Of
course, she’s not real, either.
She’s the video doctor, a computer-based multimedia
program to help real doctors reduce smoking and alcohol use among their
patients.
“The most promising advantage of video doctor technology is that
there is no human fallibility, time pressure, or inconsistency in delivery
or style,” says Barbara J. Gerbert, Ph.D., professor at the Center
for Health Improvement and Prevention Studies at the University of California
San Francisco.
In a study published in the July issue of the journal Health
Promotion Practice, Gerbert and several colleagues reported on patient response to
the video doctor.
The video doctor (prerecorded by an actor) asks the patients
about their health histories, including smoking and alcohol use behaviors.
The patient
chooses a response on the screen, and the program then comments or asks
another question based on the patient’s previous responses. The video
doctor’s side of the conversation is personalized, depending on
the number of cigarettes smoked or drinks consumed by the patient.
Brief interventions by doctors have been found to be helpful in advising
or motivating patients about improving their health. But because doctors
are pressed for time and may not be reimbursed for delivering such messages,
alternatives to physician interventions could benefit patients while alleviating
the time crunch for the doctors, the researchers suggest.
The video doctor program compared three levels of intervention. During
a pilot study of 52 patients at three San Francisco area clinics, 16 percent
were offered a pamphlet describing risk factors that the program identified,
36 percent got a 90-second to three-minute advice message and another 36
percent also received a brief motivational message that lasted three to
four minutes. Thirty-one percent of the patients were current smokers,
40 percent were drinking at risky or hazardous levels and 29 percent both
smoked and drank.
In the advice segment, the video doctor told patients
that smoking put their health in jeopardy and that “quitting smoking is the single
most important thing that most people can do to live longer and healthier
lives.” The aim of the motivational message was increasing the patient’s
readiness to change, and it urged participants to take the steps needed
At each step, the video doctor asks permission before offering information
or advice.
“We believe that the act of asking permission will enhance participants’ perception
of personal control and freedom and leave them more receptive to hearing
the video doctor’s advice and recommendations,” Gerbert says.
When a patient has had enough, the video doctor politely offers well-wishes.
Patients said they liked the program, found it easy to use, and were comfortable
discussing personal health information with the video doctor. Many also
said they were ready to quit smoking or change their drinking habits. Still,
even with this positive response, 72 percent said they would still prefer
consultation with a real doctor.
In the future, say Gerbert and colleagues, the video doctor may work best
not as a stand-alone program, but as an integrated part of primary care
practice.
The study of the video doctor was funded by a grant from the National
Institute on Alcohol Abuse and Alcoholism.
