'Doctors need to be aware how they react affects the patient'

Virtual reality app lets medical staff get a patient’s-eye view

Israeli start-up OtheReality allows doctors to revisit difficult scenarios and recharge their empathy tanks to reduce patient discomfort and dissatisfaction

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Medical students at Baruch Padeh (Poriya) Medical Center in Tiberias try OtheReality VR sets. (Courtesy)
Medical students at Baruch Padeh (Poriya) Medical Center in Tiberias try OtheReality VR sets. (Courtesy)

On average, several pregnant women learn that they have miscarried during a shift at an Israeli hospital’s obstetrics-gynecology emergency department.

This news is often confusing, and is usually devastating, for the patient and her partner, while for many doctors, delivering such unfortunate information is matter-of-fact and routine.

“For the physician, this is common and most of the time there is no danger to the patient’s life… The doctor is more focused on clearing the bed, while for the patient it may be traumatic, painful and difficult,” said Yotvat Palter-Dycian.

“The doctor needs to look at the patient as a person with a problem and not as a problem,” she said.

Palter-Dycian is co-founder and chief operating officer of OtheReality, a virtual reality (VR) technological solution that helps boost empathy among healthcare providers by enabling them to experience a situation from the patient’s perspective.

The start-up launched recently through a partnership between Bar-Ilan University and Sheba Medical Center’s ARC Innovation Center, and is being piloted at Sheba and other Israeli hospitals.

Doctors, nurses and other medical professionals go into healthcare because they want to help people. However, always standing at the foot or side of the hospital bed often makes them forget what it is like to be lying on it.

The OtheReality team (from left to right): co-founder and COO Yotvat Palter-Dicyan, co-founder and CEO Elik Almog, founder and CCO Prof. Motti Neiger, and founder Yair Neiger. (Courtesy)

“A lack of empathy is affecting everyone everywhere — globally, not only in Israel. It’s not only in the healthcare field. It also affects education, the business setting, and much more. There is a lot of research on this,” said OtheReality founder and chief creative officer Motti Neiger, a professor of communications at Bar-Ilan University.

“In the healthcare field, we know that this lack of empathy leads to lower patient satisfaction, a lack of patient compliance with medical instructions, and higher hospital readmission rates. It also leads to more malpractice suits, as well as increased dissatisfaction and burnout among medical staff,” he said.

By using existing VR technology and affordable headsets, OtherReality makes it possible for medical professionals in training to experience what it is like to be a patient. It also allows more seasoned doctors to keep their “empathy muscle” in shape.

Image from OtheReality missed abortion (pregnancy loss) virtual reality scene from the perspective of a patient. (Courtesy)

This is done by putting on the VR headset with an attached audio feed. After opening up the OtheReality app on your phone, you select the scene (from the patient’s perspective) you want to view. Then you insert the phone into a holder at the front of the VR headset so the nearly 360-degree scene is viewable.

When this reporter tried OtheReality, she “became” the pregnant woman on the hospital bed. She saw her body stretched out in front of her, with her legs up in stirrups. An anxious husband is to the left, and the resident and senior doctor move around the room, standing either at the foot of the bed or checking a monitor on the right side. The doctors talk to each other and ignore the patient most of the time.

OtheReality scenes, including the miscarriage one, are presented by specially trained actors and are scripted based on input from doctors about medical terminology and situations, and from patients about how they experience these situations.

Image from OtheReality missed abortion (pregnancy loss) virtual reality scene from the perspective of a patient. (Courtesy)

“Dozens of women wrote me about their experience in the OB-GYN emergency room. They remembered everything about what happened, including many small details, like what the light and temperature were like, the sound of the air conditioner, the bad joke someone told, and exactly where the doctor was when he delivered the bad news,” Neiger said.

Prof. Eran Weiner, chair of obstetrics and gynecology at Wolfson Medical Center in Holon, has been using OtheReality with residents and nurses, who are generally those on staff when patients come in for triage.

“We immediately understood that this is a great tool, especially for obstetricians and gynecologists. We have many staff members who are from the other gender [than the patients]. So by definition, they couldn’t have experienced the medical conditions associated with our profession,” Weiner said.

OtheReality brings to the fore details that both male and female medical professionals miss as they go about their work. For the patient, these small things are huge, but for the doctor, they are just background noise — until they perceive them from the patient’s point of view.

“There are all different noises, including the nurse speaking on the phone on the other side of the curtain. You see how dramatic it is when the curtain opens in the middle of the [intravaginal ultrasound that shows that there is no fetal heartbeat], and how the resident is not confident and leaves the room to consult with a senior doctor, and then has to repeat the test. You hear small remarks that are kind of sometimes cynical, and how things look from the husband’s point of view, as he sees the misery on his wife’s face,” Weiner said.

“When you’re breaking bad news, you expect the personnel to be at their best. From the patient’s point of view, it’s a once-in-a-lifetime event, so they shouldn’t have to don’t tolerate disturbances and these kinds of behaviors,” he said.

An Israeli television news report shows Wolfson gynecology resident Dr. Yasmin Farhadian sitting on an examination bed wearing the VR set. She describes what she sees.

Medical staff at Baruch Padeh (Poriya) Medical Center in Tiberias try OtheReality VR sets during an empathy workshop, December 2023. (Courtesy)

“That’s pretty shocking,” she says as the senior doctor, standing at the end of the bed in front of the patient’s spread legs, clinically tells the couple that the pregnancy was lost. He says that this is common and that the patient just has to take some pills to clear out her uterus.

“Pregnancy loss is a hard situation to deal with. Doctors need to always be aware that how they react affects the patient,” said Dr. Rachel Rappaport, an OB-GYN resident at Soroka Medical Center in Beersheba, who has not yet tried OtheReality, but is eager to do so.

“Empathy is a hot topic, and during my training, we did some role-playing with actors [playing patients] who gave us feedback, but this VR approach sounds super-cool,” Rappaport said.

OtheReality co-founder and CEO Elik Almog said that the initial use of the product should be in a workshop setting during which medical personnel receive an introduction before donning the VR headsets. After experiencing the scene, a facilitator leads a discussion.

According to Neiger, the OtheReality app also includes follow-up reflection questions, which a professional can use when using the product on their own.

Medical staff at Wolfson Medical Center in Holon tried OtheReality VR sets during an empathy workshop, 2023. (Courtesy)

“The questions touch upon the three aspects of empathy: Emotional, cognitive, and motivational. For example, the users are asked how they felt during the experience, how close it was to walking a mile in someone’s shoes, what was disturbing from that perspective, and what they would have done differently in real life,” he said.

Almog said he hopes seasoned doctors will see the value in using OtheReality periodically to refresh their sympathy skills.

Dr. Rachel Michaelson-Cohen, an obstetrician-gynecologist and director of prenatal genetic diagnosis at Shaare Zedek Medical Center in Jerusalem, said it could be a hard sell with older doctors, who are set in their ways and have many responsibilities.

“It is true that many times doctors are rushing to other places or make light of something that a patient finds traumatic. I am not saying that more veteran doctors couldn’t use this ongoing empathy education, it will just be harder to get them onboard,” she said.

Other medical scenes are currently being produced for use with the OtheReality system, including one that deals with how to de-escalate a violent incident in a hospital ward. The product is also being used with businesses to increase empathy in that realm.

The OtheReality team continues to sharpen its product with ARC’s MSR Medical Simulation Center and hopes to pilot it in the US later this year.

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