Reality Medicine: Video’s Impact on Patient-Centered Care

Wednesday, January 2nd, 2008
This post was written by Melanie Matthews

Two recent news articles describe how video in the hands of physicians and patients can dramatically affect the physician-patient encounter. For both patients and doctors, a (moving)picture can be worth a great deal more than a thousand words.

First, a good number of doctors are turning to video to communicate test results to patients, create video blogs, or post video of lectures or procedures, impressing patients with their tech savvy and accessibility, reports American Medical News.

Doctors are creating video blogs, or posting video of lectures or procedures, or as Dr. [Loring] Jacobs is doing, adding video to e-mail. Some are posting video to their own Web sites, to YouTube or to doctor- or health-specific sites.

Creating Web video doesn’t have to be expensive. Dr. Jacobs pays $9 per month for his video e-mail system and made a one-time purchase of a webcam, which can sit atop or near the computer and feed video straight into it. A webcam can cost as little as $25.

Could this, we wondered, be the forerunner to video visits to the doctor? Hypothetically, a patient equipped with a webcam could send a video of a rash to a physician for an initial diagnosis. Or a homebound patient could file a visual health update with case managers and providers.

Gretchen Berland, M.D., (shown below) has spent 10 years giving video cameras to patients. The assistant professor of medicine at Yale University School of Medicine also had a previous career as a documentary filmmaker. Her impressions from a recent video project are detailed in a New England Journal of Medicine (NEJM) Perspective article, “The View from the Other Side — Patients, Doctors, and the Power of a Camera.” She gave video cameras to three wheelchair-bound patients, who captured their daily experiences over a two-year period. One of the patients is Dr. Galen Buckwalter, vice president of research and development at eHarmony.com, which describes itself as a “relationship service.” The resulting video starkly contrasts the patients’ demeanors in their doctors’ offices with the challenges of their daily lives.

Dr. Berland

By the time Galen Buckwalter’s physician knocked on the exam-room door, Buckwalter’s video camera had been recording for nearly 40 minutes. He had booked the appointment because his shoulders were hurting, and the camera recorded his view of the examination table, the comments he made while waiting and, eventually, a largely transactional and superficial exchange with his physician. Two weeks later, in his home, the camera would record a strikingly different take on his shoulder pain — a growing problem that, Buckwalter worried aloud, might cost him even more of his cherished independence.

As an internist, I was disturbed by the contrast between those two scenes, the second revealing the depth of Buckwalter’s concerns and fears, none of which were apparent during the conversation with his doctor. In the later tape, Buckwalter’s struggle is palpable. If such stark contrasts are common, how much do I really know about my own patients? Probably far less than I care to admit.

Dr. Berland and her team eventually turned the 200 hours of participants’ video into a film, Rolling. She concludes:

Recent work on the quality of care calls for creating a patient-centered health care system. But in order for it to be patient-centered, don’t we need to understand patients’ perspectives? Though I know it would be impossible to give every patient a video camera, wouldn’t it be interesting to imagine what they might record if we did?

Video and audio interviews with Drs. Berland and Buckwalter are available at the NEJM site.

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