• Practice Perfect

    Patient Education in a YouTube World

    Written By: Kierstan Boyd, Academy Director of Patient Education, interviewing Hardeep S. Dhindsa, MD, Devin A. Harrison, MD, and Paul Weber, JD

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    You see it all the time in your waiting room—patients focused on their smartphones. Often, they are using video-based media to access information and entertainment. YouTube, for example, is used by almost a third of people on the Internet and gets billions of views every day. The fact that so many people are accustomed to getting information by video provides an opportunity for ophthalmologists.

    “Years of studies establish the effi­cacy of videos in patient education,” said Devin A. Harrison, MD, a compre­hensive ophthalmologist in Richland, Wash., who chairs the Academy Patient Education Committee. “In fact, a re­view of 25 studies found that video is especially effective in decreasing patient anxiety and pain while increas­ing short-term knowledge and coping ability.”1

    Why a Retina Practice Began Using Video

    Until a couple of years ago, Hardeep S. Dhindsa, MD, had never tried using patient education videos in his Reno, Nev.–based retina practice. “But once I saw what was available, it made me rethink the value of video,” said Dr. Dhindsa, who now uses short videos to augment his personal discussions about surgery’s risks, benefits, and alternatives. “I realized that using these videos reiterates what I need patients to understand. I’m not elimi­nating my discussion with a patient but reinforcing it.”

    Video can counter mis­cues. When you are talking with patients, their percep­tion of what you are saying may be influenced by many variables, said Dr. Dhindsa. “Studies show that we sim­ply don’t know how we come across to other people. I may have to deliver bad news to Patient A, then go into another exam room and tell Patient B they need surgery. Although I try to be a ‘blank slate’ with every patient, the fact is that my interac­tion with Patient A might inadvertently be carried over into my interaction with Patient B—and, im­portantly, I may not be aware of this,” said Dr. Dhindsa.“When I show the Academy’s patient education videos, I know the information is presented in a clear, concise, and neutral way, in a reassuring manner.”

    Patients can watch videos when they are better able to process the information. “If a patient comes in with a retinal detachment and I review the mechanism of the condition, along with 3 or 4 treatment options and the risks and benefits of each—that is a lot of information for someone to process. Often, the patient is anxious, which may further limit his or her ability to accurately take in information and make an informed decision,” said Dr. Dhindsa.

    “I decided that, if possible, I would schedule patients to come back for a preop visit on a day when I am in surgery and the clinic is less crazy, and they could watch the video in a more relaxed setting. They’ve had time to process the diagnosis and information I gave them at their initial visit. Then, after watching the video, a tech answers any further questions that they may still have.”

    Feedback from patients has been positive. “Patients confirm that the video session reinforces and crystallizes the information I have given them,” said Dr. Dhindsa.

    March 2016 Practice Perfect Web Extra

    Tips for Incorporating Video Into Your Practice

    Decide the best time to show video. Consider your practice volume, staffing support, patient demographics, and office space when you think about how to show video. None of these aspects should be a barrier to showing video but, instead, should help you deter­mine the most opportune time to do it. Examples include:

    • During dilation—perhaps in the wait­ing room on an iPad with headphones, or in a separate area if you have one.
    • While waiting in the exam room for the doctor. This can help mitigate the patient’s impression of “waiting around for the doctor.”
    • After the visit, when the patient gets home. Video can be sent via your patient portal, or the patient can be referred to watch the video on your practice website. This can be especially helpful when you want the patient’s family to watch the video as well.
    • At a separate preop visit, when the patient is not overwhelmed with the information and complexities of a regular appointment, and has access to staff to answer questions immediately afterward.

    Work with your practice’s IT admin­istrator. A technically savvy person in your practice can help you assess how to most effectively deliver video. Some examples to consider include:

    • Loading videos onto tablets or iPads for use in various locations.
    • Having videos loaded onto a practice server that delivers video to computers in each exam room.
    • Putting videos on your practice website for patients to access. (You can choose to have this section of your website password protected.)
    • Incorporating video into your patient portal system. (See if your electronic health record provider can help you do this.)
    • Providing videos on thumb drives or DVDs as a take-home viewing option for appropriate patients.

    Standardize a documentation process. Documenting in the patient’s record that he or she watched the video should be as routine as—and in the same format as—other documentation. Reliable documentation is key in reduc­ing your malpractice risk (see below), and the documentation is also import­ant for satisfying the patient-specific education resources objective of the meaningful use program.

    Protect Your Practice

    The Ophthalmic Mutual Insurance Company (OMIC) recommends using patient education videos to help mit­igate malpractice risk. “Establishing a good informed consent process begins with asking yourself, ‘What steps can I take to ensure that my patient is prop­erly informed?’” said Paul Weber, JD, vice president of OMIC’s Risk Man­agement department. “In addition to talking with your patient and handing them a brochure, showing them a video about their condition and the recom­mended treatment option is taking that extra, important step toward ensuring their understanding.

    “Documenting that the patient was shown a video is a powerful measure that any practice can take to help refute a claim of lack of informed consent. It shows that you delivered a consistent, accurate, and engaging message about treatment options and their benefits, risks, and alternatives.” Consistency is key, noted Mr. Weber. That way, you know and have documentation that every patient was given the same com­plete, accurate message.

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    1 Gagliano ME. J Med Educ. 1988;63(10):785-792.

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    Dr. Dhindsa is a retina subspecialist based in Reno, Nev. Relevant financial disclosures: None.

    Dr. Harrison is a comprehensive ophthalmolo­gist in Richland, Wash., and chairs the Academy Patient Education Committee. Relevant financial disclosures: None.

    Mr. Weber is vice president of Risk Management at OMIC. Relevant financial disclosures: OMIC: E.

    See the disclosure key at www.aao.org/eyenet/disclosures.

    Academy Videos

    “Adding video to your patient ed­ucation tool kit is one of the most effective ways to help improve patient understanding and increase compliance. And with today’s tech­nology, it’s easier than ever to make it work, either within or outside of the patient visit,” said Dr. Harrison, who urges ophthalmologists to consider the Academy’s Waiting Room Video and its 5 subspecialty-specific video collections.

    Augment the physician-patient discussion. The 5 video collections explain benefits, risks, and alterna­tives for many common procedures. The videos within each collection are all succinct (just 5 minutes or less), have high-definition resolution, and are free of advertising. Both English- and Spanish-language ver­sions are included. Use them on any platform, from desktops and tablets to smartphones, patient portals, and websites.

    There are 5 subspecialty-specific collections:

    Make time in the waiting room more enjoyable. The new Waiting Room Video for the Ophthalmic Practice (Vol. 3) features education­al segments on eye health that are interspersed with relaxing music, at­tractive images, and interesting facts about eyes and vision. (View sample clips at www.aao.org/waitingroom3).

    For more information, go to https://store.aao.org/patient-education/media-type.html?media_type=Video.