Thursday, March 29, 2007

The Medium is the New Health Care Message

In a recent post on his MEDINNOVATIONBLOG Dr. Richard L. Reece suggests that McLuhan's theories help us understand the problems facing hospitals today. Citing the practice of NCI, a medical consulting firm under the direction of Brian Klepper, Ph.D., to use visual aids to enhance discussions of these operational issues, Dr. Reece notes that:

"To me what’s different and innovative about the NCI approach is its talk show approach. This approach consists of integrated videos featuring three expert guests talking on a single topic; a seasoned talk show moderator; a mini-documentary based on one of Brian’s visits and directed towards the audience of interest; and a closing video by Brian summing up the implications of what has been said.

Under the rubric of “Taking an honest look at healthcare,” these videos are presented to health care conference audiences on subjects like comprehensive cancer care, proactive pay for performance programs, quality management, greater efficiencies, and rationalizing supply chain costs.

The Medium is the Message

NCI with Brian as its executive video producer is on the right track. To use John Naisbitt’s words, “a visual culture is taking over the world.” In a culture dominated by video games, TV, Internet images, cell phone and Blackberry pictures, and YouTube, this visual approach has profound and broad implications beyond health care. Naisbitt lists eight manifestations of a visually dominated world.

  1. The slow death of the newspaper culture
  2. Advertising – back to a “picture is worth thousands of words”
  3. Upscale design of common goods.
  4. Architecture as visual art
  5. Fashion, architecture, and art
  6. Music, video, and film
  7. The changing role of photography
  8. the democratization of the American art museum

In health care, visual forms of communication – animation and voice-guided online interactive programs featuring illustrations and simple language- may soon replace or at least supplement powerpoint presentations. Everyday Americans listen to 25 million powerpoint talks, and many, including myself, are growing weary of bullet points. Subconsciously, whether we’re aware of it or not, many of us now may be wearing bullet-point protective vests. Many will welcome straight talk, clear pictures, and moving images to tell the story."

Dr. Reece implies that, by substituting visual images for text, our transition to secondary orality (although he doesn't use this term) will help us understand and resolve many of the problems hospitals face today concerning funding and operational procedures. I'm not sure how well this would work, but I agree that using some of McLuhan's intellectual tools might help us better frame the nature of the health care crisis. We can apply McLuhan's tetrad to the medium of the hospital to shed some light on the question:


Enhance healthcare efficiency by concentrating health care providers and resources in one location.

Obsolesce personal care skills. Medical students must take special courses in "bedside manner" and other "cultural competencies" in order to compensate for their intense technical training. In earlier times, the family doctor would have developed these interpersonal skills along with his/her medical skills.

Retrieve the "witch doctor." Complex diagnostic technologies, procedures and treatments make medicine seem like magic. This encourages "secondary orality" thinking and the view of the doctor as savior.

Reverse into ineffective healthcare institutions due to the over application of medical diagnostic technologies, fiscal starvation, bureaucratic inefficiencies, insurance and lawsuit pressures and medical professional "diagnostic blinders" caused by over-specialization and the pursuit of profit.

A picture may be worth a thousand words, but I'm not sure why visual forms of communication will be superior to Powerpoint bullets in and of themselves. Should we be encouraged that secondary orality modes of thought will influence discussions concerning the delivery of healthcare services? Without an exploration of the hospital institution as a medium, the discovery of solutions to the current health care crisis may be elusive.

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