serious shortage of nurses.

However, a team led by Sir Ara Darzi, of the Imperial College School of Medicine, in London, may have come up with the answer - an electronic chaperone.

Like a maiden aunt at a Victorian date, the Synaptiq Virtual Chaperone, so named after the firm that makes it, is discreet, but omnipresent.

A camera mounted on the ceiling in the corner of the consulting room has a viewing angle of 120° - enough to see what is going on everywhere - while a microphone records the conversation between doctor and patient.

The equipment is barely visible.

This should help to avoid the tendency which many people have to play to the camera. But the system is discreet in another way, too.

The data it collects are encoded immediately, using a level of security more frequently associated with financial institutions than doctors' surgeries.

And those data are there for clinical as well as legal reasons.

For there is a third element to the system, a console on the doctor's desk that can be used to record medical information about the patient.

That means there is a complete record of the consultation that both patient and doctor, who each receive a copy, can refer to in order to jog their memories about the facts.

To decode the recording requires a special key that fits into a computer's USB port, and also a password, so unauthorised access is easy to prevent unless both key and password fall into the wrong hands.

A trial of the system, carried out in the plastic-surgery department of Charing Cross Hospital, in London, has yielded positive results.

Some 96% of patients said that having the virtual chaperone enhanced their relationship with the doctor. The NHS's managers are also keen on the system.

At the moment, the average time needed to settle a claim of misbehaviour in the consulting room is eight years.

Many innocent doctors are suspended as a result (in 70% of cases, the doctor is cleared).

An unambiguous record of what happened should stop that, and also prevent money being wasted on protracted court battles, since such cases will no longer turn on one party's word rather than another's.

The virtual chaperone, in other words, may soon become virtually indispensable.