Videotapes Educate People About Disease, Minus Bedside Manner
TO SEE THE DOCTOR, press ``play.″
Video patient-education programs are gaining ground in clinics and doctor’s offices. They’re not surrogates for real-life encounters with your physician. But in a world of increasing medical complexity, such programs are increasingly being offered to help patients feel better informed and more comfortable making health decisions.
Such videos have been used for years as marketing tools for particular procedures, like hair transplants. But now, the mission is education and a wiser and more cost-efficient use of health-care resources.
Patient-education videos focus on a particular condition, briefing you on the medical science and outlining all your therapeutic options, exploring the risks and benefits of each. The videos shouldn’t try to sell you on a particular approach. Rather, they should hand you the tools to make tough decisions in partnership with your doctor.
``People really want to hear this stuff. There’s an appetite,″ says MaryAnn Stump, a senior vice president at Blue Cross and Blue Shield of Minnesota, which uses the tapes.
What treatment a man should undergo for prostate cancer, or whether a woman should take hormone-replacement therapy, are classic examples of medical dilemmas that require well-informed patients, says Linda Adler, health-education consultant for Kaiser Permanente of northern California, the big HMO.
``The situations that cry out the most are those where there’s no one right answer, where you can look at the best medical science and go one of three ways,″ Ms. Adler says.
Kaiser Permanente’s northern California and Colorado regions have taped patient reactions to the programs. After her diagnosis with breast cancer, patient Linda Horner said, ``I was in shock from the doctor’s statement that it was cancer.″
LATER, WITH HER husband at her side, she said, ``Looking at the video I was able to see objectively both sides of all the procedures. I didn’t realize I had so many choices to make. I needed to know the facts so I could say: `Yes, that’s the right one for me.‴
Whether they’re on videotape, videodisk or CD-ROM, the programs are meant to provide a factual framework for holding follow-up talks with your doctor.
What can videos offer that a good doctor can’t? Elizabeth Mort, an internist at the Massachusetts General Hospital in Boston, says, ``because of increased demands imposed on productivity by managed care, physicians don’t have that much time to talk to patients.″ Dr. Mort was a consultant on the production of a 53-minute tape on hormone-replacement therapy by the Foundation for Informed Medical Decision Making of Hanover, N.H.
She says videos enable patients to learn in a relaxed setting, away from the examining room. Then, the next session with the doctor can focus on their personal needs, rather than ``the general rote material″ covered by the tape, she adds.
``Videos have the advantage of taking away physician bias, and ensure that every patient gets some basic information,″ says Gerald Chodak, director of the prostate center at Louis Weiss Memorial Hospital in Chicago. He hopes, however, that video producers will strive to incorporate more and better statistical data in future programs.
The programs also ``give a sense of how good or bad (various treatments) will be″ by including interviews with real patients, says Albert G. Mulley, the chief of general medicine at Mass. General and a co-developer of the foundation’s video programs. ``One way to put treatment in context is to let patients hear from people who’ve had good and bad outcomes,″ he says.
Some doctors may balk at ``anyone messing with my patient relationships,″ says one Kaiser administrator.
But when combined with face-to-face physician counseling, enthusiasts say the experience enhances rather than detracts from the doctor-patient relationship.
Other doctors may fear some tapes are too long or detailed to be absorbed. Indeed, production companies are moving toward interactive disk and CD-ROM programs that let the patient control the information flow.
VARIOUS PROGRAMS are available for direct public consumption. Here are a few examples:
The Foundation for Shared Medical Decision Making, a nonprofit New Hampshire concern, offers tapes on issues such as benign prostatic hyperplasia, prostate-cancer treatments, breast-cancer treatments, hormone-replacement therapy, low-back pain, heart disease and hypertension. The 45-minute to one-hour programs are patient-friendly but data-intensive.
Patient Education Media Inc. of New York City is producing videos for the Time Life Medical Series on 30 topics, including coronary-artery disease, depression, diabetes, alcoholism and Alzheimer’s disease. Styled like TV specials, the half-hour tapes feature animated graphics, rich-looking sets and introductions by former U.S. Surgeon General C. Everett Koop. The company plans to market the tapes at retail pharmacies early next year.
The Comprehensive Health Enhancement and Support System, or CHESS, of the University of Wisconsin’s Engineering Department has so far produced two personal-computer programs on breast cancer and HIV. More programs are planned to address adult children of alcoholics, stress and sexual assault.