Video game technology could improve physician-patient interactions

Madison, Wis. -- For some doctors, good bedside manner is just part of their persona. For others, it's a learned skill -- one that a Madison medical educator hopes to engender more quickly in students via a video game he envisions.

The development of the game is the next step in the life of Fred Kron, an assistant clinical professor at the UW-Madison Department of Family Medicine whose career has gone from outpatient medicine to television writing to education.

Throughout it all, he's observed human behavior, particularly how doctors relate to patients. His observations go back to stories he heard from a residency director as Kron was getting back into fulltime medicine. He found the stories very gripping.

"The information was compelling and very valuable, because I had a context for understanding," said Kron, who attended medical school at Georgetown and who did his residency at Vanderbilt.

The younger residents, on the other hand, were not as impressed. "The residents walked out of the room and said, "What a bunch of bull," or `Why are they wasting my time with this stuff?' or `I have boards coming up, I have patient charts to dictate,'" Kron said. "They couldn't appreciate the value because they'd never had embodied experience in the world of medical practice."

Kron had come to realize during his years in outpatient service and in residency that the best doctors can attract a following -- patients who trust them as human beings and who are hesitant to go to anybody else for medical care. Furthermore, there is an element of that bedside manner that is hard to communicate or to teach; experience is the only way to pick it up, he notes.

Multiplayer game

About two and a half years ago, however, Kron began to map out an idea that could address those concerns: a massively multiplayer online game that would serve as a simulation of the medical experience. Medical students would be put in virtual settings, making up anything from a small practice to a full hospital setting, and deal with patients and doctors that could be virtual one moment and controlled by other players in the next.

It is Kron's hope that such a game -- which he says could be ready within two years -- would impart in medical students some sense of the human element that is essential to good doctorting.

"When people say games, a lot of times their minds immediately go to Pong and Donkey Kong, fairly trivial games like that," said, who wrote for television from 1986 to 2001 while still handling patients on reduced hours.

He contrasts the conception of video-parlor games with the advanced technology that goes into modern game programming. "Specifically, it's very exciting to think you can create a medical cyber-world, and help not only patients but students and existing physicians to have embodied experience in that world, to share in the experiences of more seasoned, veteran physicians."

Costly endeavor

There are challenges to creating such a setup, though. Kron estimates that it could cost $20 million to $60 million. While he has been getting some guidance from UW-Madison, he also says the likely course would be the creation of a spin-off company or some other sort of technology transfer, and that he would seek different educational and corporate sponsors within the healthcare sector.

One company Kron has contacted is Physician's Plus. Ron Parton, the company's chief medical officer, said Physician's Plus "supports this innovative technology for its potential to improve physician-patient communication and patient outcomes."

Work around time demands

The project not only faces the demands of development financing but, also, of time -- medical students simply do not have the hours that many gamers put into their playing.

"Generally, massively multiplayer games that are purely for entertainment are set up so that people can play for 20, 30, 40 hours a week; some of them really go overboard," said Noah Falstein, a freelance game designer working with Kron. "For a game that's meant to be used as training for doctors, they clearly can't afford to put in 20 hours a week."

Instead, Falstein says the game would have to be structured in a way that a student could sit down for a brief period at a computer in some scheduled fashion, possibly as a lab assignment or even during a class.

Fostering fruitful communication

In addition to structure that would meet the time demands of medical students, Kron and his collaborators have been working to structure the crucial human element.

"There are a variety of activities that occur in the context of medical care," said UW-Madison professor Doug Maynard, a sociologist who has done research in conversation dynamics in general and doctor-patient relationships in particular, and who has been approached by Kron to help map out the behavioral models of characters.

Maynard explained that medical care involves cooperation and exchanges of information at every step of the process, from the patient describing symptoms to a doctor, to the doctor conducting tests and communicating a diagnosis and then feedback between the two as treatment proceeds.

"All of these are forms of realms of activity where, depending on the kinds of practices a physician uses and patients use in response, their communication can be more or less fruitful and effective," Maynard said.

Telling a good story

Kron is also turning to his connections in screenwriting to help craft the environment of the game and the situations players would be put through. One such colleague is Dorothy Fontana, a veteran television writer involved with Star Trek and other science fiction properties.

"We're looking at this point to find out where our stories can go, what the situations would be, and how much must be scripted before player involvement can take over," Fontana said, noting that the discussion is still at the formulation stage that would lead to creating initial demo levels to show off to prospective partners and customers. The key questions to be resolved, however, are where the situations would go and the balance of control by the program versus group interaction by the players.

Fontana said that when approached by Kron, she saw the potential in the idea and shared it with others to get additional feedback.

"What many people have said, especially if they are in the medical profession, is doctors get involved in their specialties and their work, and they sometimes forget this is a human being; this is a patient I am talking to here," Fontana said.

See previous WTN coverage of educational gaming:
• Gaming technologies alter classroom, textbook models
• Video games promoted as effective health-care training