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.

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