The Public's Health: Should Black Boxes Be Welcome in Medicine? | Public Health Post

It has become an article of faith that technology will improve the practice of medicine in coming decades. Medicine enthusiastically embraces novel technical approaches that may improve patient care. But what if those technical approaches bring greater scrutiny to clinical work? What if they may cast a harsh light on work that medicine typically does behind closed doors?
Such questions emerge as efforts grow to introduce “black boxes” to surgery.
When an airplane goes down, there is an urgent search for the plane’s black box. The black box contains both the audio recording of all cockpit discussion as well as a recording of flight instrument readings. These two flight recorders are required by international regulation and together offer the best possibility of learning what happened in the minutes preceding any aviation accident or incident.
This kind of recording technology that captures medical conversation and physiological parameters, allowing for post-surgery analysis, is just making its way into the world of medicine. Early reports suggest that intraoperative error events are far more frequent than previously noted and a high number of operating room distractions contribute. Black box recording devices would bring a new transparency to what actually happened during adverse events, allowing us to improve our surgical procedures.
But the operating room is a sacred space. Its sterilized choreography and chatter have never before been scrutinized in this way. The work of surgeons—detailed, immodest, sequestered, and focused on a small part of the body of a single unconscious patient—is the labor of mortal lessons.  
So the new technology raises important questions. Will surgeons (and other health professionals) be put in malpractice jeopardy by such new information? Will patients and their families become more likely to sue? Will more information undermine patient trust?
Surgical safety depends on team dynamics and communications, technical issues, and an alertness and rapid response to a patient’s trouble. Will constant surveillance produce a different kind of accountability and therefore a different level of stress? Will surgical staff be more likely to speak up when they see something amiss?
These questions will require sober assessment. But at heart, we are an information culture, and medicine aspires to create a culture of continual improvement. We can imagine black box technology entering medicine widely over the next years, beyond surgical suites and into delivery rooms where maternal mortality is rising, and where we might study what goes wrong, identify solutions, share lessons learned.

That seems right for the public’s health.

Michael Stein & Sandro Galea