How should we deal with mobile video in the exam room?

Mayo Clinic CEO John Noseworthy, M.D. conducts a regular early morning phone conference call with Mayo staff to highlight issues of interest and concern to Mayo physicians. Farris Timimi, M.D., our Medical Director for the Mayo Clinic Social Media Network, was a guest on yesterday's Morning Rounds call, discussing the phenomenon of patients using mobile phones to record or stream video of clinical encounters, and offering helpful tips on how physicians might respond. Below is a transcript of that discussion, which also included Christina Zorn, CAO of Mayo Clinic in Florida:

Dr. Noseworthy: Last topic today, we are going to come back to Farris Timimi, who has been on the show a number of times, and talking about patient privacy when we are doing video calls and video broadcasts with patients in their homes. Farris?

Dr. Timimi: Thanks, John, and I thank everyone for the opportunity to share this. So as you are all aware, mobile broadband has become ubiquitous in our culture, and social media penetration continues to escalate now at over 80 percent. And for many of our patients, particularly those who are traveling individually, it can be challenging to process a large amount of information, and they would like to access their support network.

In the current era, there are numerous video-streaming options that are available to them that they may take advantage of. It provides advantages to them. It is a second set of ears that can listen and understand and perhaps ask questions on a patient’s behalf and engage for the patient with their support network, but it also poses potential risks for our providers.

For example, if a patient tries to live stream from a public area, they may jeopardize the confidentiality of other patients. In addition, in the exam room, there is the potential that live streaming can preclude the ability to engage in a deep and meaningful conversation between the patient and the provider that needs to take place. And so I think of in the era of escalating broadband penetration and the access patients have, that it is critical that our providers be cognizant of this as a growing potential trend in their clinical practice.

Christina Zorn: Thanks, Dr. Timimi. Can you help us understand the actual difference between a live video call and what is a live video broadcast?

Dr. Timimi: That is a great and critical question. So a live video call is best thought of as a closed loop between the individual who initiates the call and either one other individual or their individual that they have identified as their friends or colleague on a particular platform; you know, think about Facetime, Skype, or Google Hangouts. A live video broadcast is public. It can be downloaded. It can be archived. It can be viewed based on privacy settings, but it can be a much wider audience, and you think of Periscope and Facebook Live and YouTube Live as well, and both are prevalent, but both have different implications for the provider.

Christina Zorn: Thank you and so obviously patients and you made a point of saying family members, caregivers, others who may not be able to actually attend the appointment in person can really benefit from this but, obviously, there is a privacy aspect as well. What advice would you give to our staff to help them understand the privacy risk and really minimizing that risk to Mayo Clinic while still enabling the communication for the patient?

Dr. Timimi: That is a wonderful question. So there are three things I do when I walk in the exam room. First, I pay attention to what the patient is carrying; you know, do they have an open laptop, tablet or iPhone? And then I ask them, you know, I might say, “Hi, who is joining us at our appointment today?” Or if I see Facebook open, I may say, “I noticed you have Facebook open; are we live?” and use that as a way of entering the conversation.

My primary approach is that I try to transition that conversation from public broadcast to a more private format, and I use a phrase along the lines of, “I understand that you want to share your appointment with your Facebook followers; you are welcome to invite someone in particular during the conversation, but I am concerned we will not be able to be as open as necessary if we stream this publicly. Is there someone specific we can call to join our conversation?” and move it from a live video broadcast to a live video call.

So we have seen live video calls in clinical encounters, particularly if a patient is traveling solo. We have not seen live video broadcasts be a dominant factor in clinical practice; but given the prevalence of live video broadcasts and its ubiquity, I think it is just a matter of time.

Dr. Noseworthy: Well, this is around the corner, Farris. Thank you for giving us a peek around the corner, and we will bring you back again soon to tell us what else is coming.

Editor's Note: Mayo staff can access the full audio and transcripts for these calls by searching on the intranet for Morning Rounds.

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