Monday, May 25, 2009

Reality TV and then some

E-patient Dave sends me a note about this article in the New York Times about Methodist University Hospital in Memphis webcasting brain surgery as part of its marketing campaign.

Is this all a good idea or a bad idea? We regularly use live webcasts as teaching tools. The most notable one is a worldwide CME course offered by Doctors Ram Chuttani and Doug Pleskow and others, in which they present two days' worth of endoscopies in real time. This kind of course is extremely valuable to doctors and nurses.

But broadcasting live to the public raises ethical concerns, particularly if and when things go wrong. Read these excerpts as to how MUH handles things and see if you share Mr. Morreim's view.

Mr. Ferris said: “One concern is what happens if something goes wrong — you’re making this public in a very real-time way. Our general plan is we would gently take a break from the twittering if the situation became very dire. You don’t necessarily want to be tweeting that somebody might be dying on the table, and God forbid the patient’s family learns about it that way.”

Methodist Hospital records an identical surgery on another patient, so if “something unforeseen happens and you need the camera to cut away from the surgery, you can fall back on your previous surgery,” Ms. Fazakerly said.

E. Haavi Morreim, an ethicist at the University of Tennessee College of Medicine, said “If you don’t show the bad along with the good, people can end up misinformed or with excessively optimistic expectations.”


Marlo said...

Well Methodist Hospital, so much for transparency.

To say that you would switch out a real live case/patient for a taped one, without alerting your viewership, automatically makes you lose all credibility.

I believe there is no reason to air a surgery live to the consumer. (It's different with medical students/other surgeons where a lot can be learned watching developments in real time). Sure, the public will be more interested in watching a live webcast, but for the wrong reason. It's like a car race-- they watch for the possibility of a crash. That's not in anybody's best interest.

If the goal is to educate the public about the potential benefit of the surgery (which SHOULD be the goal), tape it. If it's unclear what is happening, edit it so it is clear to the viewer (disclosing that it's been edited). If something goes wrong, include it--but understand the patient/family still ultimately have control. Even most (reputable) media outlets that tape surgeries for story purposes will respect the family/patient's right to pull consent post-surgery.
The patient's well-being should always be the priorty.

e-Patient Dave said...

I was gonna leave this comment on the article but somehow I can't find the comment link! Here:


My hospital, Boston's Beth Israel Deaconess, created a 5-minute infomercial about their renal tumor program, where I got my life-saving surgery and intensive biological treatment

Patients are starting to use social media, too, to spread the word. In my online community of kidney cancer patients we sometimes find that a new member's physician didn't mention various options for treatment or surgery. As one step, I interviewed my own surgeon about options - the same things he tells anyone - and posted it as a podcast on my personal blog

A Twitter friend who has Cushing's Syndrome has done a substantial series on BlogTalkRadio about her disease, which is important because patients so often go through years of wrong diagnoses or missed diagnoses. She's heard back from hundreds of people.

This is a great example of the new move to "participatory medicine," in which patients collaborate with their doctors and each other to share information. Physician partnership is key, to help filter out the garbage - my doctor's term is "Embrace knowledge symmetry." But Web 2.0 technologies are clearly making it easier to spread awareness of vital information.

My mission, my schtick if you will, is evolving into a deep commitment to do what I can to help patients (and docs!) do the best they can in a crisis. (And non-crises, of course, but everything makes more difference in a crisis.) Fundamental to this is helping people answer the question that stuck in my mind in the early days, after I got over the shock: "Okay, what are my options?"

e-Patient Dave
Co-chair, Society for Participatory Medicine

Medical Quack said...

That is a hot topic of sorts. On my blog I link to a site called ORLive, which is a professional website who's aim is to air these for the purpose of learning and they offer CME credit on some of the procedures too.

Some of their videos too end up on YouTube, but again it's more from the side of education instead of the emphasis being targeted explicitly to market.

The surgeries are performed live and have an educational introduction as well as all the comments, etc. from the surgeons participating. I think even Beth Israel has done some of these too.

After the surgery has been broadcast live, the site maintains an archive where they can be viewed later. Do I have many readers going there, not a lot but some. Those who have a hard time with the sight of blood obviously would not be the curious individuals to venture over there I would say.

I agree, putting the information out in a learning scenario versus just another video to promote seems like a much better idea to me.

Anonymous said...

Since we are conditioned to view all advertising with some degree of skepticism, hospital advertising smacks of desperation to me, and this particular example particularly so. Also, call me old-fashioned, but it just seems unseemly. I think that's why one sees few physicians doing it - yet.

nonlocal MD

tczinpa said...

Though I believe in the essence of what ePatient - Dave alludes to in his comments, I don't see live telecast of a procedure doing nothing more than trying to garner more business. I think most anyone is fine with use of technology for provider education purposes. I also think the general public is ok with taped procedures being available to learn what the procedure they are contemplate entails (for those that want that level of detail). None of these require broadcasting a procedure "live". I am surprised their legal counsel/risk management people allow them to do it!