Mar 14 2016

Patients Prefer Video to Face-to-Face Consultation

atmThere are now many aspects of my life in which I prefer to interact with a computer rather than a person. When I stop to fill up my tank or remove some cash from my bank account, I can do so quickly and efficiently by interfacing directly with an automated machine. It is interesting to think about exactly why this is, but first let me discuss the findings of a new study looking at this very question.

Dr. Matthew Winter and his fellow researchers presented the results of a randomized trial at the European Association of Urology 31st Annual Congress in which they compared giving informed consent via video vs in person prior to a urological procedure.

The study randomized 88 patients to either have a face-to-face consultation with the surgeon, or to viewing a prepared video including animation to describe the procedure. They then quizzed them on their knowledge of the procedure, and did a follow up cross-over in which the groups switched and then were re-tested.

The researchers found that the group watching the video had an improved understanding of the procedure by 15.5%.  This is understandable, as the video is scripted and includes animation to help explain what will happen. Doctors may forget to include details, and will make variable use of visual aids.

Perhaps even more interesting, 80.7% of the subjects preferred the video, while only 19.3% preferred the face-to-face interaction. This is not surprising when doing something simple and impersonal, like withdrawing cash, but is interesting with regard to a discussion about an upcoming surgery.

The authors are quick to point out that watching a video will not substitute for talking with a physician as adequate for informed consent (at least not anytime soon), but can greatly facilitate the process. Specifically, patients can watch the video, then meet with the physician to ask any follow up questions.

Something similar is already common practice, but involving pamphlets. We often will give patients the information they need in writing, perhaps with pictures, and then meet with them to answer any questions, emphasize certain key bits of information and make sure they understand. This way the physician does not have to spend their limited time regurgitating a script that the patient can simply read.

Onto the key question – why do people prefer video to in person delivery of information? What follows is my own speculation, based on both my personal and professional experience.

For me the biggest advantage of automated vs in person information is that I am in total control. I can proceed at my own pace, go back and re-read or watch something again if necessary, pause to think, and take whatever time I need.

When other people are involved, then we have the added burden of social interaction. Humans are social creatures, we have a lot invested in our social interactions and they tend to command a great deal of our attention and mental energy – even when we don’t want them to.

When consulting with a professional we are dividing our mental effort between the information and the social interaction. Patients are also often intimidated by the interaction. They might be embarrassed to ask what they think is a stupid question. They may feel they are under time pressure. They are concerned with how they are being perceived, trying to avoid social errors.

All of this adds a layer of effort and stress to the interaction. That effort and stress are eliminated when you are by yourself with a video or pamphlet.

For similar reasons I prefer shopping online, as do many people. Online I can spend as much time as I want exploring my options, and then decide at the end to buy nothing. People actually feel guilty if they occupy a sales person for an extended period of time then decide to buy nothing.

In some contexts there is also an issue of privacy. It’s really no one’s business what I am purchasing, or what kind of emotional reaction I have to information, or even how much money I am taking out. Computers are safe, non-judgmental, and private.

There is no question that as multi-media technology and computers advance people are increasingly interacting with machines rather than people. Some have speculated about where this is headed. In Asimov’s Robot series he imagined one world in which the inhabitants lived their entire lives in a technological cocoon, without the need for any interaction with another human, to the extent that they found such interactions to be disgusting.

I doubt we will ever get to that extreme. People need social interaction. Right now we are in a period of extreme experimentation with the very question of what types of interactions will people prefer to have with machines rather than people. Time will sort that out.


The results of this study are not at all surprising. They indicate that people have a high level of comfort getting even very critical information through video, and in fact mostly prefer that to a face-to-face consultation with a person.

I think this reflects two basic phenomena. The first is that information acquisition is most efficient and effective when an individual can go at their own pace, and when that information is pre-optimized (such as a scripted video). This is a separate essay unto itself, but we are already seeing this infiltrate education.

Students today prefer to watch videos or listen to podcasts of lectures on their own time, rather than sit in a classroom and have to pay attention. Having a live person give didactic lectures is now obsolete. Schools, if anything, are really slow to adapt to this reality (but it is happening).

When a live person is needed is when there are questions not answered by the prepared information, or when interactive learning is needed. At my medical school we are making this shift, spending class time not for didactics but for interactive learning.

The second phenomenon reflected in this study is that forced social interactions, just to accomplish everyday tasks, are mostly a burden. They add a layer of effort and even discomfort that people will avoid if possible. People obviously vary in this regard, some people are more social than others, but clearly the majority of people would rather not chit-chat with a stranger in order to just accomplish a mundane task. (There is probably a cultural element to this as well.)

Both of these factors are related in that by automating tasks (so that interaction with another person is not necessary), people are given more control. They are given control over how they consume information, and control over when and how they interact with other people. A desire for control is a basic human motivation, and so it should be no surprise that people generally prefer to have more control.

5 responses so far

5 Responses to “Patients Prefer Video to Face-to-Face Consultation”

  1. Charcoton 14 Mar 2016 at 8:44 am


  2. Newcoasteron 14 Mar 2016 at 2:28 pm

    I agree with you that it is mostly about control, but I hadn’t really considered the social interaction aspect of the Doctor-patient interaction before. Interesting. It may be that patients aren’t able to absorb as much information as I expect them to because a part of their mind is occupied with the the social aspect.

    I do know that I have an assortment of talks or “spiels” as I tend to refer to them in my clinical notes. I have a quit smoking spiel, a high cholesterol spiel, a new diabetic spiel, etc. I suspect that my spiels aren’t as informative as I would like to think they are, and if I’ve already given that talk several times in a day, I may come off as bored or disinterested. It probably is better to give a patient a handout to let them consume the information in their own way, and them see me for follow up questions. These days of course there are various web resources to which patients can be referred.

    As to shopping, I also prefer to do as much as possible online, though clothes shopping still needs to be an in person experience. I’ve learned the hard way I actually need to try clothes on before buying. I’ve never enjoyed shopping for its own sake, and usually find salespeople annoying and intrusive. This isn’t just a guy thing, my wife is the same way. Sometimes I really have no idea what I’m looking for, and just want to browse uninterrupted to get ideas. The only time I may ask a salesperson for help is when I know exactly what I want, but can’t find it.

  3. FSGilberton 14 Mar 2016 at 3:07 pm

    This was an interventional study w/o a comparison other than to typical office care (iPad vs. face-to-face with doc), so we may not know a lot yet, other than patients are more happy with the computerized information than with usual care–which, in many cases, is a pretty low bar. If there had been another control group with some sort of reading material, or time with a nurse (was time with the iPad balanced with time with the surgeon?), or some other sort of intervention, it may have turned out that the iPad wasn’t all that much better.

    I’m not disagreeing with the basic premise about the social issues inherent in a medical appt, or the statement that shopping online is a better experience than shopping with a salesperson at your elbow. I prefer online shopping, too. Still, the other day there was a post on this blog about the problems with t-tests, and that’s a pretty close relative to the possible problems with this study vis a’ vis over-interpreting the results.

  4. Andreason 14 Mar 2016 at 3:13 pm

    Other social factors coming into play when trying to convey or extract information to/from humans are embarrassment, shame and conformity to accepted norms. There must be zillions of scenarios where those could be mitigated via human-computer interaction. The paper at reports that patients are more willing to disclose medical facts and emotions when interacting to “virtual humans”. I also vaguely remember reading about a finding that opinion polls can be more accurate (other factors being equal) when people give the information online or to a machine versus a human interviewer who they might feel judged by. (I cannot find the reference now – please share if you have anything along those lines.)

  5. Charonon 15 Mar 2016 at 2:54 am

    Students today prefer to watch videos or listen to podcasts of lectures on their own time, rather than sit in a classroom and have to pay attention.

    Do you have any evidence of that? Course enrollment in traditional courses v. online? Is class attendance lower now than it was 10 or 20 years ago? Etc.?

    Because I haven’t found this to be the case with my students. And yes, I devote a fair bit of class time to more interactive things (think-pair-share, small-group tutorials), but other professors in my department who don’t also still have good attendance.

    And as a professor, I have to say that what the students prefer is rarely an indicator of what will help them learn. I’m not saying kids these days are lazy; I’m saying we’re all lazy. I had a class once with optional homework. I didn’t do it. Unsurprisingly I never learned that subject (and neither did anyone else, judging by the ‘A’ I was able to pull off on the curved grading).

    Sitting watching a video doesn’t do much to engender learning. And students have always had the option of reading books instead of coming to class – most don’t learn all that well that way either. (Med students are far better than most about learning facts that way, but I’ve found their critical thinking skills undeveloped by such lower-level learning.)

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