Those working in the medical profession can find themselves chronically overworked, often to a point where the long shifts they have to work can result in patient neglect and, in extreme cases, human error that can lead to deaths. In Europe the British Medical Association has warned that junior doctors are working 100-hour weeks despite laws in place to prevent it, and one representative of the UK’s Royal College of General Practitioners said that doctors are so overworked that they may present a risk to patients.
This was certainly a considered factor in the death of Libby Zion, in the US, during the 1980s. The college student’s death led to the passing of the Libby Zion Law, officially known as the New York State Department of Health Code, Section 405. Her father claimed the staff member providing treatment was overworked, writing in a New York Times column: “A resident working a 36-hour shift is in no condition to make any kind of judgment call – forget about life-and-death”.
The case was controversial and has divided opinion but as a result of her father’s campaigning, the law was introduced to restrict the number of hours medical staff could work for to 80 hours per week. This was officially made mandatory across the entire country in 2003.
NEW HEALTHCARE POSSIBILITIES
There are many reasons why doctors and other medical professionals can be overworked, including growing patient numbers. A 1999 study recommended that doctors seeing more than three or four patients an hour may lead to “suboptimal visit content” and a 2007 study, while not putting a number on it, concluded “there is a limit to the number of patients each provider can effectively care for”.
Virtual reality could help to be an answer to this problem and have benefits for patients as well as doctors. It’s important to make clear that there’s not going to be any one scenario that fits all medical staff, countries, treatments, or any number of variables – public health is too complex to be vastly improved by one development. Yet VR can make a difference.
“It allows me to see more patients,” says Brenda Wiederhold, of the Virtual Reality Medical Center, where she has been working with VR in a clinical field for 20 years. The staff at the centre conducted the first randomised clinical control trial with VR in San Diego back in 1996, she says. As VR has progressed from static screens to being on the verge of commercially available head-mounted displays, Wiederhold says this allows different treatment possibilities.
“Instead of seeing 30 or 40 patients once a week, I can now stagger them and have double the amount of patients in therapy at the same time. So I don’t have a backlog,” she says. The approach of Wiederhold’s VR medical centre is to provide therapy to those living with a variety of conditions by teaching them a number of skills, putting them in VR environments and encouraging them to transfer what they have learned to real-world situations.
Wiederhold says that the therapies provided to patients visiting the centre started with treating “pretty specific phobias,” such as the fear of flying, and then as their experience grew moved onto anxiety disorder and post traumatic stress. The most recent project has been looking at the best way to control stress levels. One of the aims, according to Wiederhold, is to be able to use VR to “eliminate the disorders from occurring”.
“We’re now working more towards stress management, burnout and looking into preventing disorders. So doing stress management before burnout occurs,” she says. It’s believed that VR therapy work in this area and can help patients to get over their phobias.
Wiederhold says that in general most patients have around eight sessions where they are taught coping mechanisms – for stress, a “traditional cognitive behavioural model” is used – and the best ways to implement them. One example Wiederhold mentions is a patient who was scared of flying, but got on a plane from the US to Milan after just six sessions of VR therapy.
Phobias have also been tackled with VR by researchers at the University of Louisville in the US. They put patients through virtual fear-inducing situations and then taught them how to manage these, helping them to learn ways to “overcome fears, break patterns of avoidance, and build effective coping skills”.
Other applications being developed include pain management for burns victims by the University of Washington. One study of the techniques used – which was based on distracting patients with VR to allow them to handle the pain – said it worked better than morphine in some cases.
Away from supporting new therapies, other uses of VR are also emerging in the medical field. Applications for training surgeons have been in development for a number of years, creating set-ups that offer a new way of training for those learning their trade.
A review of early applications in 2008 said that for one particular surgical application, laparoscopic surgery, where only small cuts are made into patients and instruments are inserted, VR training can provide “instantaneous, unbiased, reliable and valid assessment of technical skills”. However, it went on to say that VR training should be supplementary to practice on animal models, cadavers and human patient simulators.
VR training systems are also starting to make their way out of research departments and laboratories to be available on commercial markets. Dassault Systèmes, for example, has developed a 3D heart simulator that allows medical professionals to perform virtual tests and see how the heart will react to changes. Robert Schwengel from Brown University said the model could help “to educate my patients, students of medicine, and current medical professionals, as well as lead to improved diagnostic capabilities and the personalisation of medical therapeutics”.
For Wiederhold one of the key advantages of using VR therapies, particularly as VR technologies become widely available, is that it can empower patients by allowing them to pick when they are treated and to be involved in the decision making.
“My patients are coming in, they’re very empowered, they’re very active in the treatment but they’re now coming in with new suggestions,” she says. “I’m able to implement those suggestions; I am able to give them some equipment to take home. For instance, I had one patient driving two hours, each way, to see me. I gave her the Samsung Gear VR with some of my software on it; she then only needed to come in every other week.”
There’s also the potential for VR to allow patients to do more than they are physically capable of doing. Stanford University experimented with using VR to transport housebound residents to places they can’t visit. Using the Senior-User Soothing Immersive Experience developed by the university elderly users were able to visit a beach, parks, and take hikes in national parks.
Meanwhile in the UK, children in hospital will soon be able to visit London Zoo using a VR headset with a live feed being beamed from a robot inside the zoo. In Japan VR manufacturer Fove has created a system allowing disabled children to learn to play a piano just by using the movements of their eyes.
As for the future, Wiederhold believes VR will lead to more independence for patients. “I think that a couple of things are going to occur. I think we’re going to be able to stretch out the timing between sessions even longer for some people,” she says. “I think we might even see some conditions [for which] we do initial intake in clinical history with the patient, and initial skill building sessions, and the rest they do at home and check in with us over Skype or internet session.”