Saturday, August 07, 2004

If you were any closer you'd have to wear a mask....

From The Washington Post: Live! From the OR In Hospital Webcasts, Only the Surgeon Gets in Closer
It wasn't easy for Victor Ganderson, 61, to agree to GERD surgery in June. For four years he had stalled, researching treatment options and talking to his doctors. But it wasn't until the Columbia man watched -- live, via his home computer -- the operation being performed that he decided to go ahead.

Ganderson learned about the "webcast" through his job as a database manager at the University of Maryland Medical Center (UMMC). The surgery was broadcast live on the Internet, from what was billed as the Baltimore hospital's "Operating Room of the Future."
Apparently the University of Maryland is using the webcasts as a marketing tool for their surgeons. Patients can log on to these sites and watch surgery in action.
James Gammie, a cardiac surgeon at UMMC, said one patient traveled from Florida for mitral valve repair surgery after her husband found UMMC's Web page describing its minimally invasive surgical technique. "Many [patients] have said they watched the webcast," Gammie said in a telephone interview. "So I find that probably 50 to 60 percent of people who come to us now . . . are much more prepared." Gammie provided commentary during the mitral valve operation while another doctor performed the surgery.
As usual there is someone to rain on the parade:
Some consumer health advocates question the webcasts' value to consumers. Arthur Levin, director of the nonprofit Center for Medical Consumers in New York, said he thinks a surgical webcast serves more as a public relations tool for hospitals than as education for consumers.
"The important things that patients need to know about surgery are: What are the risks? What are the alternatives? That's the kind of information people need. They don't need to see someone else's stomach open," Levin said.
What would happen if something went wrong?
Dr. X: We are dissecting around Mrs. Smith's esophagus now with our retractor. This will allow us to get the fundic wrap around the back.
Dr. Y: Hey! Does that look like an NG tube to you?
Dr. X: Damn it! We've put a hole in the esopha...

Then as Mrs. Smith's family is calling the John Edwards law firm you see on your screen:
technical difficulties please stand by
What if something unexpected occurs?
Dr. X: We have just placed all of our ports into Mr. Jones' abdomen and will now take a look around..
Dr. Y: Hey! Does that look like a tumor on the liver to you?
Dr. X: Yes it does. Let's send some for a frozen section...
So now everyone on the internet knows about Mr. Jones and his liver tumor before Mr. Jones and his family do. Such problems could be avoided by "tape delay" of procedures, but that would eliminate the "live chat" feature which appeals to the marketers.
Live broadcasts allow viewers not only to watch but to e-mail in questions, some of which are answered by an operating room narrator while surgery continues.....
A surgical webcast "allows us to demonstrate our expertise, both the physician expertise as well as the expertise of our facility," said Dave Brond, UMMC's vice president of marketing and planning. "It also wasn't a traditionally used part of our marketing toolbox. . . . This is a way of funneling more people into our Web site who are searching for health care information online."

Yes, the faculty, whose job also consists of training the surgeons of tomorrow. How many residents get "face time" with the webcasts? Organized medicine has spoken on this before:
The Society of Thoracic Surgeons issued guidelines in 1998 advising against live broadcasts of thoracic surgical procedures to the general public.

"The Society believes a possibility exists wherein participating surgeons might fail to follow proper medical procedures or might be distracted because of the media and, thereby, deprive the patient of the highest quality care," the guidelines say.
The patients watching the webcasts could get a biased view of surgery:
Hospitals often choose to broadcast minimally invasive procedures, Aitchison said, because these transmissions show off new technology while featuring procedures that reduce patient discomfort and recovery time
Not all procedures planned as minimally invasive end up that way. Even in the hands of experts sometimes you have to convert to an open operation.
Privacy may be affected. I'm sure the patient who is the star of the show signs all kinds of waivers before the procedure, but there are situations where sensitive medical information about others may be discussed (answering the pager for example) which may not be covered.
Such broadcasts, live or otherwise, have been used in surgical education for years. Walk through the display floor at an ACS meeting and Ethicon, U.S. Surgical, and many others will have scheduled "live procedure broadcasts" as they try to get you to buy their stuff. The ACS itself was video clinics where surgeons submit material for review and broadcast (I have "starred" in one of those). But the target audience for those are aware of the god, bad, and ugly of surgical procedures. The general public may not be as "nuanced". Their expectations may be raised, possibly to an unreasonable level, by this sort of thing.
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