Patient Education

From Primary Orality to

Virtual Orality

Trends in Patient Education

1. How disease causes and treatments are communicated to individuals

2. Why certain methods evolved or were favored

3. What the future is likely to look like

Early Medicine400 A.D.

• As far back as Hippocrates medical care was reserved for the wealthy and the royal families.

• Physician consultation was by correspondence. Only literate upper class men had access.

Ong’s Orality

• Most patient education was face-to-face, in the oral tradition described by Walter Ong.

Sender Utterings Receiver

Information Utterings Understanding

Ties Between Theater and Medicine1500s

• Common people got their health information from the stage, which served as the mass media of the times.

Ties Between Theater and Medicine1600s

• Religious Reformation --Theater was outlawed

• Stage physicians became medicine show performers

• Hired clowns, mimes and acrobats to draw in crowds

Health in a bottle

• Medicine show “doctors” began to make and sell their own medicines

• Drug companies and print (flyer) advertising started with the medicine show in Europe

The medicine show in America1700s

• Why it was a perfect venue– Anti-British sentiments, all

doctors in America were European

– 2.5 million people, 400 physicians, no medical schools

– Geographical constraints

– Illiteracy

– Few sources of entertainment

How did we make it our own?1800s

• Different herbs and traditions

• Mystique of the Native Americans

• Change of actors and material from British theater to Americana

Medicine Show Spin-offs

• Wild West Shows– Miss Annie Oakley

– Buffalo Bill Cody

– Wild Bill Hickock

• Circus– P.T. Barnum

• Proprietary Museums; stationary medicine shows

Entertainment as Medicine or Medicine as Entertainment?

– Bob Hope– Jack Benny– Mickey Rooney– Cesar Romera– Carmen Miranda– Jimmy Durante– Milton Berle– Minnie Pearl

–Hank Williams –Red Skelton–Roy Acuff–Harry Houdini–George Burns–Buster Keaton–Gracie Allen–Lester Flatt

Many famous actors and musicians came from the medicine show circuit

Health in a book1880-1920

• New schools taught reading using Bible

• Health seen as controllable by good or moral living

• “Safe Counsel or Practical Eugenics” sells over 1 million copies

“Golden Age” of the Physician 1920-1960

• Scientific breakthroughs

• High physician esteem

• As medicine became more effective it became more expensive

• Medicine as a luxury good

• Patients paid their own way

• Medical consumerism

Education by advertisement: “Every man his own doctor”

1940-present

Where are we now?21st Century

• Medical care and pharmaceuticals increasing in complexity

• Direct to consumer drug marketing• Steadily decreasing health literacy rates

– 49% of people have Functional Health Literacy (FHL) in the illiterate or marginally literate range

Critical needs not addressed

• Most vulnerable populations least able to understand medical information– Immigrants/Minorities

– Poor/Homeless

– Elderly

– Those in rural areas

What’s the plan?Is eMedicine the most effective means of reaching the

greatest number of people? Private highway or public road?

•Email advice

•Online Rx

•Appointment scheduling

•Lab results

•Research/education

Is entertainment the answer?

• Entertainment as medicine–76% of study population took medical advice from the television–40% choose TV as primary source; 36% chose physician

• Advertisements as diagnostic tool

–Do you suffer from heartburn more than x times a week?

Is television today’s “virtual” orality?

What does the past mean for the future?

Patient education that is:

• Entertaining

• Personalized (medical information)

• Patient driven

• Free from – Reliance on literacy

– Speaker privileged communication

– Drug advertising

– Bias

– Delivery for patient