We live in a world where monitoring people at work is nothing unusual. Airline pilots are monitored. Truck drivers are monitored. Workers in industrial plants are monitored. In my own experience working in a lumber mill, there was constant awareness that what you were doing could be observed or recorded. This isn’t necessarily because people are dishonest or incompetent. It is because when safety matters, having an objective record of what happened is valuable.

So why should an operating room be any different?

An operating room is one of the most safety-critical environments in healthcare. A patient is often unconscious and completely dependent on the surgical team. They cannot see what is happening around them or know exactly who entered or left the room. There may be surgeons, nurses, anesthesiologists, residents, students and other personnel present. If something goes wrong, the patient may wake up with little ability to know exactly what happened.

Everyone involved may have their own recollection, and medical records are important, but nothing provides an objective record quite like a recording.

I am not suggesting cameras because I believe doctors, nurses or other healthcare professionals are inherently untrustworthy. The vast majority are dedicated professionals. But professionalism should not be an excuse for avoiding reasonable safety measures.

Airline pilots are highly trained professionals, yet aircraft have recording systems. Truck drivers can be monitored. Industrial workers can be monitored. Monitoring does not automatically mean distrust. It recognizes something we already know: people can make mistakes, and safety improves when there is an objective record of what happened.

My proposal is simple: if a patient wants their operation recorded, the patient should have the right to request it.

The recording should belong to the patient—not the hospital, not the surgeon and not some other organization. The patient should decide whether the recording is made and what ultimately happens to it.

The technology to accomplish this is hardly revolutionary. The camera could be permanently installed and hardwired to a secure, tamper-resistant lockbox located outside the operating room. It should not be something that can simply be unplugged or switched off from inside the room.

If a patient requests a recording, the patient or their authorized advocate could be given a secure access code. Before the operation, they could place their own approved recording device—whether an SD card, storage device or other suitable medium—into the secure box. The box would then be locked, and the recording would be made onto the patient’s device.

At the end of the operation, the patient or their advocate retrieves the device. The recording belongs to the patient.

If the operation goes well and the patient has no reason to review it, there is nothing more to do. But if something goes wrong, the patient has an objective record that can be given to an independent medical expert for review. If that expert believes something inappropriate occurred, the patient can decide whether to make a complaint, seek another opinion or pursue the matter through the courts.

That could provide patients with something they often don’t have today: an independent record of what actually happened while they were unconscious.

But cameras in operating rooms should not only be about recording surgery.

I believe operating rooms should have security monitoring 24 hours a day, even when no patient is present.

The purpose would be security, cleanliness and infection control—not surveillance of patients. A properly designed system could provide a record of when the room was cleaned and prepared, who entered and left, whether unauthorized people gained access and whether the room remained secure between procedures.

If an operating room is supposed to be a controlled environment, then it should actually be controlled.

A curtain is not security. An operating room should be a properly secured room, with access limited to people who are actually required for the procedure or have legitimate authorization to be there. If someone enters the room, there should be a reason, and there should be a record of that entry.

The same principle applies to teaching hospitals.

Medical education is extremely important, and many patients are perfectly comfortable having students or residents observe their procedures. Those patients should be allowed to participate in teaching if they willingly agree.

But there are also patients who do not want students or other observers present. Their wishes should be respected just as strongly.

Consent should mean consent.

A patient shouldn’t be told, directly or indirectly, that because they are receiving care in a teaching hospital, they have automatically agreed to become part of someone’s education. Some patients don’t mind. Others do. Deal with those two groups differently.

There are enough patients who are happy to help educate the next generation of healthcare professionals. We should respect the rights of those who aren’t.

We should also remember who the healthcare system exists to serve.

The public pays for the hospitals, operating rooms, equipment, instruments, electricity, cleaning, infrastructure and the wages of the people who work in these facilities. That doesn’t mean healthcare workers should be treated without respect. But it does mean patients should not have to surrender their dignity and basic rights simply because they have entered a publicly funded healthcare facility.

The system exists to care for the patient.

There will undoubtedly be objections to cameras. Privacy and security concerns are legitimate and must be addressed. A poorly designed system could create problems of its own. That is why the system needs strict safeguards.

The camera should be secure and hardwired. Recordings requested by patients should be under the patient’s control. Access should be tightly restricted. There should be clear rules governing who can access any hospital security footage and severe consequences for inappropriate access.

Technology should protect patients, not become another form of uncontrolled surveillance.

And eventually, artificial intelligence could make these systems even more useful. AI could potentially monitor operating-room security, identify unauthorized access, monitor environmental conditions and flag potential safety problems without requiring someone to sit and watch a camera continuously.

The larger question is this: Why should healthcare be different from every other safety-critical industry?

We don’t tell pilots that recording a cockpit means we don’t trust them. We don’t tell industrial workers that monitoring their work is an insult to their professionalism. We recognize that safety systems protect both the public and the professionals working within them.

The operating room deserves the same philosophy.

A camera is not an accusation. It is a safety tool.

And when a patient specifically asks for that protection, I believe the healthcare system should respect that request.

Patients have already entrusted the healthcare system with their lives. The least we can do is give them the choice to have an objective record of what happened while they were unable to witness it themselves.

What Do You Think?

I’ve put forward my ideas, but I’d like to hear yours.

If you were having surgery, would you want the option of having the procedure recorded, with the recording placed entirely under your control?

Should operating rooms have cameras running 24 hours a day to monitor security, cleaning and access—even when no operation is taking place?

And should patients in teaching hospitals have the absolute right to say no to students or other observers being present during their procedure?

Do you agree with my proposal, disagree with it, or have a better solution?

Send me your thoughts. The more people who participate in this discussion, the more we can examine whether our healthcare system is really putting patient safety, privacy and dignity first.