Podcasting primer: All you need is the Internet

Long-time friends and Tulane University School of Medicine classmates Quinten Black, MD, and John O'Connor, MD, radiation oncologists in Asheville, N.C., and New Orleans, respectively, were talking last year about how their patients had trouble retaining the information they or referring physicians had given them about their cancer. So they decided to try to speak to patients through a device more of them were using -- the iPod.

Drs. Black and O'Connor did this by creating Web-based audio files that have come to be known as podcasts. Podcasts are audio and video files distributed over the Internet. Anyone with a computer, microphone, webcam (if you want to make a video podcast) and access to the Internet can create and easily share podcasts with anybody in the world. Pretty much anyone with Internet access can download them easily.

Patients can listen to Drs. Black and O'Connor's podcasts on the physicians' Web site, or download files to their portable computer audio file player. The physicians have three podcasts on their Web site, Cancercast.com, which is getting about 1,000 hits per day.

"It's ... something we feel is important and interesting, and we want to keep doing it because it can help serve our own patients. ...[It's] gratifying to see that this many people are downloading it," Dr. Black said.

Besides individual physicians, health care organizations such as the Cleveland Clinic and Johns Hopkins, medical publishers and medical societies are podcasting to keep doctors up to date about new studies, help them obtain advice about running their practice efficiently and educate patients. Continuing medical education also is available via podcasts.

To prepare for family medicine board certification, Enoch Choi, MD, an urgent care physician at the Palo Alto (Calif.) Medical Foundation, downloaded several podcasts produced by the Audio-Digest Foundation (link), a nonprofit affiliate of the California Medical Assn. that offers audio CME and medical lectures on a subscription or price-per-download basis. "It was very helpful," Dr. Choi said.

Though no specific numbers are available, podcasts have experienced explosive growth over the past three years. More than 22 million American adults own portable music players, and 29% of them have downloaded podcasts from the Web, according to a survey last year by the Pew Internet & American Life Project, a Washington-based entity that researches the impact of the Internet.

Nobody really knows how many health podcasts are on the Internet and the size of the audience listening to them, but observers believe that people increasingly could seek health information over the next several years through podcasts.

"I can't predict what's going to happen because there are so many variables," said Susannah Fox, associate director of Pew Internet. "One thing that we're looking at and are very interested in is how many people are upgrading to broadband at home. ... Broadband users are answering many more questions online than dial-up users, and health is one of the areas they are looking at."

As is the case with podcasting in general, medical podcasting is still in its infancy, said Kent Bottles, MD, a pathologist who has recorded more than 100 podcasts for SoundPractice.net, a podcast service for physicians from Greenbranch Publishing LLC, Phoenix, Md., publisher of The Journal of Medical Practice Management. Although he's no longer affiliated with either SoundPractice.net or Greenbranch Publishing, Dr. Bottles, now president and CEO of the Grand Rapids (Mich.) Medical Education and Research Center for Health Professions, a consortium of area hospitals and universities, plans to continue podcasting on his own.

He believes that doctors can use podcasting to develop a deeper relationship with patients. "I see it as a useful tool to try to decrease the gap between patient and doctors. The biggest problem we have today is that patients and doctors seem to be at different pages about what each wants from the doctor-patient relationship," Dr. Bottles said. For example, to help bridge that gap, physicians could create podcasts to introduce patients to the practice's employees, or provide information to them about the latest diabetes or hormone replacement therapy.

"If you talk to marketing experts, what they really say is the most important way to market something like a medical practice is to touch patients over and over again and to give them something of value," Dr. Bottles said. "It's going to take a lot of people experimenting with [podcasting] to see whether the best application for this is medical education of their patient, marketing [of the practice], the creation of sort of a community around your medical practice or the creation of a community of providers who talk to each other."

The desire to educate patients led Drs. Black and O'Connor to launch their CancerCast podcast in August 2005.

"We've always kind of conversed about our practices, and over time we've traded impressions about our practices. One of the common themes is that patients, and especially patients' families, don't seem to or are unable to internalize all the complex information they get during your typical hour-long initial consultation," Dr. Black said.

Last year Dr. Black was following the development of Apple expanding its iTunes Music Store to include access to free podcasts and that gave him the idea of delivering information via podcasting. "We started with colon cancer and explained it in everyday English, at a very relaxed pace and in a format that would allow patients to listen to it again if they wanted," Dr. Black said. "It gives you the basics on the cancer and then the basic treatment options but in a format that anybody can really understand."

About 40 to 50 people subscribe to their service which automatically forwards new content whenever it is available. CancerCast doesn't make recommendations, he said. "We say many times during these podcasts that [patients] need to rely on their oncologist."

Like Dr. Black, Lawrence N. Payne, MD, an emergency physician and regional director at EMP, a Canton, Ohio, emergency department staffing company, also produces podcasts.

His podcast, which is called Another Night Shift (link), targets emergency physicians. "I look for things that are interesting to me that I think are pertinent to emergency medicine, that are unique in some way and provide information that might not be available somewhere else," Dr. Payne said.

Last year, for example, Dr. Payne recorded a rally of 3,000 emergency physicians who showed up at the U.S. Capitol to support access to emergency care legislation in Congress. "While that got reported on the news, the substance of the rally and the speakers doesn't really come across in a 15-second sound bite," Dr. Payne said. "So what I did was present a recording of the entire rally put in context so that people who were interested in it could get more of the flavor of the event."

Separately from Another Night Shift, Dr. Payne also creates podcasts for internal consumption by his group, which has at least 200 physicians. Since the group's size makes it difficult for everyone to get together in one place at the same time, he records presentations by the company's CEO and meetings of the board of directors in the form of podcasts, which doctors can then access at their leisure. He also creates podcasts to help EMP recruit physicians.

"Everybody gets information in different ways," Dr. Payne said. "Some people really prefer print. Other people like to listen to audio tapes. Podcasting is really just another alternative way to get content."

While some physicians are producing podcasts, other doctors are using them professionally. For example, Dr. Choi listens to McGraw-Hill's subscription-based AccessMedicine (link) podcasts to keep up with developments that are topical and applicable to his daily urgent care practice.

"They are really short snippets that I can actually listen to on the way to work," Dr. Choi said. "I have a pile of journals that I'd love to read if I had a chance, but I don't. But I do have a chance to listen to a three-minute audio broadcast on my way to work, or say, walking to the cafeteria or whatever. A couple of minutes isn't a difficult thing to fit in."