For the personal touch in patient education—computers?
By Edward Doyle
When he sees patients at his Cambridge, Minn., practice, Donald Deye, ACP Member, likes to provide personalized service. When someone isn't familiar with a new medication, for example, Dr. Deye spends a few extra minutes discussing the drug. And if a patient doesn't quite understand a diagnosis, he takes the time to explain the patient's condition in more detail.
But when he really wants to give patients personalized attention, Dr. Deye turns to what some would consider an unlikely source: his computer.
Whenever patients have questions that are complicated and difficult to answer, Dr. Deye calls up one of his medical databases and prints out a few pages of information specific to that patient's concern. Sometimes he even lets patients use the computer themselves so they can search for--and print out--exactly the information they want.
No one seems to mind that a machine is at the center of Dr. Deye's effort to personalize the information he gives his patients. "They appreciate the attention," he explained. "They're flattered that I care about their interest in getting more information."
Like Dr. Deye, other internists are discovering that using computers to generate specific information about diseases and drugs makes patients happier and healthier. And they say that bringing computers into the learning process offers another bonus: "It gets them involved in the process and makes them more likely to read and pay attention to the information I'm giving them," explained Dr. Deye.
But for busy internists who don't have much time or money to tinker with technology, incorporating computers into their patient education efforts offers an equally important advantage: It's relatively easy--and inexpensive--to use. In many cases, internists can get started with nothing more than a basic computer and a simple word processing program.
For example, Jeffrey Carstens, ACP Associate, a cardiology fellow in the Navy in San Diego, regularly gives patients handouts that he and his colleagues have written on word processing software. The handouts address topics such as what patients can eat the night before same-day surgical procedures and how to take commonly prescribed cardiac medications like nitroglycerin, and what to do if it doesn't work.
A big advantage of computerized patient handouts, Dr. Carstens explained, is that they are easily accessible. The handouts are on the Navy's computer network and can be retrieved from almost anywhere. "Whether you're on the wards or in your office," Dr. Carstens said, "you can log onto the network, pull up one of these documents and give it to a patient."
Physicians can also supplement their homegrown handouts with a growing number of commercial patient education programs. New York internist Charles Starke, FACP, writes his own electronic handouts on diseases and medical conditions, but he also uses handout software that comes with his practice management program. Dr. Starke noted that the software doesn't allow him to customize the information he gives his patients--a feature he said is worth checking for in patient handout software. But even so, he said he would rather use electronic handouts than try to organize the hundreds of printed drug brochures the pharmaceutical companies give him. "It is impossible to keep track of all the handouts for all the medications I deal with," Dr. Starke explained. "The only way you can do it [provide handouts] is by computer."
Providing patient handouts is effective, but it is just the beginning of how physicians can use computers to educate patients. Marc Grobman, ACP Member, a general internist in Claymont, Del., uses an anatomy program called BodyWorks to provide his patients photographs and moving images on his Macintosh. When one patient had trouble understanding what his aortic valve replacement looked like, Dr. Grobman used the program to show him moving images of the heart. "It was like I saw a light go on above his head," Dr. Grobman explained. "I can describe something, but when patients see it, it makes more sense."
Alan Bridges, FACP, a rheumatologist at the University of Wisconsin, has gone even further with interactive technology. He has created a laser disk system that contains more than 7,000 still pictures and 15 minutes of video demonstrating how rheumatological diseases such as arthritis affect the body. Patients view the program and are quizzed by computer about its contents; if they answer incorrectly, the program takes them back to that section and lets them view it again.
In pilot tests, Dr. Bridges said, both patients and physicians have said they like the software. "After a 15- or 20-minute program, they understand their disease better and ask better questions."
And according to researchers, producing better patients is a very possible outcome of using computer-based education. Health educators at the University of North Carolina in Chapel Hill, for example, found that when they used sophisticated software to customize smoking cessation literature, the numbers of patients who kicked the habit jumped significantly. And researchers participating in the University of Wisconsin's comprehensive health enhancement support system project have found that HIV-positive patients who are given computer-based support (a PC with AIDS information and links to AIDS electronic bulletin boards) not only show an improvement in their quality of life but have shorter hospital stays than patients without the support.
Tackling technology's limits
Such high tech tools get results, but they are costly. Dartmouth Medical School and the Society for Informed Medical Decision Making, for example, have produced a series of laser disk programs that were proven effective in helping patients decide on treatment options for conditions such as benign prostatic hyperplasia, breast cancer and low back pain. But the medical community has been slow to embrace the programs, in part because of their cost--laser disk machines cost between $1,000 and $8,000, while the programs cost $1,000.
CIGNA, for example, wants to offer the programs to all its patients but says that the technology is simply too expensive to install in all of its physicians' offices. So, as part of a pilot test, the insurer will send video copies of the programs to patients' homes at physicians' request. The videos may lack the interactive edge made possible by laser disk technology--patients must now refer to patient handouts, not video clips, for more information on a topic--but CIGNA officials say that patients like the videos because they can be viewed at home, not in a physician's office.
In the future, however, most electronic patient education programs will appear on neither video or laser disk, but on CD-ROM. Even though CD-ROM is still a little slow to handle the images that can be used on sophisticated laser disk programs, there are already several health-related titles for physicians and consumers. (Mayo Clinic has already released several such CD-ROMs.
Even while CD-ROM technology improves, several programs for physicians are being developed. Oliver Cass, FACP, a gastroenterologist at Hennepin County Medical Center in Minneapolis, has developed CD-ROM software to educate patients about colonoscopies. The software tells patients why they need the test and what they can expect. When patients are finished viewing the program, the software not only quizzes them on the contents but also sends a report to the physician, assessing each patient's knowledge about the procedure. Dr. Cass said physicians will know how much their patients know about the procedure and how much needs to be explained.
But the greatest role of the program, Dr. Cass noted, is to reassure worried patients. In one segment, viewers watch as a polyp is removed from a patient. They watch the image of the procedure being performed and the patient's face at the same time. Viewers then listen to the patient describing the procedure. "You hear him saying afterwards that it was no big deal, that he'd do it again tomorrow," Dr. Cass said. "That's really a reassuring thing for patients to hear."
His patient handouts are hot off the modem
When it comes to getting information for his patients, Benjamin Krevsky, FACP, looks to the nation's information superhighway.
Dr. Krevsky, a gastroenterologist at Philadelphia's Temple University, uses a variety of computer-generated handouts to educate his patients. But when he needs patient information about cancer, he says nothing beats cyberspace.
His favorite source of electronic patient information is Physician Data Query (PDQ), an online data base run by the National Cancer Institute. He likes the service because it has an extensive library of information for patients and physicians and is updated regularly.
Dr. Krevsky said he particularly likes the number of ways that he can access the service. He frequently uses Grateful Med, the same software he uses to search the Medline data base, but he can also get to the service via Internet e-mail. (Dr. Krevsky can send and receive Internet e-mail through his Internet account at Temple and on his home computer using Prodigy, a commercial service.) Physicians without a computer can call PDQ via their fax machine to have documents sent to them immediately.
When he recently saw a patient with esophageal cancer, Dr. Krevsky logged onto PDQ and began navigating the system's menus. To get information on esophageal cancer, he first selected the menu item for cancer types. He then chose the category for digestive organs, the category listing esophageal cancer and the category for squamous cell cancer of the esophagus. He finally selected three patient information documents, downloaded them into his computer and printed a copy of each on his office letterhead.
The whole process took only about five minutes, Dr. Krevsky said, during which he was able to write several prescriptions. "As long as I'm at my desk," he said, "I can be doing other things while the computer is dialing up and downloading the information."
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