Medical Futures Lab

Guest posting by Kylie Balotin

After one of my team’s presentations, one member of the audience pitched a new idea for our campaign’s HIV video. Why not show doctors the consequences of not talking to their patients about HIV testing and scare them into testing their patients more frequently? At first, this seems like a great idea, but studies have shown that fear tactics alone will not change the audience’s behavior.

Video Campaigns

As there are few physician-targeted campaigns, I looked up patient-targeted HIV video campaigns to see how fear appeals can be used and if they are effective. One of the first videos I found came from the New York campaign, “It’s Never Just HIV.” After watching this video, I found that I had experienced many of the defense mechanisms listed in the article, “Fear-Based Campaigns: The Way Forward or Backward?” such as “othering” (when a person doesn’t listen to a campaign message because they don’t believe that it applies to them) and minimizing (when a person believes that the message is exaggerated and don’t respond to the campaign), even though I was not a member of the target audience. (Knowles and Challacombe) I thought the video was ridiculous and exaggerated, so the message was lost on me. The entire video seemed over-the-top, from the actors’ expressions and actions to the images used to depict the diseases to the use of the sound of a heartbeat as the video quickly flashed images of men crying and in hospitals. (NYC Health) I experienced “othering” even though I know that I also have a chance of contracting HIV if I am not careful. (Knowles and Challacombe) Additionally, I did not feel like I had gained any more knowledge about how to make sure I was safe from HIV. For example, this video made me wonder how someone could make sure his or her partner used a condom and how would someone approach a conversation if the partner seemed unwilling to wear a condom.

Example of a campaign poster employing fear tactics

Poster Campaigns

The ineffectiveness of fear-based campaigns is not limited to videos and also appears in poster campaigns, which is demonstrated in the blog post “Why Graphic Anti-Smoking Ads Make Some People Smoke More Cigarettes.” (Goldb) This post gave some examples of anti-smoking campaigns that relied on fear-based tactics in order to encourage people to quit smoking such as the one shown above. Yes, these posters are shocking and disturbing, but this type of campaign once again leaves the audience with questions. These posters don’t explain how someone can go about quitting smoking and don’t empower their audiences to make a large life change. (Goldb)

How to Fix Fear-Based Campaigns

If used correctly, fear appeals can be helpful in a campaign as it might be useful in catching the audience’s attention. However, the campaign cannot rely solely on fear tactics to convey its message. Studies have shown that the most effective HIV interventions are ones that aim to change attitudes and beliefs regarding HIV, provide information about HIV, and give people examples of how to approach discussions about HIV and its prevention. (Albarracín et al.) Even though we know that information alone is not sufficient to change behavior, we need to add more education into campaigns so the audience has more knowledge about how they can change their behavior. This is why we cannot use the suggestion of “fear mongering” for our video. We need to empower the physicians that our campaign is targeting by giving them the knowledge and resources they need to change their behavior.

References

Albarracín, Dolores et al. “A Test of Major Assumptions About Behavior Change: A Comprehensive Look at the Effects of Passive and Active HIV-Prevention Interventions Since the Beginning of the Epidemic.” Psychological bulletin 131.6 (2005): 856–897. PubMed Central. Web. 9 Apr. 2015.

Goldb, Jessica, and on. “Why Graphic Cancer Ads Make People Smoke More Cigarettes – Iodine Blog.” The Iodine Blog. N.p., n.d. Web. 9 Apr. 2015.

Knowles, Zak, and Laurel Challacombe. “Fear-Based Campaigns: The Way Forward or Backward?” TheBody.com. N.p., n.d. Web. 9 Apr. 2015.

NYC Health: It’s Never Just HIV. N.p., 2010. Film.

Guest posting by Allyson Knapper

In response to the rapidly changing field of health care, medical schools are working to design a curriculum that better incorporates new and innovative ways of teaching. In their quest, some are turning to a subset of video games known as “serious games”—games that have been created with the purpose of providing training and education. Several games have already been developed, including one designed by Stanford physicians and researchers called Septris.¹ This web-based game was created to better educate medical students on how to recognize and treat the bacterial infection Sepsis, which claims over 750,000 lives a year.² Working through a series of case studies, users develop decision making and problem solving skills as they decide the best treatment plans for their virtual patients.

Following the initial success of Septris, Stanford released a second game called SICKO (Surgical Improvement of Clinical Knowledge Ops), which was designed to help surgeons determine how to triage patients and in what situations it is safe to conduct surgery, important skills that are tested on the board exams.³ Similar games have been developed by other academic institutions that deal with a variety of conditions ranging from diabetes to neuroscience.

Although real patients and high-tech simulation centers are the optimal tools for learning, access to these resources are limited to the medical school setting. In contrast, videogames can be accessed from anywhere that there is an internet connection, making it a great and an effective way to reinforce knowledge learned in the classroom. This study tool is more engaging than reading a textbook or listening to a lecture and is highly accurate in depicting real-world experiences. For example, a research study conducted at the University Medical Center Freiburg in Germany found that student test scores on a 34 point exam increased by three points after a week of playing an electronic adventure game.⁴ Additionally, students can learn about the consequences of making a bad decision without it actually affecting a real patient.

Although there are many benefits to this type of learning, it remains to be determined what the long-term effects of playing these games are—do the skills and knowledge acquired from games “stick” as well as information gained from more traditional learning techniques (such as lecture and reading), or are these just short-term gains? How many hours of gameplay are required to master the topic presented in the videogame?  Do the hours spent working with virtual patients surpass the amount of time needed to develop a skill when working with real patients?

Despite the unanswered questions, serious games present a promising solution to the outdated school curriculum, and there is no doubt that medical schools will adopt this form of teaching as more games of this type continue to be developed.

References
1. https://www.aamc.org/newsroom/reporter/june2014/384790/technology-medical-education.html
2. http://med.stanford.edu/septris/
3. http://med.stanford.edu/news/all-news/2013/09/stanford-designed-game-teaches-surgical-decision-making.html
4. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0082328

Image sources
1. www.gameifications.com
2. www.imedicalapps.com

Guest posting by Alisa Momin

The FDA has recently given a second clearance to Sense4Baby¹, a new fetal and maternal monitoring product by AirStrip Technologies that includes a wearable monitoring device (shown below), specialized Sense4Baby software pre-loaded onto a smartphone or tablet, and a web-based portal for healthcare providers to view and assess the monitored and entered data. The FDA approval clears the product for non-stress testing by pregnant mothers in their own homes.

This is only one example of an overall greater interest in and adoption of technology that promotes patient self-administration. What does this new type of technology mean for patient health and the doctor-patient relationship? There are many obvious positive aspects that I can name just off the top of my head: patients no longer need to travel to their doctor’s office, patients have instantaneous access to their own health data, and doctors have more time available to see other patients that need more attention. It would seem that time, energy, and money are saved on both the patients’ and doctors’ parts as a result of home-based healthcare. So what are the concerns?

Superficially, for Sense4Baby, there seem to be none. In the case of non-stress testing for pregnant mothers, it may not seem necessary to take out the time and the resources needed to visit a doctor just to measure a fetus’s heart rate and contractions. There is no risk for the mother or baby², and thus no reason to drive to a doctor’s when the procedure can be done in the privacy and comfort of the home. However, I personally believe that there is something vital lost when cutting out face-to-face time with your doctor, even in this scenario. Patients have emotional needs—statistics show that forming positive relationships and maintaining supportive, encouraging interactions with others, including doctors, have an essential influence on health³. A patient who has private concerns or anxiety about some facet of her pregnancy will not benefit from replacing valuable time with her doctor with technology like Sense4Baby, which only throws numbers and data at her instead of the compassion or reassurance she may need. In fact, Dr. Suzanne Steinbaum, DO, asserted in an article titled Technology and the Doctor-Patient Relationship that, “’I don’t believe a computer could do that as well as I can.’”⁴ The patient as a result may feel that her concerns aren’t top priority, and thus may feel hesitant about bringing them up.

What are the options? Is there a way to bring the doctor into the home as well as health technology? In our Medical Media Arts Lab course, we’ve discussed how video (for example, Skype) can breach the gap we see here, and can still be efficient and save patients’ time. There would be several complexities and issues to work through in terms of implementation, obviously, but maybe AirStrip Technologies should consider incorporating video calling into their smartphone or tablet software, or their web portal, in order to at the very least give mothers an opportunity to get face-to-face time with their doctors. If this happens, it might even induce patients to bring up their concerns instead of merely fading to a name and a medical case behind the data that doctors receive.

Figure 1 Monitoring device for Sense4Baby¹

Sources:

¹http://mobihealthnews.com/42062/new-fda-clearance-will-bring-sense4baby-into-the-home/#more-42062
²http://americanpregnancy.org/prenatal-testing/non-stress-test/
³http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150158/
⁴http://www.kevinmd.com/blog/2014/07/technology-doctor-patient-relationship.html

Guest posting by Sonali Mahendran

You’ve been meeting with the same family physician for several years now. You feel that your doctor considers you, your lifestyle, and your cultural background when discussing healthcare options and prescribing medication. You become comfortable enough with your doctor to share your concerns and ask questions; sometimes you share more personal information than you would with any another healthcare provider.

You feel so close to your physician that you find yourself trying to ‘friend’ your physician on Facebook. Days go by, and you find that your physician has declined your invitation. How would you feel? Rejected? Let down? Suspicious? Or, do you understand his situation and let it pass?

PC: Hands on Telehealth

In 2012, one-third of physicians surveyed, according to “Hands on Telehealth”, said that a patient attempted to ‘friend’ them on Facebook. And three-quarters of these physicians declined or ignored these invitations, while the rest accepted them.

And, as you can imagine, there are reasons for this. The AMA guidelines state that physicians should maintain “appropriate boundaries of the patient-physician relationship” and also suggests that they “consider separating personal and professional content online”.  Overstepping these boundaries may raise ethical questions about the relationship between patients and their providers.  This relationship may take the professionalism out of healthcare. From the perspective of the healthcare provider, social media opens the floor for negative attacks and comments. It can threaten the privacy and security of organizations. Social media has the potential to negatively impact both the patient and the provider; the physician may inappropriately share confidential information about their patients or their organization. And thus, physicians are becoming hermits in their own fields of expertise; they’re barring themselves from the important things that they can say and the positive impacts they can have on their community.

You’ve seen the negative aspects of social media. But it’s important to realize that healthcare providers can benefit the community through social media, as well. Primarily, they have the opportunity to educate patients worldwide, whether it be through Facebook, YouTube, Google+, blogs, or Twitter. They create an opportunity for themselves to improve their communication with patients.

Healthcare providers have tried several methods, and yet communication between physicians and patients continues as an ongoing problem.  Providers struggle to cater their advice and information to a diverse group of patients, yet fail. It’s because every individual is different. And that then raises a question; isn’t it more efficient to alter providers’ behaviors than try and change or cater to such a diverse group of patients? What if physicians started posting their information in ways that follow the current trend, like Buzzfeeds? Authors could use striking titles and bold and bullet key points to reach the tech-savvy teen and middle-age population. We quickly realize that, then, we’ve left out the non-tech-savvy. This loop becomes increasingly obvious as we tinker with the ways that physicians publicize the information and advice they wish to share. Social media has potential to serve as an effective communication platform for physicians as they become aware and efficient with their communication.

We can empathize with our physicians who are afraid to contribute to social media, but not long after, we begin to suspect that they’re hiding or avoiding something. We fly into the arms of another physician who seems more open, in social media terms.

In today’s world, social media is not only influential in determining a physician’s competency, but is becoming prevalent in the broader field of healthcare as e-patients emerge. Providers must step up and wield this weapon, knowing that there’s risk in both using and avoiding it.

Inspired by Hands on Telehealth:

http://www.powerdms.com/resources/compliance-management-blog/12-01-16/Social_Media_in_Healthcare_Infographic.aspx

Guest posting by Jesal Shah

Dr. Brian Vartabedian, pediatrician and author of the blog, 33charts.com, recently presented to our class the major benefits of being a public physician, a doctor who has a social presence beyond the clinic. He highlighted its potential as a tool for advocacy and awareness; experts, such as physicians, are overwhelmingly less inclined to participate in the social media scene, allowing misinformation supplied by pseudo-scientists and misguided celebrities to serve as the predominant and most accessible content. He also underscored the role social media has played in personal marketing and branding; it can offer unparalleled avenues for career growth. Finally, he also mentioned the role of social media in personal development; it grants the opportunity for reflection in daily routine and overarching medical trends as well as the freedom to generate and then share one’s own idea with the online community. These aspects of the “public physician” accentuate social media as a platform to connect the medical with the non-medical individual in addition to any other person in between interested in such topics. This underlying feature made me extremely interested in SERMO, which looks not at the broad public reach of social media, but instead, advertises the benefits of a communication system focused on a niche population of simply doctors.

SERMO is a large (i.e. 40% of all physicians are members), private and exclusive social network for ONLY physicians. It allows its members to talk anonymously about the practice of medicine from system and administrative aspects to the level of patient diagnosis and personal mistakes/lessons/opinions. As it provides a collaborative, safe and informative environment, I definitely appreciate SERMOs utility and power in promoting change and progress in the medical community. SERMOS’ implications for doctor-to-doctor level information-sharing are indeed unparalleled and fascinating; however, I also wonder about possible negative consequences arising from a social media enterprise with such an exclusive member base. Does the system capitalize on a physician’s insecurity in sharing and owning up to one’s views? In a medical landscape dominated by HIPAA/malpractice concerns, fear of employment repercussions from improper or unacceptable opinion sharing, and the lack of direct reimbursement or payment schemes associated with greater social connectivity, to name a few, does this anonymous medical bubble provide an escape for concerned physicians? Or is this simply a separate medical advancement in collaborative learning supplementing the “public physician” role? Personally, the qualities of this online network indirectly signal systemic issues with the medical establishment. The current structure and norms pressure a physician to be a perfect professional, dehumanized and separate from the patient population. The healthcare sector and its influential actors need to create a system where doctors can willingly, without worries, showcase their individuality and personality…where a community of sharing does not require anonymity or even exclusivity.