A hospital in South Devon is defying clichés about the National Health Service and swiftly implementing a novel, virtual reality-driven solution to one of its thorniest problems: reminding doctors to empathise with patients.
PatientVR is designed to place doctors, nurses and other frontline healthcare providers in the shoes of overwhelmed patients. It's far from the first time that virtual reality has been introduced in a healthcare environment. In France, Rémi Rousseau's 'Surgevry' has pioneered the concept of a VR surgical training tool, while in the US Skip Rizzo of the University of Southern California regularly uses VR to treat soldiers suffering from PTSD.
It's less common, however, for a national healthcare provider to commit to using new technology in the style of a classic startup beta test. But that is exactly what PhD student Nick Peres is helping Torbay Hospital achieve; Peres came up with the educational VR concept in November 2014, and if funding is secured in time it could be rolled out as a teaching tool, alongside normal clinical skills training, from autumn. "It's relatively low risk because it's part of the education route," Peres tells WIRED.co.uk, explaining his uncharacteristically speedy progress.
The former video producer had been working in medical simulation as part of his PhD within the South Devon Horizon Centre's innovation team, using mannequins that can blink, breath, bleed and speak -- or, as they are fondly known in the healthcare world, manikins. But for some time he had wanted to integrate cinematic elements to employ the patient's voice in a more realistic way. "We use these manikins, but we still have no idea how the patient feels or what they see. It seemed quite obvious to me what technology could help us do this."
PatientVR began life as a Google Glass trial, after Peres and colleagues used the augmented reality specs at Torbay to record surgical operations. Initially, manikins donned Google Glass to record the patient's perspective.
But when the team watched the film back they realised if they were to to nail the human factor, a more immersive environment was needed.
The system behind that immersive scenario is fairly basic. The demonstration video -- focusing on a patient experiencing chest pains and their journey from ambulance, to resuscitation bay, to an operating theatre -- was filmed using two GoPros. "I had a 3D rig on my head, positioned low to get it at eye level," says Peres, who played the part of the patient. To get a full 360-degree view of the surrounds, a rig of seven GoPros was used and the footage stitched together. For now, the team has one Oculus Rift DK2 (the plan is to buy four or five headsets once the new Crescent Bay model comes out) that is used to experience the demo. Viewers can look around the room and zoom in and out, but have no agency. Once a practitioner has experienced the 360 film, a debrief is carried out where the patient's state of mind, the doctor's actions, and the environment are dissected.
Other test scenarios are in the works, including delivering bad news to a patient, and there are plans to use VR for things like waste management. "We're looking at analysis of events and pathways, in simulation but also in operating theatres," says Peres. "For instance, how people move around the space, how much stuff is wasted, what equipment is chucked, how people move about."
But it is the current patient demo that has made the most impact at Torbay. Peres' work at the South Devon Healthcare Foundation Trust is, according to consultant anaesthetist and PatientVR test subject Tod Guest, "a powerful reminder of why we're doing the job we do". "We're here to make people feel better, not just to treat them," he tells WIRED.co.uk. The subtle difference is key to Peres' work.
Doctors know they are meant to be sympathetic, to have a good bedside manner and put the patient at the forefront of care. The reality, with time-short staff and ongoing budget cuts, can be quite different. "It reinforces the need to be sensitive to the patient's needs and their ability to understand the information you're trying to give them," explains Guest. "Their vulnerably and emotional state is important, especially if they are suddenly taken ill with something serious. But it's easy when you're seeing this day in and day out to get a little bit used to it, and perhaps start to drift away from the compassionate behaviour and interaction that we as doctors hold our hands up to and say 'yes this is what I do'." "Of course many of us have been patients along the way, but we're not usually focussing on that. Being a patient without actually being a patient definitely has a very powerful impact on you."
The film itself was not, says Peres, designed to be perfect. The whole point is to include imperfections, and everyday natural mishaps. "There are obvious mistakes in there to try to highlight what we are working on," says Peres. "In the video there is a conversation going on between two clinicians outside of your visual field -- that's frightening; you can hear them but don't know what it's about. At one point you'll see a lamp in the operating theatre is blown." They are subtle things, and purposefully so. A doctor might not notice them, day in and day out, but to a patient things can start to quickly feel uncomfortable, with physicians looming over them and hushed conversations occurring.
For Guest, the experience was particularly arresting since he was in the unusual position of playing the doctor in the demo. "Watching me treating myself was pretty freaky, but it was very powerful to see my behaviour and what my patents might feel like.
It's a very powerful mirror, to see your bedside manner, and adult learners very much rely on the opportunity to reflect on what they've done in order to develop their skills."
Peres and his team, working under the guidance of the centre's director of education Matt Halkes, are currently working on a series of further demonstrations in order to refine PatientVR. But this project has been eagerly welcomed by hospital staff and Peres is confident that funding will be secured to ensure a rapid rollout. "People really see the value, it's attracting attention from entry level up to those who have been working in medicine for a very long time. It proves that learning doesn't just stop in early training. It's meant to be a reflective experience, at any point in your career you could watch it and get a better understanding, even a eureka moment, of what you've been doing wrong."
This article was originally published by WIRED UK
