More than a game: New wave of video games have health benefits

Video games are moving out of the basement rec room and into the world of medicine, with more physicians using them for training or for aiding treatment.

By John McCormack, amednews correspondent — Posted July 23, 2007

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Moselle Brotman, DO, a Riverside, Ill., ob-gyn, played her fair share of video games while growing up in the 1980s. She still likes electronic games, although her busy schedule doesn't allow for much more than an occasional -- but spirited -- Pac-Man challenge.

Like many other physicians, Dr. Brotman has, for the most part, kept her gaming and doctoring worlds separate. But she started to see how gaming and medicine could meet when she recently played "Trauma Center: Second Opinion" with her 8-year-old son, Ben, and his 9-year-old friend, Matt.

The game requires players to perform surgery, from repairing shattered bones to fixing perforated lungs or failing hearts. The game is produced for the Nintendo Wii gaming system, which has remote devices that require the surgery be done by a player moving his or her hands and arms, rather than using a controller, making the surgery seem more realistic, even when players acquire such unrealistic tools as a magic "healing touch."

"The game is a lot of fun. And I could see how the boys were actually learning some very basic surgical concepts," says Dr. Brotman, who works with her partner, ob-gyn Vybert Greene, MD, in a private practice that serves patients at Michael Reese Hospital in Chicago.

While there has been plenty of attention and discussion on the negative impact of video games, from their potentially addictive qualities to their effect on the obesity rate, a growing number of gaming advocates within the profession are trying to figure out what good things games have to offer physicians and patients. The effort is growing stronger in part because the latest generation of physicians grew up with video games, and many of their patients are comfortable with them.

For example, James "Butch" Rosser, MD, chief of minimally invasive surgery at Beth Israel Medical Center in New York City and an outspoken video gaming evangelist, is quick to encourage doctors to give games a second look. His 2004 report showing that surgeons who played video games performed better than those who did not kicked off the movement to link gaming with medicine.

"The No. 1 thing I would say to doctors is that they are unaware of the legitimacy of the potential impact of video games in addressing everyday medical challenges," Dr. Rosser says. "Video games can be embraced in several areas of medicine, from manual dexterity and skill to decision-making to enhanced patient communication."

Accentuate the positive

Learning about video games should be a priority for all physicians, according to Dr. Rosser, author of Playin' to Win: A CyberSurgeon Scientist and Parent Makes the Case for the Upside of Video Games, a book that is slated to be released by Morgan James Publishing in November. Why should physicians bother? Mainly, Dr. Rosser says, because games are so pervasive. "Video games are extremely popular with the patient population. It's a $40 billion to $47 billion industry. The average gamer is now 31 years old. So because it is such an integral part of so many patients' lives, learning about video games has to become a high priority with physicians."

Dr. Rosser became enamored with video games playing what is often considered the first popular video game, "Pong," in the 1970s. He views all the game playing he did in his formative years as the foundation for his success as a laparoscopic surgeon. According to his study, published in the Annals of Surgery, surgeons who had played video games more than three hours per week made 37% fewer errors and completed surgery 27% faster in a simulated test than surgeons with limited or no gaming experience. Dr. Rosser and his researchers stopped short of saying long hours playing video games automatically creates better physicians, instead advising anyone to play in moderation.

But Dr. Rosser is steadfast in his belief that the technology can result in huge benefits when it is purposefully developed for health care applications. For example, he is developing a game designed to help teach young people how to avoid morbid obesity.

"Obesity is public enemy No. 1," Dr. Rosser says. "So instead of sitting back and blaming video games for inactivity, why not embrace video games and develop them to help combat the problem?"

Finding their groove

Ed Fletcher, an executive producer with Hunt Valley, Md.-based BreakAway Games, agrees that video games can be developed to have a positive impact on health care. For example, some of the same technology used in commercial games can be added to physician training games, creating a much more dynamic learning environment.

"Pulse," a medical treatment simulation game developed by Breakaway in conjunction with Texas A&M University-Corpus Christi, is one example of a video game that has been specifically developed to help physicians. In "Pulse," physicians try to get a better handle on trauma situations by working their way through virtual situations that require quick thinking and advanced decision-making skills.

"When you are creating a commercial game, you make a choice between what is realistic and what is fun. You always pick what is fun," Fletcher says. "When you are creating a medical training simulation, you make a choice between what is realistic and what is fun. You always pick what is realistic. You still try to make the game as engaging as possible, but you always have to pick realism over fun."

Fred Kron, MD, an assistant clinical professor at the University of Wisconsin-Madison Dept. of Family Medicine, has developed a multiplayer online game that can be used by medical students to place them into a virtual medical practice or hospital setting. He says video game technology is especially suited for creating electronic simulations that can help medical students and physicians learn how to handle real-world communications -- a skill that he says gets short shrift in traditional textbook-based learning programs.

In addition to using gaming technology to enhance their own skills, physicians are using games to improve patient care.

Anuradha Patel, MD, assistant professor of neurology at New Jersey Medical School, Newark, has found a way to make a good thing out of the "zoning out" that is so frequently associated as a negative effect of gaming.

After observing that pediatric patients who played with video game systems before surgery appeared calmer than other patients, Dr. Patel decided to test her observation. She studied 4-to 12-year-olds in three groups of 26 children each. One group received a tranquilizer, one did not, and the third group received no tranquilizer but played with a handheld gaming system.

The gaming group, as measured by the Yale Prop Anxiety Scale, showed no increase in anxiety before surgery. But among the patients who received tranquilizers, anxiety levels jumped 7.5 points. In patients who did not receive tranquilizers and did not play with a video game, levels jumped 17.5 points, Dr. Patel says.

While her findings, first presented at medical conferences in late 2004, have not been published in a peer-reviewed journal, other hospitals and practices have added video-game systems to waiting rooms or other patient areas.

"Playing with a video game is a great thing for a child about to go into surgery. ... Yes, they are in their own little world and they don't perceive other sensory stimuli. Right before going into surgery, that is a very good thing," Dr. Patel says.

Gaming also is being used to help children deal with their own chronic or severe conditions.

For example, as part of the work he has done with the Starlight Starbright Children's Foundation, a Los Angeles-based national nonprofit organization that develops technology programs for seriously ill children, Gary Rachelefsky, MD, director of the Center for Asthma, Allergy, and Respiratory Diseases, University of California, Los Angeles, has created "Quest for the Code," a video game that helps children learn how to deal with handling chronic asthma.

The game helps children learn about what happens to their bronchial tubes when they exercise and when they are exposed to secondhand smoke.

"It's important to make learning about asthma fun for children. If it is not fun, then they will not learn," Dr. Rachelefsky says. "Children like to play video games -- and they can learn from these games. As doctors, we need to recognize that fact."

A test of 375 cancer patients between the ages of 13 and 29 at 34 sites across the United States, Canada and Australia found that 217 participants who played "Re-Mission," a game designed to help young people deal with cancer, took their antibiotics more often that those who played a control video game. In addition, 54 Re-Mission players saw their blood levels of an oral chemotherapy medicine maintained at a higher rate. The study was posted Dec. 15, 2006, on the American Assn. for Health Education's The International Electronic Journal of Health Education.

While this study is encouraging, Dr. Rachelefsky says more far-reaching and encompassing studies are needed to finally push video games into the mainstream of medicine.

After playing "Trauma Center: Second Opinion," Dr. Brotman says she has a better idea of the potential value of video game technology in medicine. Though she says the game doesn't provide the level of detail and sophistication that medical students and other health professionals need, it does provide some exposure to medical concepts.

But Dr. Brotman doesn't think that the medical community should abandon tried-and-true forms of professional training and patient education for these emerging electronic gaming alternatives.

"Everything in moderation," she says. "Parents should not let their children sit in front of video games and think that they are going to easily become surgeons."

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Healthy gaming

Among the initiatives to link video games and health care is Games for Health, produced by the Serious Games Initiative. The initiative was begun in 2002 by the Woodrow Wilson International Center for Scholars, a Congress-established, nonpartisan think tank that wanted to see how gaming could be used to advance policy education, exploration and management. The Robert Wood Johnson Foundation has partnered with Games for Health for a health gaming contest. Both organizations cited these games as examples worth following:

"Ben's Game": The idea came from a then-9-year-old leukemia patient named Ben Duskin. In 2004, an engineer from LucasArts followed Ben's concept to create a game in which a skateboarding child moves inside a body, killing mutating cells and collecting shields to fight the side effects of chemotherapy. The game has been translated into at least nine languages, and pediatric hospitals have used it to help children understand their disease and care. Ben, now 12, and engineer Eric Johnston also have received recognition from the Dalai Lama for the game, which can be downloaded, free, from the Make-a-Wish Foundation Web site (link).

"Dance Dance Revolution": DDR is not a health game, per se, but it has been adopted as one and does include preprogramed cardio workout modes. The game, produced by toymaker Konami, uses a pad plugged into a video game system. Players follow the on-screen dance steps by stepping on specific spots on the pad. West Virginia public schools began incorporating the game after a study by West Virginia University found students who did not participate in sports or other physical activity were still very likely to want to play DDR (link).

"ACLS Trainer": Legacy Interactive (link) is using its experience with emergency department simulations to develop a game focusing on advanced cardiac life support. The game has not yet been released.

"Immune Attack": The Federation of American Scientists is developing Immune Attack to simulate how the human immune system works. In the game, the federation says, "The protagonist, a teenaged prodigy with a unique condition in which the immune system is 'present, yet non-functional,' must pilot a microscopic nanobot to save his own life." The game is not yet available, but those interested in downloading it can see demos and sign up for it at the "Immune Attack" site (link).

"Re-Mission": One of the more famous health role-playing games is by HopeLab, which is sponsoring the Robert Wood Johnson-Games for Health contest (link). In Re-Mission, a character moves inside various bodies to battle cancer cells. A study found patients who played the game followed their courses of treatment better than those who did not. See more details at the "Re-Mission" site (link).

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