Personal communication goes a long way in establishing and cementing surgeon-patient relationships. I learned years ago that something as simple as giving patients my email address diminished their fear and anxiety because it gave them direct access to me. Now, due largely to the recent pandemic, more numerous and sophisticated forms of “telemedicine” have come to the forefront of health-care delivery.
In the February 3, 2020 issue of The Journal, Kingery et al. report results from a randomized controlled trial investigating whether brief day-of-surgery communications between surgeons and patients who underwent an outpatient sports-medicine procedure affected patient satisfaction scores. To find out, the researchers randomized 3 surgeons into 1 of 3 patient-communication modalities:
- No contact (standard of care)
- Phone call the evening after surgery
- Video call the evening after surgery
Satisfaction among the 250 participating patients was assessed at the first face-to-face postoperative visit using the standardized S-CAHPS questionnaire, which evaluates patient experiences before, during, and after an outpatient surgery. Patients also completed a 9-item questionnaire specifically designed for this study. The authors focused on the rate of “top-box” responses (the highest rating possible) in each of the 3 groups group.
Kingery et al. found that day-of-surgery postoperative communication between patients and surgeons, either by video or phone, significantly improved S-CAHPS top-box response rates relative to the no-contact group. Specifically, phone calls were associated with a 16.1 percentage point increase in the top-box response rate, while video calls were associated with a 17.8 percentage point increase. The authors also found that patients contacted by video or phone were more likely to recommend their surgeon and felt more informed than those who were not contacted.
Although the authors did not record the content or duration of the conversations in the 2 contact groups, these data strongly suggest that patients welcome day-of-surgery communication—and that such encounters improve patient satisfaction. I therefore think we all should consider leveraging technology, especially that which has arisen from the COVID pandemic, to help give our patients a better overall health-care experience. A few non-reimbursable minutes at the end of the day could have lasting, positive effects on both patients and us.
Matthew R. Schmitz, MD
JBJS Deputy Editor for Social Media
In addition to the recently announced JBJS Journal of Orthopaedics for Physician Assistants (JOPA) writing awards, JBJS is offering two additional $1,000 awards for the following:
- Best Physical Exam Video by a certified, practicing PA or NP (suggested length of 10 to 15 minutes)
- Best Injection Technique Video by a certified, practicing PA or NP (e.g., subacromial, knee, or trigger finger injection)
Please submit videos without accompanying text, except for the title and author(s).
Submit your video via the JOPA Editorial Manager submission site, and please include a signed Video License Agreement.
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Providing information online is neither free nor easy, despite the general perception that online information can or should be free.
The perceptual problem is one we business types describe in terms of “variable costs.” The variable costs of online are small, usually a fraction of what they are to deliver a printed issue. Because the user discerns no significant variable costs when downloading information, the perception is that online can be free or much cheaper than print, where the variable costs are more readily apparent (printed materials and postal costs that vary in proportion to the quantity of output).
However, where online information differs significantly from our print legacy is in fixed costs – those costs we have to incur to make the first instance of something—to design a site, to make content accessible, to program interfaces and data systems, and so forth. These fixed costs of online information publishing are significant, and they are not decreasing.
Fixed costs for online information delivery include 24/7 worldwide availability; long-term contracts with providers of publishing software, media players, analytics packages, email packages, and so forth; and management staff to develop new systems, migrate systems through software upgrades, and migrate content from earlier generations of Web markup languages to newer ones. The list is long and growing longer.
Boiling it down a little, here are the main reasons why the fixed costs of providing information online are not decreasing:
- Users want more convenience, options, and capabilities. From tablet versions to inline video to online customer service, publishers and others are continually building new services and incurring new fixed costs.
- Expertise in software and content development is expensive. It takes really talented people to make online a reality. These people command good wages, and the market for their talent is very competitive.
- Content is more like software. Content used to be a one-time event – you’d finish editing an article, put it into a nice page layout, and print it. Now, content goes through versions just like software. The markup languages that render it online evolve, and publishers have to revise their entire archives with each major evolution. Multimedia introduces new layers of similar work–and additional costs.
- Print business models are under stress, so online has to carry more of the costs. A decade ago, online was an accessory for a robust print publisher. Now, print is losing its ability to carry the full load, shifting the fixed costs for print to online. This means a higher proportion of the cost for content creation, editorial work, art work, and management has to be carried by the online business.
As we’ve been doing for hundreds of years, publishers are trying to find a balance for users between cost and value. It’s especially tricky right now because so many factors are changing all at once.
Users want more and better information through their tablets, smartphones, and laptop and desktop computers. We’re continually adapting to meet these expectations. In the coming months, we will have many exciting announcements about our developing online capabilities. Already, we are publishing inline videos and accepting video content from authors at a high rate. Our new JBJS Reviews journal has a well-reviewed iOS and Android app you can use now. More tablet capabilities are coming later this year, as are revamped Web sites.
We’re excited about the future, and we love the capabilities online publishing provides –making information more immediately available worldwide, showing and telling, and providing users with ways to find content quickly and easily. But while it’s amazing and useful, online represents a new kind of information economy for us content providers – one that has more in common with software companies than with printers.